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Synopsis of Prenatal Care

Your prenatal care serves two purposes:

1. Identify and manage any medical conditions that may affect the pregnancy.

2. Provide anticipatory guidance as to what to expect until the next appointment.

6-12 weeks (Initial OB visit):

A comprehensive medical history is taken. Your provider will ask about many medical conditions that put the pregnancy “at risk” for complications. A few examples are a history of high blood pressure, diabetes, seizures or connective disorders such as lupus. An obstetrical history will be obtained, since that information will guide us with your care in the current pregnancy. A surgical history will help identify procedures that may increase the risk of obstetrical complications. For instance, treatment to the cervix with a cone biopsy or Leep procedure may increase the risk of cervical shortening early in the pregnancy. For these women, the length of the cervix is evaluated several times in the pregnancy to reduce the risk of preterm labor or delivery. A family history as well as a genetic history will be obtained. You will be counseled about age related risks for chromosomal abnormalities such as Down's Syndrome.

A comprehensive physical exam will be performed. Included is a complimentary ultrasound to confirm the due date and the heart beat.

Required testing:

Optional testing:

Anticipatory Guidance:

The first trimester (weeks 1-12) is a time of great chemical change in the body.

Most women experience some amount of nausea and vomiting . Simple steps may help to alleviate the symptoms. Try eating something before getting out of bed in the morning. Frequent small meals are better than three big meals a day. Numerous studies have shown that ginger products decrease the severity of nausea and vomiting. Examples include ginger ale, ginger snaps and plain crystallized ginger.

Fatigue is common. Many women describe it as “fall on the couch” pathological fatigue. Make sure to allow as much rest as possible.

Urinary frequency bothers many women as the uterus begins to enlarge, placing pressure on the bladder. This usually improves as the first trimester ends.

Next Appointment: 4weeks

Weeks 16-20

This appointment consists of checking maternal weight, blood pressure, urinalysis for protein and glucose, and listening for fetal heart tones. Fetal heart tones can usually be heard with a hand held Doppler starting at approximately 10-11 weeks.

You will be counseled about and given the option of having blood drawn for the Quad Screen. This is a maternal blood test that screens for certain chromosomal abnormalities and birth defects.

Anticipatory Guidance:

Most women start to feel well by the time of this visit. It is expected that there will be weight gain. Most women gain approximately a pound per week from this point until delivery. Too much or too little weight gain can affect the pregnancy, or be a sign of altered fetal growth. If you have gained too little weight your doctor may discuss adding more meals to your day or supplementing with high calorie/high protein drinks. If you have gained too much, your doctor may review your eating habits, and reinforce that the pregnancy only requires an extra 300 calories per day. It is important to remember that weight recommendations are only a guide. One of the truest quotes comes from the Girl Friend's Guide to Pregnancy: “You gain what you gain and that's what you're going to gain”.

Because the baby is growing rapidly at this stage many women start to develop ligament pain, sharp stabbing pains that radiate into the groin. These pains are generally made worse with sudden movements, rolling over or standing. Warm heat, rest, stretching and Tylenol can help relieve this pain.

Fetal movement may be felt during this time period. Many women who have had other pregnancies notice fetal movement as early as 16weeks. Most first time moms report movement starting at 20 weeks. Detection of movement can be altered by the location of the placenta or the amount of amniotic fluid.

Next appointment: 4 weeks with fetal anatomy ultrasound. The ultrasound should be scheduled with the ultrasound technician in our office.

20-24 Weeks:

This appointment consists of checking maternal weight, blood pressure, urinalysis for protein and glucose, and listening for fetal heart tones. Your provider will ask about bleeding, uterine contractions or leakage of amniotic fluid. The results of your quad screen will be reviewed if you elected to have it performed. If the anatomy ultrasound was performed prior to your appointment the results will be reviewed and discussed with you.

Anticipatory Guidance:

You will be able to feel the baby move on a more regular basis. The top of the uterus (called the fundus) will be approximately at the level of the belly button at 20 weeks. It will grow a centimeter each week. During each remaining visit your provider will measure the uterine growth from the pelvic bone to the top of the fundus.

Next appointment: 4 weeks, includes glucola screening for diabetes. Make sure you get the bottle of glucola and instructions before you leave.

24-28 weeks

This appointment consists of checking maternal weight, blood pressure, urinalysis, measuring height of the uterus, and listening to the fetal heart tones. Your provider will ask about signs and symptoms of premature labor and may check to see if your cervix is starting to open. Blood will be drawn for the gestational diabetes screen and a blood count to look for anemia. Many women need supplemental iron in the later part of pregnancy. If you are Rh negative an antibody screen will also be drawn. If you are Rh negative and the father of the baby is Rh positive, you will receive an injection of Rhogam. Rhogam will help to protect your body from reacting to any red blood cells that are a different Rh type than yours, from the baby or the father.

Anticipatory guidance:

Some women experience an increase in back pain due to the loosening of ligaments, pressure from the baby and the change in posture as the baby grows. Stretching the lower back and maternity support belts can reduce the amount of discomfort.

The pancreas has to double the amount of insulin produced to maintain a normal blood sugar (glucose) level. High blood glucose levels can be harmful or even fatal to the developing baby. If the first glucola test is abnormal, a second test (the three hour test) using a whole bottle of glucola and four blood draws is required to detect gestational diabetes. Approximately 85% of women pass the one hour test, of those that fail the one hour screen 85% will pass the three hour test. Women with abnormal three hour tests have gestational diabetes, but 85% of those women will be able to control their blood sugar with diet alone.

The fetus has just reached viability, the ability to survive outside the uterus. You will be instructed on performing fetal movement counts . Most providers recommend monitoring the movement of the baby for one hour each day and calling if you don't get a minimum number of movements, usually 4-10/hr. If you do not get the desired number of movements call the office day or night.

In addition to the fetal movement counts, now is the time to pre-register at the hospital of your choice. We do not want you waiting at admissions while your insurance and demographic information is collected. Now is also the time to start looking into pediatricians. We have a referral preference list at the front desk.

If you ever thought of doing the 3-D ultrasound to surprise your spouse,

now is the time to schedule the study to get the best images.

Next Appointment: every 2 weeks until 35-36 weeks

35-37 weeks

The appointment will consist of checking maternal weight, blood pressure, urine analysis, uterine size and fetal heart tone determination. Instead of asking about premature labor we will ask about any signs or symptoms of labor. We will also check the cervix to see if there has been any dilation. A Group B Strep culture of the vagina will be obtained. Group B strep is a bacterium that lives on the skin of 30% of women. It is not infectious or sexually transmitted but can cause infection in babies. If your culture is positive, the only treatment needed is intravenous antibiotic therapy during the labor process.

Anticipatory Guidance:

Labor precautions start at this appointment. You should call the main office number day or night for contractions of moderate to severe intensity lasting one minute in duration and occurring every 5minutes for one hour (5-1-1 formula). You should also call with leakage of fluid, bleeding like a period (you may spot after cervical exams or intercourse), or if you are not feeling enough fetal movement. Your baby's movements may change in character close to term but you should still feel distinct movements.

Sleep may become more problematic. Establishing a sleep routine with a warm bath, relaxation techniques and Tylenol will help alleviate some insomnia. If a number of days have passed without good sleep the use of a sleep aid like Benadryl or Tylenol pm is allowed.

Next appointment: 1 week

37-41 weeks

These weekly appointments consist of the usual weight, blood pressure, urine, cervical dilation check, and fetal heart tones. We will check for signs of labor. After 40 weeks, a non-stress test and an amniotic fluid ultrasound will confirm continued fetal well being. If there is indication for labor induction one will be scheduled. We do not let women go more than two weeks past their due date.

Anticipatory Guidance:

Labor induction is accomplished through a number of methods. The simplest method, if the cervix is dilated, is to rupture the membranes and await spontaneous labor. Another is to administer pitocin intravenously (pitocin is a synthetic form of oxytocin, the hormone made by the body to initiate contractions). If the cervix is not starting to dilate or is still too firm, prostaglandins can be used to cause chemical changes that are described as “cervical ripening”. The final method of induction used is mechanical/chemical stimulation using a catheter that is inserted through the cervix, with a balloon inflated to cause traction on the cervix.