INITIAL EXAM

Your first visit includes a complete physical exam. If you have not had a recent pap test, which is a screen for precancerous lesions of the cervix, it would be done at this time. A cervical swab to test for gonorrhea and chlamydia is also standard at this exam if it has not been recently done.

First Visit: Urine pregnancy test, physical exam, pap test, gonorrhea and chlamydia test

ROUTINE PRENATAL CARE

There are five of us in our practice and we encourage you to see all of us. We do not share call with any other Doctors or practices.

6-10 weeks: Ultrasound, blood tests
12 weeks: Ultrasound, hear heartbeat, prenatal tests
16 weeks: Prenatal test
20 weeks: Ultrasound
26-28 weeks: Diabetes screen. Sweet drink and blood test 1 hour later.
32 weeks: Whooping cough vaccine (Tdap)
36 weeks: Vaginal swab for group b strep, cervical check
37 weeks
38 weeks
39 weeks
40-41 weeks: Non stress tests, ultrasound
41 weeks: Delivery

ROUTINE PRENATAL BLOOD TESTS

Standard blood tests done during the first prenatal visit:

• Complete Blood Count: tests for anemia
• Blood Type: Rh negative or positive
• Antibody screen: Looks for antibodies that may harm your pregnancy
• Rubella Titer: Tests for immunity to German measles
• Urine Culture: Looks for bladder infection
• Thyroid Stimulating Hormone: Tests for thyroid disease
• RPR: Tests for exposure to syphilis
• HIV: Tests for exposure to the AIDS virus
• Hepatitis B Surface Ag: Tests for hepatitis B

EXERCISE

It is a good idea to get regular exercise while pregnant. Recent studies have shown better outcomes with moderate exercise as opposed to bedrest and mild exercise. Walking, swimming and aerobics classes are all good choices. Be careful with anything that requires good balance. Your body is changing rapidly and your balance can be a bit off while pregnant.

BODY TEMPERATURE

It is important to keep your body temperature normal. A high core temperature increases the risk of birth defects such as Spina Bifida. Stay out of hot tubs, jacuzzis, saunas and steam rooms. If you have a fever (over 100º Fahrenheit) call us. Common causes of fever should be diagnosed and treated. This includes bladder infections, influenza pneumonia and sinusitis. Tylenol® can be used to lower your temperature if you have a cold.

CIGARETTES

There is no safe number of cigarettes. Smoking increases the risk of infertility, miscarriage, stillbirth, small babies and early delivery. Delivering before 37 weeks increases the risk of cerebral palsy and intellectual delay. After delivery, there is more asthma and pneumonia among children who have a parent who smokes.

EAT HEALTHY DURING YOUR PREGNANCY

Eat eggs, fish, poultry, meat, dairy, vegetables, nuts. Avoid sugar, flour and high fructose corn syrup. Especially avoid liquid sugars such as juices and full sugar soda. Cookies, cakes, crackers, chips and cereal should also be avoided during pregnancy because they can cause diabetes and excessive weight gain.

CAFFEINE

More than 4 cups of American style coffee per day is related to a slightly higher risk of miscarriage. Tea and colas have relatively little caffeine. European coffees have higher caffeine content. Mountain Dew® and Red Bull® have a lot of caffeine; these should be eliminated from your diet.

ALCOHOL: HOW MUCH IS SAFE

The quick answer to this is none. There is no known safe amount of alcohol. Birth defects and developmental delay may occur with relatively modest amounts of alcohol, and women consuming large amounts may have a normal baby. Among women consuming 4 or more drinks per week 70% of children have some evidence of Fetal Alcohol Syndrome. Fetal Alcohol Syndrome is a group of physical, behavioral and intellectual abnormalities that occur as a result of maternal alcohol consumption. It includes poor growth, heart and kidney defects, vision and hearing loss and intellectual and behavioral problems.

FISH

It is recommended that pregnant women eat fish 2 times a week. This reduces the risk of autism, high blood pressure and improves your mood. Certain fish, however, contain high amounts of mercury that may be harmful and cannot be removed with cooking.

Fish not to eat:

Shark
Swordfish
Tilefish
Spanish Mackerel

Good fish to eat:

Salmon Tilapia Catfish Trout Whitefish Sardines Anchovies

Herring Trout Sole Shrimp Shellfish Oysters Halibut

RAW RED MEAT

This includes steak tartare, carpaccio and cured meats. Do not eat any raw hot dogs, mortadella, bologna, salami, etc. Do not taste meat loaf or meatballs before cooking. The meat does not have to be well done, just heated all the way through.

SOFT CHEESES

Do not eat brie, feta, camembert, queso or blue cheeses. Do not eat cheese or milk that is unpasteurized. Hard cheeses such as swiss, cheddar, american and gruyere are OK.

VITAMINS

Taking vitamins for a month prior to your pregnancy and during your pregnancy can lower the risk of birth defects and blood transfusion. A multivitamin that contains 800-1000mg of folate, as well as iron and vitamin B6, will reduce the chance of a birth defect and help you feel better during and after the pregnancy. Omega 3 fatty acids are also recommended. These nutrients are available in healthy foods such as meat, fish, nuts and vegetables.

TRAVEL AND DEEP VEIN THROMBOSES

Pregnancy increases your risk of getting a blood clot in a deep leg vein. These blood clots can travel to your lung and be life-threatening. The risk is higher if you are older, overweight, smoke or are pregnant with twins. The other thing that increases your risk is sitting still, not moving for hours at a time. Long airplane flights such as to Europe or Australia can involve many hours of sitting. Flying in a plane is not intrinsically dangerous to your pregnancy, but sitting still for many hours at a time is. If your job involves sitting, you might consider getting up every few hours to stretch your legs and do some of your work standing. Symptoms include a red, painful, swollen leg.

ZIKA

Zika is a mosquito-borne virus with minimal symptoms. Occasionally there may be a rash, fever or conjunctivitis. It occurs in most Central and South American countries as well as Caribbean countries, southeast Asia and India. Mexico and Puerto Rico have significant outbreaks. There have been cases in Miami, Florida and Brownsville, Texas. 15% of women infected during their pregnancy have a baby that is affected. Sometimes it is not evident until after delivery. There is a blood test, but there are false negatives and false positives. Zika can cause intellectual delay that is severe, limb contractures and blindness. Do not travel to affected areas while pregnant. CDC.gov updates their website regularly and tells us what countries are affected. Men who get this infection can transmit it sexually for 6 months. Your husband should not travel to these areas during your pregnancy.

TOXOPLASMOSIS

Cats carry an infection that is dangerous to your baby. You should not be in contact with their urine, feces, vomit or saliva. Wash your hands after touching a cat. If there is no one else in your home willing to clean up after the cat you should consider having someone else care for your cat. Do not get a new cat while you are pregnant. You can also get this from gardening. Wear gloves while gardening and wash your hands afterwards.

SEX

It is safe to have sex during a normal pregnancy. If you are in labor, have broken your bag of waters or have vaginal bleeding, do not have sex. Call us right away. If you have medical conditions such as preterm labor or placenta previa do not have sex.

TESTING FOR RECESSIVE GENES

There is testing available to find out if you and your husband are carriers for genes that may harm your baby. You may carry a gene for a serious illness even if you have no family history and no symptoms. Your husband may also carry the same gene and similarly have no family history and no symptoms. If you are both carriers there may be a 1 in 4 chance that your child has the disease.

Some of these diseases can cause significant disability and even death. They can be diagnosed prenatally with amniocentesis. There is something called Preimplantation Genetic Diagnosis (PGD) which can identify an affected embryo before it is implanted in your uterus. This allows selection of unaffected children in future pregnancies. It is recommended that everyone be offered testing for Cystic Fibrosis, Spinal Muscular Atrophy and Fragile X Syndrome. If you or your partner are of Eastern European Jewish descent, there is a panel designed to cover diseases such as Tay-Sach’s which are more common in this group. This testing does not have to be repeated in subsequent pregnancies.

TESTING YOUR BABY

It is possible to know during the pregnancy if your baby has Down syndrome (trisomy 21) or another extra chromosome. Down syndrome involves intellectual delay and heart defects. Other extra chromosomes are not compatible with life. This is not something that runs in families, or would necessarily happen again in a subsequent pregnancy. It is more common with mothers over 35. There is a blood test that tests for cell free DNA (presumably the baby’s DNA) in the mother’s blood. This is fairly accurate and can be done at 12 weeks gestation. This test also lets you know the gender of your baby.

There is also testing available for Spina Bifida. This is a birth defect of the spinal cord that can keep a child from being able to walk. The blood test for this is done at 16 weeks. There is surgery available during or after the pregnancy for this condition. Abnormal results would need to be confirmed with amniocentesis. This is a procedure done under ultrasound guidance at or after 16 weeks gestation. A small amount of water from the baby’s bag of waters is removed with a syringe and sent for testing. This is very accurate. There is a small risk of miscarriage with this procedure.

The information in these tests is valuable and can change the management of the pregnancy and delivery. However, you may decline testing for carrier genes or testing your baby for birth defects.

THINGS TO CALL US FOR:

• Fever greater than 100º Fahrenheit
• Vaginal bleeding
• Gush of fluid from the vagina
• Reduced fetal movement
• Painful contractions every 5 minutes for an hour

COLD SYMPTOMS

If you have basic cold symptoms such as nasal/head congestion, sore throat, body aches or a low grade temperature of 98.7º to 101º, please treat with the following:

• Increase your fluid intake, especially warm fluids such as chicken broth.
• Increase rest, try steaming. Stand or sit in a warm shower and take deep breaths in. You can also do this by placing your head over a sink of warm water and draping a towel over your head.
• Take Tylenol® if needed for pain or fever.
• Use throat lozenges or cough drops.

If symptoms persist after trying the above recommendations or you develop a severe sore throat or persistent fever please call the office.

MEDICATIONS

It is ok to take Tylenol®. Please call us with any other medications you are taking. Bring them with you to your first visit so we may review the risks and benefits of any medication with you.

IT’S OK

It is ok to get a permanent, dye your hair or have your nails done. Feel free to look good during your pregnancy!

NORTHWEST COMMUNITY HOSPITAL

We do all our deliveries at Northwest Community Hospital. We encourage you to take a class and/or take a tour to see the hospital yourself. Sign up at NCH.org. All laboring and postpartum rooms are private. There is 24 hour anesthesia available for epidurals. We have a caring and conscientious nursing staff and ready access to specialists and emergency facilities should that be necessary. We have a level 3 NICU. We encourage you to download the NCH Baby App for more information. We suggest you choose a pediatrician on staff at NCH to examine your baby after delivery. You will need a car seat to take your baby home in.

VAGINAL BIRTH AFTER CESAREAN SECTION

We offer vaginal birth after cesarean. If you have had a cesarean section please read our Vaginal Birth after Cesarean consent form and review this issue with us individually. You should be aware of your options and the risks and benefits of each choice.

VACCINES DURING PREGNANCY

We offer flu vaccine to pregnant women during flu season. There is evidence that pregnant women who get the flu get sicker than other people who get the flu. Influenza prior to 37 weeks may lead to miscarriage or early delivery. Women who get the flu vaccine during their pregnancy have babies that are less likely to get the flu during the first 6 months of their lives. For these reasons it is safer for you and your baby to get the flu vaccine versus not get the flu vaccine during pregnancy. The vaccine cannot give you the flu. People with egg allergies, history of flu vaccine allergy, or Guillian-Barre syndrome should not get the vaccine.

Due to deaths of healthy newborns from the whooping cough, it is recommended that all pregnant women get the whooping cough vaccine in the third trimester. Giving Mom the vaccine creates immunity in the mother that travels through her bloodstream and the placenta and protects the baby. Immunity also goes through Mom’s breast milk. If you are allergic to the Tdap vaccine or have had Guillian-Barre syndrome you should not get the vaccine.

BREASTFEEDING

We encourage everyone to try to breastfeed. To establish a good supply, try to breast feed exclusively before your milk comes in. Lactation consultants are available in the hospital and after you go home to help. Advantages to you include more weight loss and less breast cancer. Advantages to your baby include fewer infections and less obesity. We understand it does not work for everyone and it is ok to supplement with formula or switch to formula if it is not working for you.

3D PHOTOS

You may make an appointment to obtain a 3D photograph of your baby during the pregnancy in our office. There is an additional cost for this service.