Initially, your visits will be monthly in the first and second trimesters, unless your doctor recommends a different schedule. Routine lab work is usually obtained after your first visit. An ultrasound may need to be done as well to accurately determine your due date; however, if your periods are regular and normal, and you know with certainty your last menstrual period (first day of your last menstrual period), your doctor and you may decide to postpone your first ultrasound until 18 weeks.
Starting at 28 weeks, your visits usually become more frequent (every two weeks); at 36 weeks, we start seeing you weekly until you deliver. Other screening tests will be ordered as your pregnancy progresses. These include, but not limited to glucose challenge test at 26-28 weeks to screen for gestational diabetes, and a swab for group B Streptococcus (GBS) at 35-36 weeks. At each visit, you will be asked to provide a urine sample to make sure you don't have a silent bladder infection.
Your doctor will discuss with you options for screening for Down's syndrome, trisomy 18 and neural tube defects (such as spina bifida).
Sometime between 18-22 weeks, most moms will begin to feel their baby move for the first time. If this is your first baby, you will probably feel it closer to 22 weeks. Initially, it may feel like "flutters" or "gas" to you. But with time, as the baby grows and becomes more active, distinct movements will be obvious. Remember that babies have sleeping and waking cycles, which may not correspond to yours!
Counting fetal movements beginning at 28 weeks may be recommended. This is called "kick counts." Your doctor will talk to you about this as well. Generally, after a meal or eating something sweet/drinking something cold, concentrate on your baby's movements and count them. Lying down may be helpful. In 2 hours, you should be able to count at least 10 movements, unless the baby is sleeping. If you don't, continue for another 2 hours and/or call us. The most important thing is to pick up any change from baseline. If the baby is not moving as much, we want to know about this so that we can assess the situation. If you don't feel your baby move normally or at all, please call immediately or go to the hospital.
It is common to experience mild contractions called Braxton-Hicks in the third trimester. These are usually not very painful and irregular. If you experience contractions that are getting progressively stronger, taking your breath away, more regular where they are occurring five minutes apart, and are not relieved with rest, fluids and Tylenol, you should be seen. Also, if your water breaks, causing either a big gush of fluid running down your legs or a steady watery discharge, OR if you have vaginal bleeding, you should also be seen. Also, if you are sexually active, you may experience contractions and/or spotting after intercourse. If these don't resolve and become more intense and regular, OR if you start having heavy vaginal bleeding, you also should be evaluated.
If you would like to prepare a birth plan and discuss it with your doctor, please be sure to mention it. We are more than happy to work with you and assure that your wishes are respected.
Up to 30 percent of all women may carry this bacterium in their vagina or rectum. While the women may not be affected by it, the baby may become infected as he/she is passing through the birth canal. This may lead to complications in the newborn such as pneumonia, meningitis, and sepsis. This can be a scary and severe infection for the baby. Therefore, to prevent this from happening, all women get screened for this bacterium around 35-36 weeks, unless they already have had a GBS-positive bladder infection or a child affected by GBS disease after birth. If your culture is positive, then you will be given antibiotics in labor or if your water breaks. This typically involves getting penicillin. If you are allergic to penicillin, a different antibiotic will be given. Sometimes GBS can also cause uterine infection after or during delivery. You will be monitored closely for this.
After 20 weeks of gestation, for patients without any prior history of blood pressure problems, persistently increased blood pressure may represent gestational hypertension or preeclapmsia. Gestational hypertension describes cases in which elevated blood pressure is present without any other additional abnormalities. Preeclampsia is a syndrome defined by hypertension and proteinuria (i.e., when abnormally high protein levels are found in urine), and may be associated with myriad of other signs and symptoms, such as increased swelling of the feet, ankles, hands, and face, visual disturbances, headache, and upper abdominal pain. Preeclampsia is a more severe problem than straight-forward gestational hypertension. Severe preeclampsia and HELLP syndrome are complications that may require delivery even if patients are remote from full term. During your pregnancy it is routine to check your blood pressure and urine at each visit. This way, we can check for early signs of gestational hypertension and preeclampsia. Once diagnosed, both moms and babies are monitored a lot closer and may need to be hospitalized.
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