Pregnancy testing schedule & checklist

Pregnancy Testing Schedule & Checklist
First and Second Prenatal Visit (6-12 weeks) o History and physical o Pap, gonorrhea and chlamydia screening o Confirmation ultrasound o Review medical and genetic history of both parents. o Prenatal labs: CBC, RPR, HIV, HepB, rubella, ABO Rh and urine culture o Schedule first-trimester screening at 12 weeks (if desired). o Start prenatal vitamins and DHA supplement. o Diabetes screening (If BMI >30 or prior gestational diabetes) o Prenatal labs: Quad screen (if desired) o Schedule sonogram for evaluation of fetal anatomy. (gender may be revealed if desired) o Prenatal labs: CBC, one-hour glucose test (screens for gestational diabetes) o Prenatal labs: three-hour glucose test (only performed if one-hour test is o If maternal Rh-negative blood type; get antibody-screen blood test and o Review preterm labor warnings. o Register for childbirth, breastfeeding and infant CPR classes (optional). o Increase water intake to 60-80 oz./day. o Start side sleeping. o Monitor for fetal growth, high blood pressure and preterm labor. o Group Beta Strep (GBS) culture obtained from vagina and rectum (If test is positive, antibiotics are required during labor.) o Begin pelvic exams to check for cervical dilation (if desired). o Discuss birth plan. o Select infant’s pediatrician. o Take birth-center tour. o Pack your hospital bag. o Decide about cord-blood donation or private storage (if desired). o Monitor fetal kick counts. Medications Safe in Pregnancy (Category B)

Acyclovir Erythromycin
Azithromycin Flonase Preparation H Unisom Bactrim Gyne-Lotrimin Protonix Diflucan Monistat Rolaids Zithromycin Dramamine Mucinex Singulair Excedrin Mylanta
(Category C) medications that may be prescribed to treat certain conditions in
pregnancy include: Advair, Allegra, Ambien, Fioricet, Imodium, Phenergan, Prilosec,
Terazol, Zoloft. These medications have been used in pregnancy and appear safe, but
no adequate studies have been done in humans. The benefits from the use of these
drugs in pregnant women may be acceptable despite potential risks. Most over-the-
counter topical ointments, hair-care products, hair dye, self-tanning lotions, facial
cleansers and over-the-counter acne treatments (including benzoyl peroxide and
salicylic acid) appear to be safe to use in pregnancy. Do not use Retin-A or Retinol
products in pregnancy.
Dentist’s Office
All patients are encouraged to receive dental care prior to pregnancy or once past 12
weeks of pregnancy. Research has shown that cavities may lead to preterm labor.
Listed below are some general guidelines for dentist visits.
 No routine x-rays. Diagnostic x-rays are permissible with appropriate lead  Use only antibiotics listed above in Category B.  Tylenol and narcotic combination pain relievers (Percocet) are permissible on a  Do not use NSAIDS (Motrin, ibuprofen, Aleve, aspirin) after 28 weeks of  Novocain without epinephrine should be used.  If patient is visibly pregnant, please avoid a flat supine position. Place a towel roll, pillow, or wedge, under one hip so she is tilted to the side. Common Genetic Testing Options in Pregnancy

First Trimester Screening
o Your appointment will be scheduled between 12-13 weeks at a Fetal Testing Center. You will be contacted with an appointment date and time. o The first appointment will consist of blood work and an ultrasound to measure the thickness of the nuchal fold of the baby’s neck. o The combination of the blood work and ultrasound can detect up to 90% of o If your screening should show increased risk of Down syndrome or Trisomy 18, then you will be offered optional diagnostic testing (Chorionic Villus Sampling
or Amniocentesis).
o A second appointment will be scheduled at the Fetal Testing Center at about 17- o At the second appointment, a single blood test will be performed that can detect up to 80% of neural-tube defects. In addition, a detailed ultrasound of the fetal anatomy will be performed at 17 weeks to screen for abnormalities. You may learn the gender of the baby at this time.
Quad Screen
o For those who don’t choose to have first trimester screening, a single blood test may be taken in our office between 15-20 weeks that can detect up to 80% of
Down syndrome, Trisomy 18 and neural-tube defects. Optional diagnostic
testing will be offered if you are found to be at increased risk. (Detailed
ultrasound and/or amniocentesis are also available if desired.)
o You will also be scheduled for a detailed ultrasound for evaluation of fetal Fetal Anatomy Screen Ultrasound
o An ultrasound to evaluate fetal anatomy is scheduled at 18-22 weeks gestation for those who did not have it done with the First Trimester Screening Program. Aloha and welcome to Pali Women’s Health Center, Congratulations on this important moment in your life. We are excited to take this journey with you. Pali Women's Health Center is the premier gynecological and obstetrical practice on the windward side of Oahu. We strive to provide you with the best possible maternity care that is both compassionate and research-based. We pride ourselves in being up-to-date with current recommendations and testing opportunities for our patients; yet, we respect the individuality of the birthing process and each person’s desire for a specific birth plan. Ultimately, we share in your desire for a healthy mother and baby and we will work with you to provide the best possible birth experience. Pali Women’s Health Center encompasses a large staff that is eager to help you with whatever may arise throughout your pregnancy. We are a collaborative practice made up of five clinicians. We each bring our unique experiences together to provide you with the best possible care. Our physicians are Dr. Susan Chapman, Dr. Alison Moore and Dr. Emilie Stickley. Our physician assistant is Alisha Wallace. Our certified nurse-midwife is Tina Doyle. All of our clinicians provide both gynecological and obstetric care to our patients. Thanks to the implementation of our Electronic Medical Record we are able to provide continuity of care regardless of which clinician you see for your OB visits or delivery. We encourage you to meet all of our clinicians throughout your pregnancy. The doctor or nurse-midwife will be available for your delivery based on a rotating call schedule. Only inductions or scheduled cesarean sections can be scheduled with a specific provider. The Vera Zilber Birth Center at Castle Medical Center shares our philosophy of care and is the safe and loving environment in which we prefer to deliver our patients. Our providers deliver only at Castle Medical Center. We look forward to discussing your excitement, concerns, and expectations for this pregnancy with you and are happy to answer any questions you may have. We encourage you to bring your questions with you to your OB visits so that we may discuss them in more detail. Please read “Our Philosophy of Care” to learn more about our practice. Thank you again for choosing Pali Women’s Health Center. Mahalo, The clinicians and staff Pali Women’s Health Center Our Philosophy of Care

Suggested Reading
Please refer to: Your Pregnancy and Childbirth: Month to Month, fifth edition, written
by The American College of Obstetricians and Gynecologists — the leading experts in
Women’s Health Care (copyright 2010).
We are aware that there are many things both in books and on the Internet that may
give you conflicting information and create unnecessary fears. We have collaboratively
put together “Our Philosophy of Care” so that you may know exactly how we care for
our patients and how we approach prenatal care and delivery.
 Our first priority is a healthy mother and baby.  We believe that pregnancy is a normal healthy state of being and we do not approach it as an illness, although complications sometimes can arise.  We believe that women have a right to birth the way they choose.  We believe in open communication with our patients.  We give our patients options in their birthing experience and allow them to  We support both natural childbirth and medicated childbirth.  We prefer patients go in to labor naturally.  Those desiring induction may not be induced prior to 39 weeks unless there is a medical or fetal condition requiring induction.  We encourage patients to walk, Jacuzzi and be out of bed for labor.  We allow patients a regular diet until active labor and then encourage clear  We do not routinely do an episiotomy.  We do not routinely use forceps or vacuum.  Our c-section rates are less that 15%, far less than the national average.  We allow the placenta to expel naturally.  We routinely give Pitocin IV immediately after the placenta is expelled to prevent hemorrhage and decrease bleeding.  We prefer patients have a saline lock or IV when in labor.  We believe in family-centered care.  We believe in mothers not being separated from their babies.  We encourage breastfeeding be initiated within one hour of delivery. Lifestyle Modifications for Pregnancy

Weight Gain in Pregnancy:
Expected weight gain in pregnancy is based on your Body Mass Index (BMI) at the time
you become pregnant. See the table below for your expected weight gain.

Food Related Modifications:
 Avoid raw meats in pregnancy. All meats should be thoroughly cooked.  Intake of certain fish should be avoided or limited in pregnancy. Refer to Hawaii  Avoid unpasteurized products, including cheeses such as feta, brie or blue  You may consume caffeine - up to one (8 oz.) cup of coffee, tea or soda per day.  No amount of alcohol, beer or wine is safe in pregnancy.  Refer tfor nutritional guidelines for pregnancy and Activity:
 No smoking or drug use (tobacco, marijuana, cocaine, LSD, heroin. meth., etc.)  Hot\-tub use is safe with the temperature under 100 degrees. No saunas.  No lifting greater than 20 pounds in pregnancy.  Exercise is encouraged in pregnancy. Walking, running, swimming, low impact aerobics and prenatal yoga is fine. Refrain from abdominal exercises and activities where you could fall or cause abdominal trauma. Your heart rate should stay under 160 bpm.  Sleeping on your side is preferred after 20 wks of pregnancy.  Intercourse is safe in pregnancy unless otherwise indicated by your provider.  Travel is permitted without a doctor’s note prior to 36 weeks in low-risk pregnancies. Take a copy of your prenatal record with you when traveling.  Painting is OK with adequate ventilation after 12 weeks.  Hair coloring and highlights are believed to be fine during pregnancy.  No litter box changing or gardening without gloves. Wash your hands well after  Breastfeeding? We recommend you wean your infant after your first trimester.
Common Remedies for Morning Sickness:
 Avoid triggers for nausea such as stuffy rooms, odors, perfumes, smoke, humidity, noise and quickly changing positions  Eat small frequent, low fat, high carbohydrate meals. Eat before or as soon as  Eat dry crackers or dry toast first thing in the morning.  Drink fluids: cold, clear, carbonated or sour (especially ginger ale and  Aromatic therapy- especially lemon, mint and orange.  Acupressure wristbands, acupuncture and hypnosis have also been found to be  Try eating crushed ice cubes made from frozen Gatorade or Pedialyte.  Pharmacological treatments such as Zofran or Phenergen may be necessary for patients experiencing extreme nausea and vomiting. Call us if you are experiencing this.
When to call after business hours:
 Birth Center (808) 263-5270
 Physician Exchange (808) 524-2575
 If you think you are in labor. Contractions every 5 minutes consistently, for 1 - 2
hours or leaking of fluid. (Please call us before heading to the hospital.)  If you have pre-term labor symptoms (under 36 weeks), having five or more contractions (tightening) in an hour that do not resolve with rest and hydration.  Dehydration - unable to keep any food or liquid down for more than 24 hours.  Vaginal bleeding.  Fever greater than 100.4.  Pain with urination.  Increased swelling, especially if accompanied by a headaches or visual changes.  Decreased fetal movement (after 28 weeks).
Fetal Kick Counts (after 28 weeks) - If you are concerned that the baby is moving less
than usual, we ask that you monitor fetal kick counts. After eating a small meal, sit
down and count how often you feel the baby move in one hour. The baby should kick or
move at least 10 times. Every little movement counts. If the baby moves less than 10
times in the first hour, count for another hour. If there is still decreased movement,
please call Physician Exchange, 808-524-2575, and notify the on-call clinician.

Source: http://www.paliwomenshealth.com/Portals/911/Pali%20Women's%20OB%20Packet%202013.pdf