Patient Education and Anticipatory Guidance at 28 Weeks Gestation
At 28 weeks gestation, pregnant women should receive the Tdap vaccine, undergo screening for gestational diabetes, and receive education about fetal movement monitoring, preterm labor signs, and delivery planning. The third trimester marks a critical period for maternal and fetal health monitoring with specific interventions recommended at this stage.
Immunizations
Tdap Vaccination
- Tdap (tetanus, diphtheria, acellular pertussis) vaccination is strongly recommended between 27-36 weeks of gestation, preferably closer to 27 weeks 1
- This timing maximizes maternal antibody response and passive antibody transfer to the newborn, protecting the infant during the vulnerable period before they can receive their own vaccination at 2 months 2, 1
- The vaccine should be administered during each pregnancy, regardless of prior Tdap vaccination history 1
Influenza Vaccination
- If not already administered and during influenza season (October to May), recommend inactivated influenza vaccine 3
- Influenza vaccination is safe during any trimester and protects both mother and infant from serious complications 3
Screening and Testing
Gestational Diabetes Screening
- If not already completed, perform glucose screening with either:
- Diagnosis criteria for 75-g OGTT: fasting ≥92 mg/dL, 1-hour ≥180 mg/dL, or 2-hour ≥153 mg/dL 4
Blood Pressure Monitoring
- Continue regular blood pressure monitoring to detect hypertensive disorders of pregnancy 4
- Educate patient about warning signs of preeclampsia (headache, visual changes, epigastric pain, sudden swelling)
Fetal Assessment and Monitoring
Fetal Movement Education
- Instruct patient to monitor fetal kick counts daily
- Teach the patient to contact healthcare provider promptly if there is a significant decrease in fetal movement
Ultrasound Considerations
- If placenta previa was noted on previous ultrasounds, follow-up examination should be performed at 28-30 weeks 5
- Women with confirmed placenta previa should be referred to a level III or IV center with experience managing these cases 5
Preterm Labor Education
- Educate about signs and symptoms of preterm labor:
- Regular contractions (tightening of the abdomen)
- Pelvic pressure or cramping
- Increased vaginal discharge
- Low, dull backache
- Instruct to call healthcare provider immediately if these symptoms occur
Third Trimester Complications to Watch For
Placenta Previa
- If diagnosed with placenta previa, avoid sexual intercourse and strenuous activity 5
- Educate about the importance of reporting any vaginal bleeding immediately 5
Hypertensive Disorders
- Explain warning signs of preeclampsia requiring immediate medical attention 4
- For women with chronic hypertension, emphasize the importance of medication adherence and regular monitoring 4
Delivery Planning
- Begin discussions about birth plans, pain management options, and postpartum expectations
- Review signs of labor and when to go to the hospital
- Consider prenatal classes if not already attended
- Discuss infant feeding plans (breastfeeding vs. formula)
Lifestyle Recommendations
Exercise
- Continue moderate physical activity if no contraindications exist 4
- Avoid exercise if diagnosed with placenta previa after 28 weeks 4
Nutrition
- Continue prenatal vitamins and adequate caloric intake
- Emphasize importance of balanced diet with adequate protein, calcium, and iron
Common Pitfalls to Avoid
- Failing to administer Tdap vaccine during the recommended window (27-36 weeks)
- Missing gestational diabetes screening
- Inadequate education about warning signs requiring immediate medical attention
- Performing digital vaginal examination if placenta previa is suspected without ultrasound confirmation 5
By providing comprehensive education and anticipatory guidance at 28 weeks, healthcare providers can help ensure optimal maternal and fetal outcomes during this critical period of pregnancy.