Obstetrics

Spotting of blood may occur in 40% of all normal pregnancies during the first trimester. If you are spotting, begin best rest and call the office. Avoid heavy lifting, exercise, and sexual intercourse for 48 hours after the last episode of spotting.

You should be drinking 8 to 10 glasses of liquids a day while you’re pregnant. This will help to prevent you becoming constipated in the first place. Fruit juices such as prune and apple juice are very good at keeping you regular and should be included. You should also increase the fiber in your diet by eating bran or shredded wheat cereals, bran muffins, raw fruits and vegetables. Daily exercise, particularly walking, will also help to prevent constipation. If constipation should occur, there are several non-prescription medications that may be used – Metamucil, Citrucel, Fibercon, Per Diem, Fibermed Biscuits, Haley’s MO, and Milk of Magnesia.

Dental work is okay when you are pregnant, but you should make sure the dentist knows you are pregnant. If they take x-rays you should be covered with a lead drape.

Should this happen increase your fluids intake to at least 6 to 8 glasses every day. Avoid milk or milk products until the diarrhea has stopped. Eat foods such as bananas, rice, apple sauce, tea, and toast for 24 hours. If you obtain no relief you may use Kaopectate or Imodium which can be purchased without a prescription. If the diarrhea continues for more than 24 hours, please call the office.

Your gums may bleed more easily when you are pregnant. This is because of the increased blood supply to the oral tissues during pregnancy. You should brush at least twice daily using a soft toothbrush and also floss once a day.

You should continue routine dental care during your pregnancy but you must inform your dentist that you are pregnant. They will need to know this so that they can use the correct anesthetic and take the necessary precautions for X-rays.

As long as you have your hair colored, highlighted or permed in a well-ventilated room it is safe. However, due to hormonal changes caused by pregnancy your hair is unlikely to react in the same way as it did before you became pregnant.

Eat small, frequent meals (5 or 6 a day). Drink liquids, especially milk, between meals rather than with meals. Avoid fatty or fried foods, alcohol (which we recommend you avoid at all times during your pregnancy) and carbonated beverages. Sit up during and for one hour following meals. You may use non-prescription low sodium antacids such as Maalox, Tums or Rolaids – do not use one with simethicone (an anti-gas formula). Zantac or Pepcid may be helpful. You can also try eating crackers. If no relief with these measures, notify your provider.

There is some controversy about the safety of hot tubs during pregnancy so you should avoid them during the first three months of your pregnancy. During the second and third trimesters you should limit your time to less than 10 minutes and never have the water temperature above 105 degrees. You should also get out very slowly since dizziness may occur. You should also avoid a tub bath where the water is so hot that your skin becomes reddened and you become dizzy when you stand up. Water this hot raises the core temperature of your body and is not healthy for your baby.

Unless you’ve been told to refrain or there is a specific problem with the pregnancy, such as bleeding, leaking bag of water, or preterm contractions, sexual intercourse is safe during pregnancy. It may be necessary to experiment to avoid discomfort. If intercourse is painful or causes bleeding or prolonged contractions (it is normal to have some contractions following intercourse), please talk with your physician or midwife.

• Before taking any over-the-counter or prescription medication not mentioned below, you should check with the office.
• You should not take aspirin, ibuprofen, or naproxen sodium unless directed to do so by your physician or midwife. Regular strength acetaminophen (Tylenol) is the medication of choice for pain or fever. If you have a fever of 100.4 or higher, please call the office.
• For sinus congestion with colds, allergies, or flu, pseudoephedrine (Sudafed) may be used. You also may use a saline nasal spray, such as Ocean or Nasal. Do not use Neosynephrine nasal spray for longer than 3 days. You may take Robitussin DM for coughs or chest congestion. A warm salt-water gargle is recommended for a sore throat. Throat drops, spray, or lozenges are acceptable. A cool air vaporizer may help you sleep at night. Increased fluid intake and getting sufficient rest are essential. If your nasal or throat drainage changes from a clear color, please call the office.

Nausea and vomiting in pregnancy is commonly referred to as “morning sickness”, but it can occur at any time of the day or night, usually when the stomach is empty. Keeping something in your stomach by eating small, frequent meals (5 or 6 a day) will help to prevent it from happening. Avoid spicy and greasy foods. Try antacids to help settle your stomach and eat a clear liquid diet for 24 hours. If nausea is a problem when you get up in the morning, try a high protein snack before bed and eat something before getting out of bed in the morning such as pretzels or soda crackers. Dehydration can also increase your nausea so drink plenty of fluids. Avoid unpleasant odors. Over-the-counter seasickness medication helps some people. Taking your vitamin at night may help, or switching to a chewable formula. Emetrol, a sugar-based syrup, can be purchased without a prescription and may be helpful. Vitamin B6 over-the-counter is a good first choice in treating morning sickness. If these conservative measures are not successful in getting your nausea/vomiting to an acceptable level, please notify your provider.

You should call the office anytime you are unable to keep fluids down for 24 hours.

Caffeine, in moderation, is safe. Moderation is considered two or fewer caffeine containing beverages per day. If a mother drinks more caffeine, the baby can be born with a caffeine addiction. This addition will interfere with sleep patterns and eating during the first weeks. Beverages that contain caffeine include coffee, tea, chocolate and many carbonated soft drinks.

Meat, fish and poultry are all part of a healthy diet but you should make sure they are well cooked. However, fish and shellfish all contain traces of mercury which may be harmful to a baby’s developing nervous system. Pregnant or breastfeeding mothers should avoid shark, swordfish, mackerel and tilefish. Limit other seafood including canned tuna to 2 servings per week.

You should avoid changing the kitty litter if at all possible since cat bowel movements may contain a parasite that can cause a serious infection. These infections can lead to birth defects. If you have to change the litter, use rubber gloves, wear a mask and wash your hands afterward. You should also wear gardening gloves when digging in the dirt in an area the neighborhood cats may use as a kitty litter box.

Regular exercise is important. Walking, swimming, cycling, and prenatal exercise classes are all recommended. Swimming is safe during pregnancy as long as your bag of water is not leaking. Low impact aerobics are an excellent way of exercising during pregnancy and classes are available in the community.

You may continue normal sports activity although you should keep your heart rate under 140 (take your pulse for 6 seconds, multiply by 10). Do not exercise lying flat on your back after 16 weeks of pregnancy. If any activity causes you pain you should discontinue it immediately. Be sure to discuss specific sports activities with your physician.

Exercises that are not recommended during pregnancy are snow or water skiing and horseback riding.

Some edema, or swelling, is normal during pregnancy. Generally edema appears in the ankles and legs during the final months of pregnancy. To reduce your discomfort you should elevate your legs whenever possible. Other things you can do are to rest on your left side and reduce your intake of foods containing salt (many foods such as fast food, pizza, deli meats, boxed food, ready made meals and food from a can or jar such as spaghetti sauce and canned tomatoes contain large amounts of salt). Drinking an adequate amount of water is the best way to get rid of excess swelling, so drink 8 to 10 glasses a day. Please call the office if the swelling is severe or if accompanied by a headache unrelieved by Tylenol, or if you have visual changes, or upper right abdominal pain.

Routine Testing – we do the following tests during your first visit:

Rubella Titer – we do this test to determine your immunity status to Rubella (German Measles). If the test shows non-immunity, the immunization will be offered to you when you deliver.

CBC – A complete blood count is done to determine your body’s ability to carry oxygen and nutrients through it to your baby. This is repeated when we do the glucose challenge test (see below) and sometimes at around 36 weeks if we find you are anemic on an earlier visit.

Blood Type and Rh, Antibody Screen – If you are Rh negative and the father of the baby is Rh positive, there is the possibility the baby could inherit the father’s blood type which could cause a problem during this or future pregnancies. Fortunately, we can prevent this in most cases by giving you an injection of Rhogam – this prevents your immune system from responding to the baby’s Rh-positive blood cells. If you are Rh positive, there is nothing to worry about.

Hepatitis B – This test determines whether you have Hepatitis B, or if you are a carrier. If you are a carrier, your baby will need to be vaccinated at birth.

HIV – we recommend HIV testing to all pregnant women. If you are infected, you can transmit the virus to the baby. We can decrease the chances of this happening with medications and pregnancy management, which is why we like to perform this test. The test can be performed at any time during your pregnancy if you decide not to have it at your first visit.

Syphilis – state law requires the testing for this sexually transmitted disease.

Pap Smear – This test detects cancerous and pre-cancerous changes in the cervix (the opening to the womb, located at the top of the vagina).

The following tests are offered later in the pregnancy:

Quadruple Screen Test – This blood test combines the results of four laboratory values, alpha-fetoprotein (AFP), estriol, Beta Human Choriogonadotropin (BHCG), and inhibin A to predict the chance that your baby has a chromosomal abnormality such as Down Syndrome or Trisomy 18 while also providing valuable information as to whether or not the spinal cord was inadequately developed leading to a neural tube defect (such as Spina Bifida). Results are reported as a ratio, such as 1:200 or 1:50,000. This test is done between 15 and 20 weeks and is offered to all pregnant women. It is your choice if you would like to have this test. This is a screening tool that if abnormal would lead to the recommendation for ultrasound and/or amniocentesis.

Amniocentesis – Women who are 35 years or older during pregnancy have a greater risk than younger women of giving birth to a baby with a chromosomal defect (the most well-known is Down’s Syndrome). Amniocentesis is offered at this age because the risk of miscarriage from the procedure equals or is less than the risk of chromosomal birth defects. (Approximately 1:270 at the age of 35). We generally perform this test between the 14th an 16th week of pregnancy. Using ultrasound as a guide, a needle is placed through the abdomen into the uterus to collect amniotic fluid for testing. Cells obtained are cultured in a laboratory for evaluation of the chromosomes. Results of the studies are available in about two weeks. In addition, the fluid is tested for the level of alpha-fetoprotein, to detect a neural tube defect such as Spina Bifida.

Chorionic Villi Sampling (CVS) – This test is offered to the same age group as amniocentesis, but is performed earlier in the pregnancy (10 to 12 weeks). A small sample of cells is taken from the placenta where it is attached to the wall of the uterus, rather than from amniotic fluid. Chromosomal birth defects, such as Down’s Syndrome, can be detected. Results of the chromosomal studies are available in approximately two weeks. The risk of miscarriage is about the same as with an amniocentesis but there is an additional risk of limb deformities with this test. The CVS is performed too early to detect neural tube defects. A separate blood test (AFP) can be performed between 15 and 20 weeks.

Glucose Challenge Test (GCT) – This screening test is performed on all pregnant patients (who are not already known to be diabetic) between the 24th and 30th week of pregnancy as a screening test for gestational diabetes (diabetes during pregnancy). If your score is elevated, a nurse will call you to arrange for a 3 hour glucose tolerance test, a definitive test for gestational diabetes.

Ultrasound or Sonogram – A sonogram is an image of the developing fetus produced using specially directed sound waves. This painless procedure can give information concerning the age of the baby, the position, the possibility of multiple gestation, and some major birth defects. Minor birth defects are usually not seen on routine ultrasound screens. Ideally this test is done between 18 and 20 weeks to allow for confirmation of the due date and adequate evaluation of the fetus.

Non-Stress Test – An external fetal monitor is placed on your abdomen. The baby’s heart rate is evaluated with relation to its movements. This test generally takes from 20 to 30 minutes and predicts the baby’s well-being inside the uterus. This test may be recommended for a variety of reasons, including:

-Multiple gestation
-Maternal smoking
-High blood pressure
-A perceived decrease in fetal movement
-Age (older than 35 or a teenager)
-Diabetes or gestational diabetes

Travel by any mode of transportation is considered safe up to the seventh month of pregnancy. Eat healthy snacks and take along lots of water to drink. If traveling by car, you should stop every 1 to 2 hours and stretch your legs. Always use seat belts, and place the lap belt low on the abdomen. After the seventh month, check with the office before traveling.

Symptoms of a urinary tract infection include pain or burning with urination and increased frequency of urination. The urine may be cloudy or have a strong odor. Unexplained lower abdominal cramping, often accompanied by a backache, can also mean a UTI. An untreated urinary tract infection can cause premature labor, so do not delay seeking treatment. If you suffer from these symptoms you should call the office and we will arrange a urinalysis for you. It is essential to drink plenty of water and fruit juices (8 to 10 glasses a day) if you think you have a urinary tract infection. You should also avoid caffeinated and carbonated beverages, as they can irritate the bladder and increase your pain and discomfort.

The important warning signs of pregnancy are:

-Vaginal bleeding
-Leaking vaginal fluid
-Change or decrease in baby’s movement (once you start feeling  movement at 18-24 weeks)
-Severe headaches accompanied by increased swelling in hands and feet and/or face and visual changes such as spots before your eyes
-Burning with urination
-Temperature above 100.4 degrees

If any of these occur please contact the office immediately.

The weight gain recommended during pregnancy is generally 20-30 pounds. However, this can be different for each individual. As everyone is different you should discuss your particular situation with your doctor.