A pregnancy panel will be drawn at or near your first visit. It includes blood typing, Rh factor, complete blood count, syphilis, hepatitis, and rubella.

If your blood type is Rh negative, a RhoGam injection will be given at 28 weeks to prevent fetal anemia and death in subsequent pregnancies.

An HIV test is offered and highly recommended by the American College of Gynecologists.

At 20 weeks, a comprehensive fetal ultrasound is performed. The purpose is to evaluate placental and fetal anatomy. If desired, the sex can also be determined at this time.

Around 24 – 28 weeks, you will have a Gestational Diabetes screening test. On the morning of the test, eat a breakfast with protein and avoid carbohydrates. At your visit, you’ll drink a sugary drink and we’ll test your glucose level an hour later. If abnormal, you’ll have a 3 hour confirmatory test within the following week. The 3 hour test requires that you fast: nothing to eat or drink after midnight before the test.

Two vaccinations are recommended during pregnancy. Tdap (Tetanus, Diphtheria, and Pertussis) is given at 28 weeks to protect the fetus from the whooping cough after delivery. It is recommended that family members, including the father of the baby and grandparents, be vaccinated too. The flu vaccine is administered during the flu season: October to March. Please see resources below:

https://www.acog.org/Patients/FAQs/The-Flu-Vaccine-and-Pregnancy

https://www.cdc.gov/vaccines/pregnancy/pregnant-women/index.html

(Adapted from ACOG Practice Bulletin No. 163)
The purpose of prenatal screening for aneuploidy is to provide an assessment of the woman’s risk of carrying a fetus with one of the more common fetal aneuploidies, like Trisomy 21, 18, 13, etc. Screening tests are optional and your doctor will discuss the wide variety of options. No one screening test is superior to another; they each have advantages and disadvantages. Screening for aneuploidy should be an informed patient choice, with an underlying foundation of shared decision making that fits the patient’s clinical circumstances, values, interests, and goals.

Cell-free DNA
Cell-free DNA screening evaluates short segments of DNA in maternal blood and can be used to screen for a variety of fetal conditions. Cell-free DNA screening also can be used to determine fetal sex, to identify the presence of a Rh-positive fetus in a Rh-negative mother, and to detect some paternally derived autosomal dominant genetic abnormalities. Screening can be performed from as early as 10 weeks of gestation until term and offers the highest reported detection rate for Down syndrome. The detection rate is lower for trisomy 13 and trisomy 18. This option is not always covered by insurance and can incur a cost of around $150.

Nuchal Translucency
Nuchal translucency refers to the fluid-filled space measured on the fetal neck. An enlarged nuchal translucency is associated with fetal aneuploidy and structural malformations. Paired with other bloodwork, the detection rate is around 90%.

Quad Screen
The best time to perform a quad screen is from approximately 16 weeks to 18 weeks of gestation. The quad screen involves the measurement of four maternal serum analytes to calculate a risk estimate. First-trimester and quad screening have similar detection rates for Down syndrome, about 80%.

For More Information
The American College of Obstetricians and Gynecologists has identified additional resources on topics related to this document that may be helpful for ob-gyns, other health care providers, and patients. You may view these resources at www.acog.org/more-info/AneuploidyScreening

DO

  • Tylenol can be used for headaches, colds, fever, back pain, etc. Do not exceed 4g in 24 hours.
  • Robitussin for congestion.
  • Chloraseptic spray or lozenges for sore throat.
  • Saline nasal spray or Netty Pot can be used to rinse sinuses.
  • Colace, Milk of Magnesia, Metamucil, Senokot S tablets can be used for constipation.
  • Tums, Rolaids, Mylanta, Maalox, Zantac, and Pepcid are all safe for heartburn and indigestion.
  • Monistat vaginal cream can relieve yeast infection.
  • Benadryl is safe for itching or difficulty sleeping.
  • Caffeine in moderation is safe. Ingest less than 200mg/day, equivalent to a small coffee.

DON’T

  • Non-steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen, Aleve, Motrin, Advil
  • Alcohol
  • Cigarettes
  • Saccharin
  • Tetracycline, Accutane, Afrin Nasal Spray
  • Tranquilizers, sedatives
  • Herbal/natural compounds (without your Doctor’s permission)
  • Pepto-Bismol
  • Headaches: Headaches can worsen in pregnancy. Stay well hydrated and try Tylenol. If headaches persist, please call.
  • Dizziness: Dizziness and feeling faint are common. Try rest and eating a snack to restore normal blood glucose levels.
  • Extreme Fatigue: It is normal to be extremely fatigued and want to nap frequently during the first trimester.
  • Mood swings: Feeling emotional, crying and extreme moodiness are common. Rest, eating well, and exercise should help.
  • Difficulty sleeping: Sleeping patterns change during pregnancy. Practice good sleep hygiene: cool, dark room with comfortable bedding.
  • Rash: A red, itchy rash can develop on the abdomen. If you experience itching without a rash, tell your doctor.
  • Nosebleeds: Nosebleeds can be a common annoyance during pregnancy. Cold compresses and gentle pressure are used to stop bleeding immediately. To prevent bleeding, keep nasal passages moist with saline washes, Vaseline, or humidifier.
  • Nausea and vomiting in the first trimester, also called “morning sickness,” can happen any time of day. The cause is thought to be hormone levels rapidly changing in early pregnancy. Not eating for several hours or certain odors can trigger nausea.  Rarely does nausea and vomiting require hospitalization.
  • The first line treatment is an oral medication called Diclegis that your doctor can prescribe.
  • Tips to alleviate symptoms: Eat smaller, more frequent meals. Avoid greasy, fried, spicy foods.
  • When vomiting does occur, take sips of clear fluid like water, apple juice, tea, broth, and clear soft drinks (“Sprite”).
  • Call you Doctor if you cannot tolerate liquids for 24 hours or if you have abdominal pain, fever, dizziness, or severe weakness.
  • Exercise during pregnancy is recommended. Low impact exercise is encouraged. Do not plan to begin a strenuous new activity
  • Hair coloring and perming are safe.
  • Travel, including air travel, is allowed until 34 weeks. For prolonged road trips, make frequent stops to walk and stay hydrated. Compression stockings have been shown to prevent lower extremity blood clots.
  • Painting in a well ventilated area is usually tolerated. If fumes are irritating, stop painting.
  • Dental treatment: Tell your dentist about your pregnancy. Local anesthesia is allowed. If X-rays are needed, use an abdominal shield. You may want to postpone dental work until after the first trimester.
  • Intercourse is not harmful. Be prepared for potential spotting and cramping afterwards.
  • Pet care: If you have a cat, do not empty the litter box as there is a risk of contracting Toxoplasmosis. Wash hands after handling pets.
  • Nausea and Vomiting: Eat small, frequent meals. Try small bites of a bland diet (toast, rice, chicken, etc.) and clear liquids.
  • Heartburn, Bloating, Excess Gas: Avoid spicy, greasy food and citrus or tomato based foods. Antacids such as Mylanta, Maalox are helpful. Tums and Zantac are safe.
  • Frequent urination: Pressure on the bladder from an enlarging uterus is unavoidable. Please report all burning, stinging, or pain to your doctor.
  • Swelling: Swelling is normal during pregnancy, especially around the hands and feet. Elevate your feet and change positions often. Compression socks are helpful.
  • Any bleeding. Spotting in early pregnancy can be normal, but should still be reported.
  • Pain or burning with urination.
  • Any leakage or gush from the vagina.
  • Regular contractions. A tightening of the uterus lasting 30 – 60 seconds that is repetitive and increasing in intensity.
  • Decreased fetal movement.
  • Temperature of 101° F or greater.

The definition of labor is contractions plus cervical change. Your uterus starts to contract to dilate the cervix to allow for delivery.

Contractions

  • Contractions occurring up to six time per hour or every ten minute is considered normal uterine activity in late pregnancy.
  • If contractions are more frequent, two to five minutes apart, then active labor is likely. If they continue for two hours and increase in frequency or intensity, you should proceed to Labor and Delivery.

Rupture of Membranes

  • Also known as “water bag breaking” or “amniotic bag rupture.” It can occur with or without contractions.
  • It may be a large gush or a slow trickle. If you think you are leaking, proceed to Labor and Delivery.

Vaginal Bleeding

  • Spotting due to a recent vaginal exam by your Doctor or early changes in your cervix are normal. Mucousy discharge, or “losing you mucous plug,” is not cause for concern and doesn’t mean you are in labor.
  • Bleeding heavily, soaking pads, is not normal, proceed to Labor and Delivery.

Fetal Activity

  • If the baby has not been moving as normal, lie on your left side in a place free of distractions. Place your hands on your abdomen and count the fetal movements. If you count less than 10 movements in one hour, drink something with sugar (milk, juice, tea, soft drink, etc.), and resume counting. If you still feel less than 10 movements in the second hour, proceed to Labor and Delivery.

You and your doctor will discuss anesthesia during labor. Women have different pain tolerances and there are many ways to block pain if that is the desired goal.

  • Natural Child Birth
  • IV Anesthesia
  • Pudendal Block
  • Epidural