Recommended Check-ups and Interventions at 29 Weeks of Pregnancy
At 29 weeks of pregnancy, routine monitoring should include assessment of maternal vital signs, fetal heart rate, fundal height measurement, and screening for signs of preeclampsia, with additional testing based on risk factors. 1
Essential Maternal Assessments
Vital Signs and Physical Examination
- Blood pressure measurement (target diastolic BP 85 mmHg) 1
- Weight measurement to assess gestational weight gain
- Fundal height measurement
- Assessment for edema, particularly in hands and face
- Check for signs of preterm labor (contractions, cervical changes)
Laboratory Tests
- Complete blood count to assess for anemia 2
- Urinalysis to screen for protein (preeclampsia screening) 1
- Blood glucose monitoring if diabetes is present 1
Fetal Assessment
- Fetal heart rate auscultation
- Assessment of fetal movement patterns
- Fundal height measurement to assess fetal growth
- Initiate antepartum fetal surveillance at 32-34 weeks if high-risk factors are present 1
Special Considerations Based on Risk Factors
For Women with Pregestational Diabetes
- Continue tight glycemic control monitoring
- Begin antepartum fetal surveillance at 32-34 weeks 1
- Schedule third-trimester ultrasound for growth assessment
For Women with Hypertensive Disorders
- More frequent blood pressure monitoring
- Consider low-dose aspirin (81mg daily) if not already taking 1
- Monitor for signs of preeclampsia (headache, visual changes, epigastric pain)
For Women with Obesity
- Assess for excessive or inadequate gestational weight gain
- Monitor fetal growth carefully 1
- Consider growth scan between 28-32 weeks if clinical assessment is limited 1
For Women with Previous Bariatric Surgery
- Check serum indices: full blood count, ferritin, iron studies, folate, vitamin B12, vitamin A 1
- Consider vitamin B12 supplementation (1 mg IM every 3 months) 1
- Monitor for signs of internal herniation if RYGB was performed 1
Anticipatory Guidance for Third Trimester
- Discussion about fetal movement monitoring
- Signs and symptoms of preterm labor
- Review of birth plan and preferences
- Education about breastfeeding
Immunizations and Preventive Care
- Influenza vaccine if not already administered
- Tdap vaccine between 27-36 weeks if not already given
- Continue prenatal vitamins and any prescribed supplements
Common Pitfalls to Avoid
- Failing to screen for gestational diabetes if not already done
- Missing signs of preeclampsia by focusing only on blood pressure without assessing for proteinuria
- Overlooking nutritional deficiencies in women with bariatric surgery history
- Delaying evaluation of decreased fetal movement
Follow-up Recommendations
- Schedule next prenatal visit in 2 weeks (at 31 weeks)
- Consider more frequent visits for high-risk pregnancies
- Ensure third-trimester ultrasound is scheduled if indicated
- Begin planning for Group B Streptococcus screening at 35-37 weeks
By following these recommendations, healthcare providers can ensure appropriate monitoring and interventions at this critical stage of pregnancy to optimize maternal and fetal outcomes.