First OB Appointment/Pre-natal Intake
Your first appointment is referred to as the "Prenatal Intake" or PNI. This appointment will occur between 7 and 12 weeks. It is recommend that you print and complete the New Patient OB paperwork prior to this appointment. We will review your history, assessing and counseling for risk factors during your pregnancy. We will review your due date which is based on your last menstrual period (LMP).
To calculate your due date yourself:
- Subtract three months from the month of your LMP
- Add seven days to the day of your LMP
We will perform a pelvic exam, pap smear and cultures. We will send you to the lab to have your initial OB labs drawn. This includes:
- Blood type
- Blood count
- Hepatitis B
- RPR (syphilis)
- Rubella titer
- Urine analysis and culture
- Varicella titer (if you have not been exposed to chicken pox)
- Sickle cell screen (for high risk ethnic groups)
- Early glucola (diabetes test, for high risk groups)
Counseling for the New OB/PNI appointment
A balanced healthy diet is one of the most important aspects of a healthy pregnancy. If you already eat a balance diet, all you need to do is add 300 extra calories a day to sustain your pregnancy needs. Take your prenatal vitamins and you will have all the nutrients and calories you need. If you do not, this is a great time to learn what you need to change to your diet plan to maintain a healthy lifestyle. There are some excellent resources to educate yourself about nutrition.
- The food pyramid recommendations for pregnancy:
- Bread/Cereal/Rice Pasta: 9 servings
- Fruit Group: 3 servings
- Vegetable group: 4 servings
- Meat/poultry/fish/eggs: 3 servings
- Milk/yogurt/cheese: 3 servings
- Fats/Oil/Sweets: Use sparingly
- Additional nutrients required during pregnancy include folic acid, iron and calcium
- Folic acid: 400 micrograms
- Iron: 27 miligrams
- Calcium: 1000 miligrams
You will get these additional nutrients from your prenatal vitamins.
Too much vitamin A has been associated with birth defects. Your prenatal vitamins have all the Vitamin A you need.
Weight gain during pregnancy depends on your pre-pregnancy weight
- Underweight (BMI less than 18.5): 28-40 lbs 1 to 1.3 lbs per week
- Normal weight (BMI 18.5 to 24.9): 25-35 lbs 0.8 to 1 lb per week
- Overweight (BMI 25 to 29.9): 15-25 lbs0.5 to 0.7 lb per week
- Obese (BMI 30 or more): 11-20 lbs0.4 to 0.6 lb per week
To calculate your BMI go to https://www.yourpregnancyandchildbirth.com/topics.php?page=nutrition
Where the does the weight go?
- Baby: 7 ½ lbs
- Breast: 2 lbs
- Body fat stores, blood, fluid: 15 lbs
- Placenta, uterus and amniotic fluid: 5 1/2lbs
Fish and Shellfish can be a rich source of protein and other nutrients. You can safely eat 12 ozs (2-3 meals) per week. You should not eat:
- King mackerel
- Tile fish
- Avoid albacore tuna - Canned chunk light tuna is ok
Listerosis is a bacteria found in certain foods
- Unpasteurized milk
- Hot dogs
- Lunch meat
- Smoked seafood
If you desire to eat hot dogs or lunch meat - heat them up until they are steaming hot!
Exercise is an important aspect of a healthy pregnancy. The current recommendation is 30 minutes a day, most days of the week. If you had a regular exercise routine prior to pregnancy - keep it up. Just keep in mind some of the recommendations discussed below. If you did not have a regular exercise routine - start making some plans to get moving! Start slow and gradual increase to reach a goal of 30 minutes a day. Exercise has many benefits during pregnancy. It increases your energy, improves your mood, decreases back pain, constipation and sleeping difficulties which can occur during pregnancy. It also helps you prevent excessive weight gain during pregnancy, decreases your risk for gestational diabetes and prepares you for labor.
- Stop exercise immediately if you experience dizziness, weakness, shortness of breath chest pain or uterine contractions/cramping
- Avoid becoming overheated
- Drink lots of water
- Limit weight bearing exercises
- Ask yourself - could I fall and hit my abdomen
Remember your body is changing and your center of gravity is shifted. You may be at a high risk of falling while running, gymnastics, skiing or bike riding. Avoid contact sports.
Swimming is a great exercise as it's a full body cardiovascular workout, less impact on your back and joints and minimal risk of injury. Other great choices are walking, stationary cycling and low impact aerobics.
After the first trimester, avoid exercises that require you to lay flat on your back
In a normal uncomplicated pregnancy, there is no reason to interrupt your normal sex life. Some people worry that it may hurt the baby. Your baby is well protected by the uterus, placenta and fluid. The motions or activity will not harm your baby. Orgasms will not put you into labor. It is not uncommon to have some light spotting after intercourse. Do not let this alarm you. If the bleeding is heavy or persists then stop having intercourse for a few days and discuss it with your healthcare provider. If you have a history of miscarriage, vaginal bleeding during pregnancy, or a high risk condition such as placenta previa or preterm labor your doctor or midwife may have you maintain 'pelvic rest.'
When you complete your New OB form, there is a section about genetic history. We review your answers to assess if you have any risk factors to encourage genetic testing. In the past, we only offered genetic testing to those at risk. Recently, the American College of Obstetrics and Gynecology (ACOG) recommended genetic testing should be offered to ALL pregnant women. These tests should be offered to everyone but are still optional tests. Screening tests are easy to perform and do not pose a risk for mom or baby. If the screening test shows an increased risk of having an affected baby, further tests may be done to diagnose the problem. An abnormal screening result, while alarming, only signals a possible problem. In most cases, the baby is healthy even though the screening test result indicated a possible problem. Likewise, a birth defect can occur even though the screening test did not indicate an increased risk.
Please be aware that even though these are offered it may not be covered by your insurance. Most insurance plans cover first and second trimester testing but cystic fibrosis testing is not always covered. Please check with your insurance provider.
First trimester testing
First trimester screening tests include blood tests and an ultrasound exam. This screening can be done as a single test or as part of a step-by-step process known as sequential screening. Some women may not need further testing. First trimester screening is done between 11 and 14 weeks of pregnancy to detect the risk of Down syndrome and Trisomy 18. The blood tests measure the level of two substances in the mother's blood:
- Pregnancy-associated protein-A(PAPP-A)
- Human chorionic gonadotropin (hCG)
An ultrasound exam, called nuchal translucency screening, is used to measure the skin thickness at the back of the neck of the fetus. An increase in this space may be a sign of Down syndrome, Trisomy 18, or other problems.
The results of the nuchal translucency screening are then combined with those of the blood test and the mother's age to assess the risk for the fetus. In the first trimester, this combined test detects Down syndrome in about 85% of cases and it allows for early detection. When first trimester testing is combined with second trimester testing (sequential screening) it increases the detection rate to 90-95% of Down syndrome.
When the nuchal translucency thickness is increased, the fetus may have a heart defect or other genetic condition. In this case, your provider may suggest a more detailed ultrasound exam at around 20 weeks of pregnancy.
Second trimester testing/Quad Screen
In the second trimester, a test called "multiple marker screening" or "quad screen" and is offered to screen for Down syndrome, Trisomy 18 and neural tube defects. This test measures the level of four of substances in your blood:
- Alfa-fetoprotein (AFP) - A substance made by a growing fetus, which is found in amniotic fluid, fetal blood, and, in smaller amounts, in the mother's blood.
- Estriol- A hormone made by the placenta and the liver of the fetus.
- Human chorionic gonadotropin (hGC) - A hormone made by the placenta.
- Inhibin-A - A hormone produced by the placenta.
This tests usually are done around 16-21 weeks of pregnancy. The stage of pregnancy at the time of the test is important because the levels of the substances measured change during pregnancy. The quad screen detects Down syndrome in 80% of the cases. The AFP tests neural tube defects in 80% of the cases.
Some birth defects are inherited. Just as a baby gets certain traits like eye color from the parents, certain diseases or disorders can be passed on to the baby, These inherited diseases are called genetic disorders. They can be passed from parent to child through genes.
A carrier is a person who shows no signs of a particular disorder but could pass the gene on to his or her children. Carrier testing can be done to check for many genetic disorders, including Cystic Fibrosis, Sickle Cell disease and other blood disorders, Tay-Sahs disease, and Canavan disease. Some tests are recommended for people of certain ethnic backgrounds or who have a strong family history of a genetic disease. Your provider can help advise you on which tests may be best for you. He or she can explain what the results mean or refer you to a genetic counselor.
Cystic Fibrosis screening is available for all pregnant women. Cystic Fibrosis is a genetic disease that causes breathing and digestive problems. It ranges in severity from mild forms which is detected later in life to more severe forms which is diagnosed in the first few years of a child's life. There is no cure for cystic fibrosis but treatment advances have improved the outlook for cystic fibrosis. Frequent hospitalization, breathing treatments and physical therapy are life long issues for a child affected by cystic fibrosis.
Cystic Fibrosis is an autosomal recessive disorder. This means that both parents must be carriers to have a child affected by cystic fibrosis. If both parents are carriers their risk of having a child with CF is 25%. We offering testing to the pregnant mother, if it returns positive then we test the father of the baby. Anyone can be a carrier of cystic fibrosis but it is more common in certain ethic groups.
Carrier risk by ethnicity
- Caucasian1 in 25
- Ashkenazi Jewish 1 in 26
- Hispanic1 in 46
- African American 1 in 65
- Asian1 in 90
For further reading on genetic testing:
The Next Steps
If the results of a screening test or other factors raise concerns about your pregnancy, diagnostic tests can be done to provide more information. These tests include:
- Detailed ultrasound exam- A type of ultrasound exam that can help explain abnormal results and provide more detailed information about the growth and development of the fetus
- Amniocentesis- A procedure in which a small amount of amniotic fluid and cells are withdrawn from the sac surrounding the fetus and tested.Chorionic villus sampling (CVS) - A procedure in which a small sample of cells from the placenta is tested.
Expectations for your OB care
We see you every four weeks during the first two trimesters of your pregnancy. Starting the third trimester (28 weeks) your appointments increase to every two weeks until the last month (35-36 weeks) when you start weekly appointments. At each appointment we will check your weight, blood pressure, measure uterine growth (fundal height), and listen for fetal heart tones (baby's heartbeat). We cover any specific questions or concerns you are having.
Additional lab draws occur at 16-20 weeks (optional) and 28 weeks.You will have an ultrasound preformed around 20 weeks. The purpose of the ultrasound is to look at the baby's growth, his/her organs are forming correctly, placenta and fluid. Hopefully, you will also find out the sex of your baby, the closer we wait until 20 weeks, the more likely you are to see the baby's sex. Additional ultrasounds occur if there are any pregnancy complications or concerns about baby's growth.