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Obstetric & Prenatal Care
The physician’s role during prenatal care is to assess the health of mother & baby, prescribe interventions, try to influence behaviors, and to advise/assist patients as they undergo the physical & emotional challenges of pregnancy.
PRECONCEPTUAL CARE
- Time period prior to pregnancy where a patient’s health status, potential risk factors are identified, and patient education occur.
- Medical history and physical exam
- Opportunity to optimize management of chronic medical conditions such as hypertension, diabetes, asthma, and obesity.
- To discuss and encourage potential hazardous lifestyle modifications such as alcohol and tobacco abuse.
- To review current medications and their safety in pregnancy with possible adjustment of medicines to prevent fetal harm or malformations
- Counseling in mothers of later childbearing and the risk of chromosomal abnormalities
- Lab work may be ordered to check rubella, Hepatitis B, & chicken pox immunity
- Initiation of folic acid supplementation of 400ug prior to attempting conception.
INITIAL PRENATAL VISIT
- Your first prenatal visit will occur at around 8-10 weeks of pregnancy
- This visit provides an opportunity for your healthcare provider to obtain a detailed pregnancy, menstrual, medical, surgical, and social history from you and a detailed physical exam is performed including a pap smear with evaluation of the uterus, cervix, ovaries, and pelvic bones
- This visit also is an opportunity for your personnel questions to be answered and education from the healthcare provider regarding the anticipated course of prenatal care as well as to address common pregnancy symptoms.
- Initial laboratory work that is obtained includes: white blood cell count, hemoglobin, platelets, blood type and Rh, antibody screen, syphilis, rubella titer, hepatitis B, urinalysis, and optional HIV testing.
SUBSEQUENT PRENATAL VISITS
- The frequency of visits are monthly up to 28 weeks; bimonthly up to 36 weeks, and then weekly until delivery
- Each visit involves an interval history from prior visit; monitoring of weight trends; blood pressure; fetal heart tones, and fundal height which is a clinical measurement of adequate fetal growth.
- Education and advice are given to the patient and the patient is also given an opportunity to address personal concerns/questions
OTHER LABS
- Maternal Serum Screening Test (15-20 weeks)
- Optional maternal blood test that screens the fetus for neural tube defects; abdominal wall defects; and Trisomy 21 & 18.
- Detects 85% neural tube defects; 60-70% Trisomy 21; & 60% Trisomy 18
- One hour Glucola screen (26-28 weeks)
- Screening test for gestational diabetes
- Involves drinking a 50g glucose drink and then checking a maternal blood glucose level to screen for diabetes
- If this value is abnormal, then a three-hour glucose tolerance test is performed. This requires a patient to be fasting after midnight. An initial fasting glucose level is obtained and then the patient drinks a 100g-glucose drink. Your blood sugar is then checked in 1 hour, 2 hours, and 3 hours later. If two or more values are abnormal, then gestational diabetes is diagnosed.
- Group B Streptococcus screening (35-37 weeks)
- This is a vaginal/anal culture obtained to screen for Group B Streptococcus bacteria which is a normal vaginal bacteria in 30% of the female population.
- If positive for this bacterium, antibiotics are given during labor to prevent transmission to the baby since it can contribute to pneumonia or a blood infection in the newborn.
ULTRASOUND
- A first trimester ultrasound is performed to verify the due date, to see if a multiple gestation is present, and to evaluate any potential problems with the uterus or ovaries.
- At 20 weeks gestation an anatomical survey of the fetus is performed to rule out any malformations or suspected chromosomal abnormalities.
- Additional ultrasounds may need to be performed if indicated such as in situations of abnormal fetal growth, multiple gestations, to monitor fetal oxygenation in mothers with diabetes, chronic high blood pressure, or fetal growth restriction.
CONCERNS SPECIFIC TO PREGNANCY
- Nutrition & Weight Gain
- Weight gain during pregnancy depends on several factors such as body mass index and multiple gestation.
- Underweight females (BMI <19.8) gain between 28-40 pounds
- Normal weight females (BMI 19.8-26) gain between 25-35 pounds
- Overweight females (BMI >26) gain between 15-25 pounds
- Patients on strict Vegan diet need additional Zinc, Vit B12, and iron supplementation
- Caffeine
- Restrict caffeine intake to less than 3 cups of coffee daily
- Large amounts of caffeine can lead to increased risk of miscarriage as well as maternal insomnia, heartburn, and urinary frequency.
- Exercise
- There is not an increased risk of miscarriage, fetal malformations, or fetal growth restriction with regular low-impact exercise regimen.
- Exercise should be stopped if extreme fatigue, dizziness, or shortness of breath occurs which may be signs of oxygen deprivation.
- Stay well hydrated and exercise in cool place to avoid becoming overheated.
- Avoid prolonged exercise in the supine position during the second & third trimester since this can lead to low blood pressure and fainting.
- Nausea & vomiting
- Symptoms begin at 6-8 weeks, peak at 12-14 weeks, and may last up to 22 weeks.
- Avoid fatty or spicy foods, eat small frequent meals, drink ginger teas, inhale peppermint oil vapors, and increase rest periods during the day.
- Sometimes anti-nausea drugs may be prescribed to assist with nausea symptoms.
- Vitamins may need to be stopped during this time since they can exacerbate the symptoms
- Constipation
- Increase fluids and intake of high fiber foods
- Over the counter psyllium may also alleviate symptoms
- Hemorrhoids
- Caused by compression of rectal veins by enlarging uterus, constipation, or straining with stools
- Treat with witch hazel, topical preparations, stool softeners, & cool sitz baths
- Leg cramps
- Muscle spasms of the lower calf muscles especially at night
- Increase calcium and potassium in diet
- Massage, heat, and stretching of the muscle
- Backache
- May be alleviated by decreasing the amount of time spent standing, Tylenol, support belt, and low back exercises
- Sexual relations
- No restriction on sexual relations during pregnancy
- It is contraindicated with the following conditions:
- Rupture of membranes
- Known condition of placenta previa
- Travel
- Risk of blood clot formation in lower extremities with prolonged inactivity
- Walk for 10 minutes every 2 hours to decrease this risk during long flights or road trips
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Obstetrical Ultrasound
Overview:
In the 21st century, the Obstetrical ultrasound has provided a means for real time evaluation of pregnancy with an accuracy and clarity previously unavailable. At Arnett Clinic, real time ultrasound using a full time ultrasonographer with images evaluated by your obstetrician is available.
First Trimester:
In the first 12 weeks of pregnancy your doctor can use an ultrasound to confirm the due date, evaluate a threatened miscarriage, diagnose twins or higher multiple gestations, and evaluate possible ectopic pregnancy. Furthermore, a first trimester scan can be used to evaluate for some possible birth defects including Down syndrome.
Second Trimester:
By twenty weeks the fetus is formed and a full anatomical scan can provide new and useful information on your baby’s development. Along with the anatomical scan the 20 week ultrasound provides an estimate of growth for the first half of the pregnancy and an excellent view of the amniotic fluid, the umbilical cord and the placenta.
Third Trimester:
In the final stage of pregnancy the ultrasound becomes important in evaluating the status of certain pregnancies. It can be used to monitor previously diagnosed problems with growth and anatomy. Your physician will also use the ultrasound to evaluate the position and orientation of the fetus, to check for possible rupture of membranes, and to test for fetal wellbeing.
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