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Third trimester, provider appointment #6 (week 37)

Your healthcare provider is a hugely valuable resource for you as you head down the homestretch of pregnancy – make sure you get your questions ready!

3rd Trimester, 6th Appointment (Week 37)

Provided you and Baby are in tip-top shape, this will be another one of those quick and easy, but super helpful 15-minute appointments. The healthcare provider will take your weight, blood pressure, and ask you to provide a urine sample, which they will screen for elevated levels of protein and sugar. Your healthcare provider will also discuss Baby’s movements with you, measure the size of your womb to get a sense of how big Baby is, and measure his heart rate with a fetal doppler. And now that he is nearly full-term, it’s really time to start thinking very seriously about delivery. If he is still in breech position, beginning at week 37 your healthcare provider may consider an External Cephalic Version (ECV) to retain the option of a vaginal delivery even if he does not turn on his own.

An ECV involves your healthcare provider pushing down on your womb and manipulating Baby to turn towards the proper, head-down delivery position, and must be performed in the hospital by an experienced provider. Because the procedure involves a slight but possible risk for the Baby, and the possibility of discomfort for you, your healthcare provider will take many precautions before performing this procedure. These may include:

  • Fetal ultrasound: Your healthcare provider needs to know exactly baby and the placenta are in your belly, and he or she almost must be able to determine the amount of amniotic fluid.
  • Fetal heart rate: Baby’s heart rate should increase a bit when coaxed into moving, so your healthcare provider will want to make sure that the slightly elevated rate is there.
  • Terbutaline: A drug that is normally dispensed to prevent pre-term labor, but acts by relaxing the uterus, terbutaline is often given to women who are undergoing an ECV, as contractions can lead to complications for the breeched baby due to the positioning of the umbilical cord.
  • Epidural: An initial failed attempt to turn Baby might lead to another try. However, ECVs can be quite painful, so an epidural may be given to lessen any ECV-related pain.

The ECV success rate is about 58%. However, an unsuccessful ECV is far from a disaster – it simply means that baby may have to be a C-section.


Reviewed by Dr. Jamie Lo
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Sources
  • Committee on Obstetric Practice. “Analgesia and Cesarean Delivery Rates: Committe Opinion Number 339.” ACOG. American College of Obstetricians and Gynecologists, 6/6/2015. Web.
  • Hofmeyr GJ, Kulier R. “External cephalic version for breech presentation at term.” Cochrane Database Syst Rev. 10:CD000083. doi: 10.1002/14651858.CD000083.pub2. Web. 10/17/2012.
  • Andrew S. Coco, M.D., M.S., Stephanie Silverman, M.D. “External Cephalic Version.” American Family Physician. 58(3):731-738. Web. 9/1/1998.
  • Mayo Clinic Staff. “Third trimester pregnancy: What to expect.” Mayo Clinic. Mayo Clinic, 5/5/2014. Web.

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