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Introduction Congratulations on your pregnancy and we look forward to working closely with you throughout this amazing process. Our goal at Golden Gate OB/Gyn is to provide you with individualized, high quality medical care in a positive and supportive environment. Because you have a wide variety of reproductive choices, it is important that we are diligent in providing you with the information you need to make informed decisions throughout the entire experience. We have prepared this information for you to review prior to your first visit and to refer to as your pregnancy progresses, so that you will have the opportunity to understand the options and choices you will be given as part of your prenatal care. After your first visit, we will prepare a checklist to ensure that options and choices in your particular case have been communicated, and that the high standard of care that we provide is implemented consistently. It is important that you communicate to your provider any special personal or family medical history so that we may identify particular issues that could impact your pregnancy and prenatal care. Information for the First Visit Your Prenatal Visits Optimally we would like to see you between 9 and 10 weeks from the first day of your last menstrual period for your first visit. At that time we will review your medical history, your menstrual history and previous pregnancies. You may be due for a full examination and Pap smear at your initial exam. It is likely that a limited obstetrical ultrasound will be performed to confirm your due date and that your pregnancy is progressing normally in the first trimester. During this visit we will discuss a variety of options you have for prenatal testing. Because there is a large volume of information, and each patient has individual preferences, we ask that you preliminarily review the information provided here so that our discussion can be tailored to your individual needs. In a low risk pregnancy, your initial visits will be scheduled every 4 weeks. At 28 weeks they will increase in frequency to every 2 weeks, and in the last month of pregnancy you will be seen weekly. Because there is a chance that your own doctor will not be able to attend your delivery, we give you the opportunity to rotate your prenatal visits to meet other doctors. This is your choice, and is not required. First Trimester Considerations Prenatal Testing At your first visit there will be a discussion of your prenatal testing options. Some prenatal blood tests are standard and apply to every patient. Your doctor uses the results of these tests to monitor your general health, and to provide special care that might be necessary for you or your baby. These include: Complete Blood Count Blood Type and Rh with Antibody Screen Rubella Syphilis Hepatitis B Hepatitis C Urinalysis and Culture HIV (with consent) A Pap smear and cervical swab for STD screen may be recommended as well Special Genetic Testing The vast majority of babies are born healthy and normal. 3-4% of babies can be born with a birth defect ranging from mild to severe. Some birth defects are genetic or inherited and some are of environmental or unknown causes. There are tests available to help determine if you might be at risk for carrying a baby with a specific birth defect. The information about these tests can be confusing and overwhelming to patients so it is a good idea to review the provided information before your first visit. Many of the tests available are blood tests that can be done at the time of your first visit. Other tests are performed at specified times in your pregnancy and are combined with special ultrasound evaluations done by experts who are trained to specifically evaluate pregnancies for their risk of birth defects. It is important that you understand the difference between a screening test and a diagnostic test. It is also important for your doctor to know if there are tests that would be important for you to consider based on your ethnic or family history. The purpose of a screening test is to identify patients who are at a high enough risk for carrying a baby with a particular genetic condition that they might want to consider a diagnostic test. Diagnostic tests are more definitive, are invasive and carry certain risks to the pregnancy.
Genetic Screening Tests Common Single Gene Abnormalities for which Carrier Screening is Available Cystic Fibrosis Fragile X Ashkenazi Jewish Diseases Hemoglobinopathies California Prenatal Screening Program Down Syndrome (Trisomy 21) Edward’s Syndrome (Trisomy 18) Smith-Lemli-Opitz Syndrome (SLOS) Diagnostic Testing Amniocentesis Chorionic Villus Sampling For more detailed descriptions of these abnormalities, screening options and description of diagnostic testing please visit the San Francisco Perinatal Associates website. As Your Pregnancy Progresses Weight Gain The guidelines for pregnancy weight gain are issued by the Institute of Medicine (IOM), most recently in May 2009. Here are the most current recommendations: If your pre-pregnancy weight was in the healthy range for your height (a BMI of 18.5 to 24.9), you should gain between 25 and 35 pounds, gaining 1 to 5 pounds in the first trimester and about 1 pound per week for the rest of your pregnancy for the optimal growth of your baby. If you were underweight for your height at conception (a BMI below 18.5), you should gain 28 to 40 pounds. If you were overweight for your height (a BMI of 25 to 29.9), you should gain 15 to 25 pounds. If you were obese (a BMI of 30 or higher), you should gain between 11 and 20 pounds. If you're having twins, you should gain 37 to 54 pounds if you started at a healthy weight, 31 to 50 pounds if you were overweight, and 25 to 42 pounds if you were obese. Obstetrical Ultrasound Your doctor may ask you to schedule an obstetrical ultrasound at 18-20 weeks to evaluate fetal anatomy and dating, placental location, amniotic fluid volume, and the length of your cervix. Usually this is the last ultrasound you will be asked to schedule and there are some options for where this examination can be performed. You should obtain a requisition from your doctor before scheduling any ultrasound so that your doctor can specify where the exam should be performed and for what reason. Depending on your specific situation, ultrasounds may be necessary more frequently and your doctor will let you know if this is the case. Second Trimester Considerations Between 21 and 26 weeks gestation your doctor will give you a requisition for a 1-hour Gestational Diabetes screening blood test and a repeat complete blood count. For patients at high risk for gestational diabetes, this test may be performed earlier in pregnancy and repeated at the standard time if the first test is negative. If the screening test is positive, a follow-up 3-hour test will be ordered. Our office will contact you with the results of this test if it is abnormal and will assist you in scheduling the follow-up test. For patients who are Rh Negative, an antibody screen will be included with the 1 hour Gestational Diabetes Screening test. If you are Rh Negative and the father of your baby is Rh Positive, you will be given a prescription for Rhogam, which will be given in the office as an intramuscular injection. Third Trimester Considerations At 35-36 weeks your doctor will take a vaginal swab to for Group B Strep. If your strep test is positive, this does not mean that you have an infection, but we will treat you with antibiotics in labor to minimize the risk that your newborn could have an infection. If you have a history of genital herpes, we will recommend that you begin taking an antiviral medication from 36 weeks until your baby is born. This will minimize the risk to your newborn of contracting a herpes infection even if you are unaware of an outbreak. Who Will Attend Your Delivery? Each doctor at Golden Gate makes an effort to be available during daytime hours on weekdays for their own patients’ deliveries. There is a call schedule for nights and weekends and you may be attended by one of the other doctors in the practice for your delivery should it occur after hours. Your detailed medical and prenatal history is available to all the doctors in the practice and the doctors share a basic philosophy in labor and delivery management. Important Additional Information:
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