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I. Prenatal Visits

• Your prenatal visits will take place every four weeks until you are approximately seven months (28-32 weeks) pregnant.
• Starting at 32 weeks, your prenatal visits will be every two weeks. During this time, we will schedule your visits with the other doctors in our office so that you can meet them. One of them may be the doctor who does the actual delivery, depending the type and time of your delivery.
• At around 36 weeks, you will be seen on a weekly basis until your delivery. During your weekly appointments, you may have a pelvic exam at each visit.
• Patients at high risk for complications (high blood pressure, diabetes, pre-term labor) may be seen more frequently.

II. Testing during pregnancy

• At your initial visit, the we will collect specimens for these tests:
  • a complete blood count (CBC),
  • blood type and RH,
  • antibody screen,
  • sickle cell (if needed),
  • rubella titer,
  • VDRL (syphilis check),
  • urine culture,
  • hepatitis screen
• A sonogram may be performed at your first visit, to confirm pregnancy, if gestation is less than 12 weeks.
• A Pap Smear and a Chlamydia/Gonorrhea screen will be performed unless previously done in the last 6 months.
• Other tests may be ordered / offered if deemed necessary. Although, some insurance companies may not cover these tests, they are highly encouraged.
  
• Throughout your pregnancy, we will check for anemia, diabetes and hypertension. Urine samples will be collected and checked at each visit for the presence of protein, glucose and blood. Blood pressure and weight will also be assessed.
• A maternal serum Quad Screen can be performed at approximately 16-18 weeks. This is an optional blood test that screens for neural tube defects such as Spina Bifida and Down’s syndrome. Screening should be performed no later than 18 weeks.
• A sonogram may be done between 16-20 weeks if medically necessary. This sonogram will check the physical well being of the baby as well as placental location and amniotic fluid volume. You will need to have a full bladder. We encourage you to bring a blank VHS tape to this visit! Fathers and other family members may want to be present, but remember that space is limited.
• At or around your 24th-28th week visit, we will conduct a Glucose test. You will drink a measured amount of glucose (Glucola). Your blood will be drawn one hour after you finish the drink. This is a screening test for gestational diabetes. Plan to be here for at least one hour. Your doctor may order this as a "fasting" test; she or her nurse will let you know if you should postpone eating before this test.
• At the 24th-28th week point, you should be thinking about choosing a pediatrician and enrolling in a prenatal or labor refresher class.
• A vaginal culture will be done at 35-37 weeks to assess for group B strep.

III. General Information

• During your pregnancy you should abstain from tobacco use, illicit drug use, and drinking alcohol. Caffeine should be avoided, if possible. Use artificial sweeteners in moderation.
• It is preferable that no medication be taken in the first 12 weeks (three months) of pregnancy, unless approved by our office. However, even in the first 12 weeks, it is safe to take small doses of some medication for mild discomfort, indigestion, etc. Please refer to the approved list of medications.
• Travel is permissible until 36 weeks, in an uncomplicated pregnancy. After 28 weeks, a pelvic exam will be done before your doctor approves any travel. Travel is not recommended after 36 weeks!
• Extensive dental work should be postponed until after the first twelve weeks of pregnancy. Routine dental work such as cleanings and fillings may be performed during pregnancy. Please advise your dentist of your pregnancy so that precautions are taken to shield abdomen during x-rays. Local anesthesia including Lidocaine and Novocain without Epinephrine may be used.
• Artificial hair color application should be avoided until after the first 12 weeks of pregnancy have passed. Artificial nail application and fills should be performed only under well-ventilated circumstances.

IV. Dietary Guidelines

• A weight gain of 25-35 pounds during your pregnancy is desirable. This is not the time for restrictive diets. Your weight will be assessed at each visit. Weight gain can vary from visit to visit.
  

V. Exercise

• Exercise during pregnancy is important and a key to your well-being and comfort. It affects how quickly you “shape-up” in the postpartum period. Swimming, thirty minutes of fast walking, or low impact aerobics are some things you can participate in during your pregnancy.
• For all activity, start slowly and if you get tired - STOP.
• Housekeeping is not considered exercise. Activity should be enjoyable - not painful or too difficult.

• Dyspnea (shortness of breath): Sleep with your head elevated, propped up by pillows. The descent of your baby in later gestation will relieve some of this discomfort.
• Constipation: Drink at least 8 glasses of water a day. Increase your intake of fruits and fruit juices, bulk-forming foods such as bran, cereals, and vegetables, and increase your exercise. Stool softeners such as Colace, Surfak, Metamucil and laxatives such as glycerin or Dulcolax suppositories may be used on occasion. Gas X may be used for gas pain.
• Hemorrhoids: You may use Tucks pads, Preparation H, Anusol cream, and do warm tub (sitz) baths as needed to relieve discomfort.
• Heartburn: Eat several small meals a day instead of three big ones. Avoid greasy or highly spiced foods. Breathe slowly and deeply. If symptoms worsen at night, sleep with your head elevated. You may use Maalox, Gaviscon, Riopan, Mylanta, Milk of Magnesia, Zantac, Tums or Rolaids. If still unrelieved, please call us.
• Colds: Increase your fluid intake, especially clear liquids. You may use decongestants such as Sudafed and Tylenol Cold. However, with fever over 100.4, we ask that you call the office. You may use Tylenol, Extra Strength Tylenol or Tylenol PM for headaches and fever. For cough, we recommend Benadryl or Rescon, Robitussin, Robitussin DM, Tavist, or Claratin. (Robitussin CF or any other medicine containing Phenylpropanolamine may NOT be used.)
• Diarrhea: Limit your diet to bland food and mostly clear liquids. Imodium A-D can also be used. Please call the office if symptoms persist.
• Nausea or Vomiting: Some nausea is common. Small but frequent meals may help. Skipping meals will aggravate the discomfort. If vomiting or nausea occurs often, please call the office. Emetrol is an over-the-counter antiemetic that may help.
• Varicose Veins or leg ache: Avoid tight garters, knee-highs or thigh highs. Support hose will help. Avoid standing for long periods of time. Change positions frequently. Elevate legs and hips several times a day by supporting them with pillows under the knees.
• Painful urination: Call the office to discuss your symptoms with the nurse. Collection of a urine sample may be required.

VII: Emergency Conditions

• Emergencies to be reported to your doctor:
  • Constant headache unrelieved by Tylenol or a decongestant
  • Unusual swelling or a generalized puffy feeling
  • Blurred vision or fainting
  • Bleeding from the vagina
  • Fever of greater than 100.4
  • Persistent abdominal pain
  • Burning on urination
  • Decreased or no fetal movement. Please call as soon as this is noticed. You may need a non-stress test (NST).

VII: Is is Time?!

• Call Your Doctor If:
  • First Baby - Contractions that are 5 minutes apart, each lasting 40-60 seconds for the duration of one hour.
  • Not first baby - Contractions 7-10 minutes apart.
  • Water breaks - Signs include a sudden gush of water from the vagina, consistent leaking of fluid or “increased wetness”. Do NOT wait until contractions start or for the fluid to stop before calling.
  • Vaginal bleeding - Anything besides the bloody show should be reported to your doctor. You do not need to notify the office for the loss of the mucus plug.
• Besides the above suggestions and recommendations, a lot of information can also be found in your prenatal books. However, please do not hesitate to ask questions. We are here to answer your questions and to help make your pregnancy a healthy, safe, and enjoyable experience.