Obstetrical Care

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Congratulations! You are nearing the end of your second trimester and heading into the beginning of your third and last trimester. You have probably been able to feel your baby move since about 18-22 weeks, and by now you will be feeling your baby move daily. You may also have a good grasp on your baby's sleep-wake cycles, different types of movements such as rolls and jabs, and what triggers activity.  

The American College of Obstetrics and Gynecology supports starting Fetal Kick Counts between 24 and 26 weeks gestation by timing how long it takes to feel 10 movements. This is used to help evaluate the health of the fetus. These movements may consist of kicks, flutters, rolls, or swishes and ideally, you will feel 10 movements in one hour. One of the best ways to do this is for you to choose two times during the day when you know your baby is most active. Let's say between 9:00 and 10:00 in the morning and then again between 4:00 and 5:00 in the afternoon. During these times you may go about your normal routine while making sure to pay special attention to your baby's movements. If you feel 10 movements in 5 minutes, then you're done, but it may take a bit longer for others to reach 10 movements.  

If you do not feel 10 movements in one hour, then eat a high-carbohydrate snack. After this, lie down comfortably on your side and put your hands on your belly so that you are better able to feel movements. If you still do not count 10 movements within one hour it is important to call your provider so that you can be evaluated for signs of fetal distress. 

Nearly 70% of women experience nausea and vomiting during pregnancy, with symptoms that most commonly occur between 4 and 18 weeks of pregnancy. Theories on the cause of nausea and vomiting during pregnancy include stimulation of ovarian estrogen production by the pregnancy hormone hCG (which peaks at about 9 weeks) and vitamin B deficiency.  Ultimately though, the root cause of nausea and vomiting during pregnancy remains elusive.

The American College of Obstetrics and Gynecology recommends as first-line therapy the combination of vitamin B6 (10-25 mg every 8 hours) and the antihistamine doxylamine (available over the counter as Unisom). Use 1/3 to 1/2 tablet of a 25 mg Unisom every 8 hours as needed along with the vitamin B6. This combination is associated with a 70% reduction in nausea and vomiting during pregnancy in randomized trials.  If the Unisom causes too much sleepiness, use the B6 alone during the day and add the Unisom at night.

Dietary management includes eating frequent snacks and small meals that are bland, high in protein and carbohydrates and low in fat. Plenty of fluid intake between meals is also encouraged.

Avoiding triggers can be helpful in reducing nausea.  Examples of triggers include heat and humidity, odors (perfume, chemicals, coffee, certain foods, smoke), loud noise, visual or physical motion (flickering lights or driving), and not getting enough sleep.

Other safe treatment options include ginger products, acupressure wristbands like Sea Band, electrical median nerve wrist stimulator like PrimaBella, and sweet candies or syrups such as Preggie Pops or Emetrol.

Should first-line treatment fail there are other medications that may be made available by your healthcare provider.

Choosing a pediatrician to look after the health of your child is a very important and sometimes stressful decision for any parent, and it is crucial that you and your pediatrician share similar philosophies on pediatric healthcare because of topics like vaccinations and monitoring developmental milestones. A pediatrician who is on the same page as you is better able to serve you and your child during these critical years.

Some things to look for in a pediatrician include proximity to your home for the convenience of those sometimes frequent visits, same day sick appointments, and easily accessible phone nurses for quick questions that pop up. In addition, depending on the practice, pediatricians who have privileges at Northside Hospital are able to begin care for your infant within 24 hours of delivery. If the pediatrician you choose does not have privileges at Northside there is no need to worry; an on-call pediatrician will care for your infant and then turn over their care at discharge to your pediatrician of choice.

When calling around to different offices make sure to inquire about hours of operation, hospital affiliations, other on-call physicians, and insurance companies accepted by the physician. It may be a good idea to meet with some pediatricians in person once you have narrowed down your list. Many offices offer a meet and greet to parents giving them a chance to evaluate their comfort level with the staff, office facilities, and the pediatrician.

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Discussing genetics can be a confusing and frustrating process for patients, but understanding this subject and your testing options helps you prepare for the future.

Inheritable Gene Disorders are disorders caused by an abnormal gene that you or your partner carry. Most gene disorders are recessive and can be passed down through many generations silently. This means that carriers of the gene show no signs or symptoms of illness or disease. These disorders include Cystic Fibrosis (CF), Sickle Cell Disease (SCD), and Spinal Muscular Atrophy (SMA). 

The above disorders differ from chromosomal disorders, like Down Syndrome, which are a type of genetic disorder caused by either the addition or deletion of a chromosome. This type of genetic disorder is almost never inherited but instead is a chromosomal error that happens at the time of conception.

Inheritable gene disorders are caused by a change or mutation in a gene. Every person has two copies of each gene, one inherited from each parent. A carrier is a person who has one normal copy of a gene and one abnormal copy. Having one normal gene is enough to prevent the disease in autosomal recessive disorders. However, if both parents are carriers of the same abnormal gene, there is a chance that each parent will pass his or her abnormal gene on to their baby. If the baby inherits two copies of the abnormal gene, the baby will have the disease. If both you and your partner are carriers there is a 25% chance the baby will be unaffected, 50% chance the baby will be a carrier and a 25% chance the baby will have the disorder.

Most people are unsure if they or their partner are carriers and the absence of having an affected family member does not eliminate the possibility of being a carrier. We recommend carrier testing for certain genetic disorders (a simple blood test) to all of our pregnant patients. 

In addition, being a member of certain ethnic groups may increase your risk for specific types of inheritable gene disorders such as Sickle Cell Disease, Tay-Sachs, or Canavan disease, among others. 

If you receive a positive test result additional testing may be indicated. Your partner may be tested to see if he is a carrier and if both parents are carriers, diagnostic prenatal testing is available to find out whether or not the baby has inherited the abnormal genes. 

There are 3 categories of problems that fetuses can be evaluated for:

• Structural Problems like cleft lip, heart defects, and limb deformities. Not all structural problems can be identified before birth, but an ultrasound (known as an Anatomy Scan) performed at 18-20 weeks looks at detailed fetal anatomy and evaluates the baby for these types of problems.
• Gene disorders are a category of genetic disorders that are inherited from family or in some cases caused by random mutations. Gene disorders include problems like Cystic Fibrosis, Sickle Cell Disease, and Spinal Muscular Atrophy. Testing for the most common gene abnormalities is available and will be discussed separately. You may be offered additional gene tests depending on your family history and ethnic background.
• Chromosomal disorders are those genetic abnormalities which increase with maternal age. This includes disorders like Down Syndrome where there is an extra chromosome and Turner's Syndrome where there is a missing chromosome. There are many different possible chromosomal errors but the most common in live born infants are Down Syndrome and Trisomy 18.

The tests discussed below are most of the available options to evaluate for chromosomal abnormalities.

Although these tests significantly reduce your risk of having a baby born with a disorder there is no combination of tests that can 100% eliminate the possibility of a birth defect or genetic problem. 

There are 2 categories of tests available for chromosomal abnormalities:

• Screening tests can help identify if a pregnancy has an increased risk of a disorder. However, a positive result does not diagnose a disorder, and a negative result reduces but cannot eliminate the possibility of a problem. Screening tests are noninvasive and carry no risk of miscarriage. They include First Trimester Screening and Sequential Screening.
• Diagnostic tests are more accurate and can definitively identify a disorder and make a diagnosis. Currently available diagnostic tests are invasive and carry a small risk of miscarriage. These tests include Chorionic villus sampling and Amniocentesis.

Many people opt to have a screening test done first and then have diagnostic tests done if the screening test indicates an increased risk. Some people, however, know they need a definitive result regardless of how reassuring a screening test might be and choose to skip directly to diagnostic testing.

Making a decision about diagnostic testing can be difficult. Some people need definitive answers because they would not continue an affected pregnancy. Some people want no testing because it would not change any decisions regarding the pregnancy. Many others opt to test even if they would continue the pregnancy so they can make advance plans if a problem is identified. 

One type of diagnostic testing is called Chorionic Villus Sampling (CVS), where a small sample of cells is taken from the placenta and tested. CVS detects the same chromosomal problems as amniocentesis does, but it is performed earlier in pregnancy than amniocentesis, often at 10-12 weeks of pregnancy. This early detection provides women with more options (especially for those who may consider termination of a pregnancy based upon the results), but the test is technically more difficult and slightly riskier than amniocentesis. Some women have cramping or spotting for a few hours after the procedure. 

Follow this link to learn more:  Chorionic villus sampling (CVS): When, why, and how it's done | BabyCenter 

In an Amniocentesis, a small sample of amniotic fluid (the fluid that surrounds the fetus) is withdrawn from the mother's uterus for testing. This procedure can help detect certain birth defects in the fetus during pregnancy, such as Down Syndrome and spina bifida. Amniocentesis is usually performed at 15-20 weeks of pregnancy.

Follow this link for more information:  Amniocentesis: Purpose, Procedure, Risks & Recovery