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Prenatal Care

About 8 weeks:

Physical examination and Pap smear. Assign due date. Discuss prenatal vitamins.
Orientation to The OB/GYN Center.
Prenatal blood tests drawn in outpatient lab (Quad Screen).

About 12 weeks:

Discuss prenatal laboratory testing.
Listen for fetal heart tones.

About 16 weeks:

Listen for fetal heart tones and check uterine size.
(Amniocentesis may be done for patients over the age of 34)

About 20 weeks:

Listen for fetal heart tones and check uterine size. An obstetric ultrasound may be ordered about this time. The ultrasound will be done by our ultrasound tech at the Sky Ridge office at a separate visit. Please have a very full bladder for the ultrasound.

About 24 weeks:

Listen for fetal heart tones and check uterine size.
Patients who are interested in taking childbirth education classes should register for these classes at the hospital.

About 28 weeks:

Listen for fetal heart tones and check uterine size. One hour glucose test and hematocrit test is done. (Stop at the lab prior to your office visit to drink the glucose solution. The blood is to be drawn one hour after drinking the glucose. Fasting is not necessary. No appointment is required at the lab.)
Rhogam shot is given to patients who have Rh negative blood type.
Review information sheet about warning signs of premature labor and fetal movement counts.

About 30 weeks:

Listen for fetal heart tones and check uterine size.
Discuss glucose test results.

About 32 weeks:

Listen for fetal heart tones and check uterine size.
Check baby's position.
Schedule your remaining appointments well in advance through the week of your due date. Please schedule at least one visit with each of the doctors at the OB/GYN Center; because of our "On Call" schedule, any one of the doctors may be there for your delivery.

About 34 weeks:

Listen for fetal heart tones and check uterine size.
Check for the baby's position.

About 36 weeks:

Listen for fetal heart tones and check uterine size.
Check for the baby's position.
Discuss Labor and Delivery.
Review information sheet about when to call the doctor.
Obtain Group Beta Strep culture.

37, 38, 39 weeks:

Listen for fetal heart tones and check uterine size
Check for the baby's position
A cervical examination may be done.

40 weeks:

Listen for fetal heart tones and check uterine size
Check for the baby's position
Cervical examination
Discuss management plan for delivery on an individual basis.

What Medications Can I Take?

Tylenol (including Extra Strength Tylenol) is safe at any time during the pregnancy in its usual dose. We do not recommend other pain relievers such as Advil, Aleve or aspirin.

Over-the-counter antacids are safe in pregnancy. Either the liquids (such as Maalox or Mylanta), chewable tablets (such as Tums or Rolaids) or acid reducers (such as Pepcid AC or Zantac 75) are acceptable.

For nausea and vomiting of early pregnancy ("morning sickness"), the over-the-counter sleeping pill Unisom often has an Anti-nausea effect, although it may make you sleepy. You may take 1/2 to 1 tablet at night. This often has a residual effect into the next day. You may also take a 1/2 tablet in the morning if necessary. Vitamin B6 25 mg three times a day (brand name Nestrex) may also be helpful for morning sickness. Prenatal vitamins and iron can cause nausea. You may need to substitute your prenatal vitamin temporarily with a children's chewable vitamin with folic acid. You should take at least 0.8 mg of folic acid daily. Frequent small meals often help with morning sickness as well as ginger tea, acupuncture, motion sickness bands or hypnosis. You may also find Emetrol to be helpful.

Over-the-counter cold medicines are fine during any stage of the pregnancy. However, we do not recommend cold syrups that have alcohol in them or combination cold preparations which have Advil or aspirin in them. The following are suggested medications for cold or flu symptoms:

  • Cough-Robitussin or Robitussin DM
  • Constipation-Colace
  • Diarrhea-Kaopectate or Imodium
  • Fever-Tylenol
  • Muscle Aches-Tylenol
  • Nasal Congestion or Sinus Pain or Pressure-Sudafed or nasal sprays
  • Sore Throat-any throat lozenge
  • Runny Nose-any over-the-counter antihistamine

Most antibiotics are also safe during pregnancy. However, feel free to check with us if you need to take any prescription medication just to make sure.

The American Academy of Pediatrics recommends breastfeeding for a year or more after birth. The following are short and long term benefits to both mother and baby.

Benefits to Mother and Family:

  • Convenient and cost-efficientEffective, free postpartum contraception for 3 to 6 months
  • Produces no waste
  • Promotes postpartum healing
  • Reduces parental absences from work due to child's illnesses
  • Lowers risk of ovarian cancer and premenopausal breast cancer in mother
  • Enhances mother-baby relationship

Benefits to Infants:

  • Superior nutritionBetter brain development
  • Reduced risk of necrotizing entercolitis (life-threatening intestinal infection)
  • Reduced risk of sudden infant death syndrome
  • Increased resistance to infection, fewer allergies, fewer stomach upsets
  • Lower risk of cancers
  • Emotional security and improved developmental outcome

Other information about breastfeeding:

Breast size does not correlate with breastfeeding ability. Some women with small breasts cannot breastfeed, but this is a rare condition.

You can go back to work while you are breastfeeding. You can pump milk at work and breastfeed in the morning and night.

Breast milk is particularly good for premature babies even if it has to be administered through a tube.
Women who have had breast reduction surgery may have trouble breastfeeding, because the surgical techniques done in the past destroyed the duct system. Conversely, breast implants are placed under the breast tissue where they don't interfere with breastfeeding.

If you don't have enough milk, it is important to let the baby feed longer, emptying the breast, and to use one breast predominately for each feeding. Alternating breasts from one feeding to another will help.

Mastitis often occurs in the second or third week of nursing. The breast becomes red, hot, and tender, with swelling and a fever. Treatment includes nursing on the unaffected side first. Treatment with antibiotics, heat, fluids, and a pain reliever such as Tylenol or Advil is indicated.

Lactation Consultants:

Sky Ridge Medical Center (720) 225-2225
Parker Adventist Hospital (303) 269-4000

What Can I Eat?

Pregnant women, those who may become pregnant, nursing mothers and young children should not eat shark, swordfish, king mackerel, or tilefish due to high levels of mercury.

Women of child-bearing age can safely eat up to an average of 12 ounces a week of any other type of cooked fish from a store or a restaurant.

Women of child-bearing age should not eat more than 6 ounces a week of cooked fish that are caught in local waters.

Young children should not eat more than 2 ounces a week of cooked fish that are caught in local waters. Pregnant women can eat hard cheeses, but should not eat soft cheeses such as feta, brie, camembert, blue-veined cheeses (like Roquefort) and Mexican style soft cheeses. There is an increased risk of a bacteria called listeria in soft cheeses that have not been pasteurized. If a pregnant mother becomes sick from listeria, she can pass the bacteria to the unborn baby and can cause sickness or death. Symptoms of infection may include fever, headache, nausea, vomiting, and premature labor.

Pregnant women should consume three servings of dairy products daily or the equivalent in a calcium supplement (approximately 500mg per dairy serving). Suggested supplements include Tums, Viactiv, OsCal 500, Citracal, Caltrate, or "Nature Made" brand calcium.

Pregnant women are advised not to drink alcohol in pregnancy, as no level of drinking has been proven safe. Consumption of alcohol during pregnancy may cause birth defects.

Weight Gain, Travel, and Exercise During Pregnancy

Travel & Pregnancy

You may travel by any means, including air travel up until one month before your due date, if your pregnancy is uncomplicated. After 36 weeks, one month before your due date, we recommend that you remain within one hour of a hospital.

Weight Gain in Pregnancy

The usual weight gain in pregnancy is 25 to 35 pounds for the entire pregnancy. Most of this weight gain comes in the second and third trimester at a rate of about 1-2 pounds per week. Weight gain is variable in the first trimester. You may even lose some weight as your appetite may be decreased. Patients who are underweight pre-pregnancy usually gain 18-40 pounds, while overweight patients usually only gain 15-25 pounds.

Seatbelt Use

We recommend that you wear your seatbelt whenever you are riding in or driving a car. Even in the third trimester, it is fine to have the shoulder strap go across the uterus.

Physical Activity

You may exercise throughout your pregnancy. Walking, running, swimming, aerobics and moderate weight training are all acceptable. We do not recommend participation in contact sports or sports where you are likely to fall such as snow skiing, water skiing, hockey, soccer, basketball or horseback riding beyond the first trimester. Scuba diving should be avoided throughout your pregnancy. You may have sex throughout the pregnancy if your pregnancy has been uncomplicated.

Personal Care

Although it is not mandatory, we suggest that you wait until the second trimester to color or perm your hair.

Tanning, at any stage in life, is not recommended because of its potential to cause skin cancer. If you do decide to tan, remember that your skin is more sensitive during pregnancy and it may be appropriate to reduce the amount of time spent in the sun or tanning bed.

AFP is a protein made by the baby and secreted into the amniotic fluid and mother's blood stream. Elevated levels of AFP can be found in certain conditions such as spina bifida, anencephaly (failure of brain and skull development), abdominal wall defects, fetal death, twin gestation, or inaccurate dating of pregnancy. An elevation of AFP, even with a normal amniocentesis, can be associated with a higher risk of problems in the third trimester. Some of these include placental separation (abruption), preterm labor, poor fetal growth, pregnancy induced hypertension, increased risk of stillbirth, and a lack of amniotic fluid. Low levels of AFP have been associated with a higher risk of chromosome problems such as Down syndrome.

Screening of the mother's blood allows us to check for the possibility of some of these potential problems. The blood test that is drawn is called a Quad Screen or Maternal Serum Screen 4. It includes an AFP, an estrogen level, an HCG level, and inhibin A level. The Quad Screen is more accurate at predicting a chromosome problem compared to the AFP alone. The majority of babies born with Down syndrome are born to women under the age of 35, even though the risk of Down syndrome increases at the age of 35. At the age of 35, the risk of having a baby with Down syndrome is 1:270 live births. An amniocentesis is usually recommended for women who will deliver by the time they are 35 or older. For those younger than 35, the Quad Screen will detect about75 percent of Down syndrome babies. The AFP will be elevated in greater than 90 percent of cases involving brain, spinal cord, or abdominal wall defects. An abnormal Quad Screen can be a false alarm, therefore if a quad-screen or AFP is abnormal, an ultrasound is recommended. An amniocentesis could determine if a problem really exists. A normal Quad Screen does not necessarily guarantee a normal baby.

The AFP, Quad Screen, and amniocentesis are recommended, but are all optional tests. A decision whether to have the test or not is usually a personal choice. A woman who would not have an abortion may still want to consider the testing in order to help prepare herself, her family, and her doctors for the birth of a baby with special needs.

A woman who is 35 or older needs to be aware that, even with a normal Quad Screen and ultrasound, there is still the possibility of having a baby with Down syndrome. Most chromosomal abnormalities other than Down syndrome are not detected by the Quad Screen. At times, Trisomy 18 can be detected with an abnormal quad-screen. An amniocentesis or a procedure called chorionic villous sampling (CVS) are the most accurate tests for diagnosing Down syndrome as well as some of the other chromosomal problems.

If you choose to have this test done, the blood work should be drawn between 15 and 18 weeks, along with other prenatal laboratory work. The results are usually returned to our office in approximately one week. If you are 35 or older and are going to have an amniocentesis, we draw just the AFP a few days before your amniocentesis. This will help us determine if you will be at risk of any of the third trimester problems mentioned previously.

I understand and wish to have the Quad Screen done.

Signed: ____________________________________

Date: ________________

I understand and DO NOT wish to have the Quad Screen done.

Signed: _____________________________________

Date: ________________

How common is GBS disease?

GBS is the most common cause of sepsis (blood infection) and meningitis (infection of the fluid and lining surrounding the brain) in newborns. GBS is a frequent cause of newborn pneumonia.

One of every 20 babies with GBS diseases dies from infection. Babies that survive, particularly those who have meningitis, may have long-term problems, such as hearing or vision loss or learning disabilities.

In pregnant women, GBS can cause bladder infections, womb infections (amnionitis, endometritis), and stillbirth.

Does everyone who has GBS get sick?

Many people carry GBS in their bodies but do not become ill. These people are considered to be "carriers." Adults can carry GBS in the bowel, vagina, bladder, or throat. One of every four or five pregnant women carries GBS in the rectum or vagina. A fetus may come in contact with GBS before or during birth if the mother carries GBS in the rectum or vagina. People who carry GBS typically do so temporarily-that is, they do not become lifelong carriers of the bacteria.

How does GBS disease affect newborns?

Approximately one of every 100 to 200 babies whose mothers carry GBS develop signs and symptoms of GBS disease. Three-fourths of the cases of GBS disease among newborns occur in the first week of life ("early-onset disease"), and most of these cases are apparent a few hours after birth. Sepsis, pneumonia, and meningitis are the most common problems. Premature babies are more susceptible to GBS infection than full-term babies, but most (75%) babies who get GBS disease are full term.

GBS disease may also develop in infants one week to several months after birth ("late-onset disease"). Meningitis is more common with late-onset GBS disease. Only aboiut half of late-onset GBS disease among newborns comes from a mother who is a GBS carrier; the source of the infection for others with late-onset GBS disease is unknown. Late-onset disease is very rare.

Occasional, mild, irregular contractions (so-called Braxton-Hicks contractions) are normal in the second half of pregnancy. However, it is not normal to have frequent contractions prior to 37 weeks (3 weeks before your due date).

The following are warning symptoms of premature labor:

Regular uterine tightening or contractions occurring 4 or more times per hour. This may feel as though the baby is "rolling up into a ball." Your uterus may become tight and harden to the touch. You may also perceive contractions as a rhythmic low backache. Contractions may feel like severe menstrual cramps.

An Unusual rhythmic or persistent pelvic pressure.

A large amount of mucus or watery discharge leaking from the vagina. This is especially concerning if the discharge has a red, pink, or brown color. It is normal to have a minimal amount of spotting after intercourse or after a pelvic exam. Any other vaginal bleeding should be immediately reported to a nurse or doctor at our office.

If you have any of these symptoms prior to 37 weeks, you should stop any strenuous activity, rest on your left side, and push fluids. Try to drink at least 4 large glasses of water as soon as you can.

If the symptoms persist despite fluids and rest for one hour, you should call the office at (303) 788-6657 to speak with a doctor or nurse. After office hours, you should call our answering service at (303) 762-2857, and a doctor will return your call. You may need to come to the office or hospital for evaluation.

Rest two to three times a day lying on your left side.

Drink 2 to 3 quarts of water or fruit juice each day. Avoid caffeine drinks. Filling a quart container and drinking from it will eliminate the need to keep track of numerous glasses of fluid.

Empty your bladder at least every two hours during waking hours.

Avoid lifting heavy objects. If other small children are in the home, work out alternatives for picking them up, such as sitting on a chair and having them climb up on your lap.

Avoid prenatal breast preparation such as nipple rolling or rubbing nipples with a towel. This is not meant to discourage breast feeding but to avoid potential increase of uterine irritability from nipple stimulation.

Pace necessary activities to avoid overexertion.

Sexual activity may need to be modified or eliminated.

Find pleasurable ways to help compensate for limitations of activities and boost spirits - massages, manicures and pedicures.

Try to focus on one day or one week at a time rather than longer periods of time.

If on bedrest, get dressed each day and rest on a couch rather than becoming isolated in the bedroom.

If you are 37 weeks or more (within 3 weeks of your due date), you should call if any of the following occur:

Consistent, regular, painful contractions which have been occurring every 5 minutes (from the start of one contraction until the start of the next contraction) for at least one hour. Each contraction should last from 30 to 60 seconds.

Remember the 5-1-1 Rule.

Vaginal Bleeding. A small amount of spotting is normal for a day or two after a vaginal examination. Any other vaginal bleeding should be immediately reported to a nurse or doctor at our office.

Rupture of membranes. If you break your bag of water, or if you think you might be leaking amniotic fluid, you should call right away. You will need to come to the office or to the hospital for evaluation.

Decreased fetal movement. The baby should move at least 15 times a day. This should continue right up to your baby's birth. If you think that your baby is not moving that much, lie down on your left side after eating and count fetal movements. You should feel at least 4 in an hour. If you don't feel 4 movements in the first hour, eat or drink something, lie down on your left side again, and count the movements for a second hour. If you still don't feel at least 4 movements in an hour, call immediately. You will need to come to the office or to the hospital for fetal monitoring.

How do I contact my doctor?

During our office hours, you may call the office at (303) 788-6657 to speak with the triage nurse. She will return your call promptly and help direct your course of action.

After office hours you may call our answering service at (303) 762-2857 for emergencies. A doctor will return your call. The doctor will help you determine whether you should go to the hospital. EXCEPT IN AN EXTREME EMERGENCY, PLEASE DO NOT GO DIRECTLY TO THE HOSPITAL WITHOUT SPEAKING TO AN OFFICE NURSE OR DOCTOR FIRST.

Well-baby care may be obtained through a pediatrician or through your family practitioner. These are some of the South Metro Denver pediatricians who come highly recommended. There are, of course, many other excellent pediatricians who do not appear on this list. You are also encouraged to seek input from your primary care physician as well as from friends ,relatives, and neighbors.

ACADEMY PARK PEDIATRICS
7373 W. Jefferson Ave. #102
Lakewood, 80235 (303)988-5252
Drs. Arfsten, Nichalson, Lorenzo, Dworet, Needham, & Goldberg
www.pediatricweb.com (Academy)

ARAPAHOE PARK PEDIATRICS
7780 S. Broadway #220
Littleton, 80122 (303)795-2345
Drs. DeLano, deMahy, DiMaria, Girardeau, McCall & McKenzie

AURORA PEDIATRIC ASSOCIATES
13650 East Mississippi Ave. #110
Aurora, 80012 (303)337-7111
Drs. Kurtz, Thompson, Pearlman, Ginsburg, Levin, Davison-Tracy, Shaw & Stevens

CHILD FIRST PEDIATRICS
7336 South Yosemite St. #200
Englewood, 80112 (303)770-0726
Drs. Diab, Pener, Kugelman, Renken, Caplan, Melamed, Oakes, Smith & Beard

GREENWOOD PEDIATRICS
9094 E Mineral Ave. #100
Centennial, 80112 (303)694-3200
6931 S. Pierce St #100
Littleton, 80128 (303) 973-3200
Drs. Bauer, Cooper, Feiten, Giarratana, Damon, Harrington, Mauro, Chapin & Gill
www.greenwoodpediatrics.com

KENNETH KATZ, M.D.
8120 S. Holly St. #100
Littleton, 80122 (303)779-3013
www.pediatricweb.com (Katz)

LITTLETON PEDIATRICS
206 West County Line Rd. #110
Highlands Ranch, 80129 (303)791-9999
Drs. Bublitz, Kyriazi, Rosenbaum, Van Scoy, Weiner, McDonald, Gin, Jotte & Barter

PARTNERS IN PEDIATRICS
919 Jasmine St. #100
Denver, CO 80220 (303) 388-4256
8100 S. Quebec St. #B10
Englewood, 80112 (303)779-1172
Drs. Klein, Rubin, Prina, Lataitis, Workman & Cordova
www.partnersinpediatrics.com

PARKER PEDIATRICS & ADOLESCENTS
10371 Parkglenn Way #100
Parker, 80138 (303) 841-3052
Drs. Rabinowitz, Rosenberg, Wing, Venters, Quaife & Gensler
www.parkerpediatrics.com

PEDIATRICS AT D.T.C.
9094 E Mineral Ave. #120
Englewood 80112 (303)779-KIDS
Drs. Middlemist, Tschetter, Stapp, Deckerman, Wallendal, Bosley & Bouzarelos

PEDIATRIC PATHWAYS
6065 S. Quebec St. #100
Englewood 80111(303)694-2323
Drs. Huff, Blakeman & Marceny

SOUTHEAST DENVER PEDIATRICS
10103 RidgeGate Pkwy #G21
Lone Tree, 80124 (303) 471-5060
2121 S. Oneida St. #200
Denver, 80224 (303) 757-6418
Drs. Hand, Schwartz, Tucker, Miga, Carlson, Sagal & Erdley

CASTLE ROCK AREA:
Drs. Josepher, Thomas & Lurie
1001 S. Perry St. #101
Castle Rock, 80104 (303) 688-5226

Drs. Stage & Bloomberg
1 Oakwood Park #101
Castle Rock, 80104 (303)688-2320

CASTLE ROCK PEDIATRICS
Drs. Healey, & Thieme
1 Oakwood Park #106
Castle Rock, 80104 (303)688-2228

CASTLE ROCK FAMILY MEDICINE
Drs. Kasunic & Boekes; Ladean Cross, NP
1025 S. Briscoe St. #200
Castle Rock, 80104 (303) 688-8989

ECHOGENIC INTRACARDIAC FOCUS (EIF)

Echogenic intracardiac focus (EIF) is defined as a small bright spot in the papillary muscle of the heart. EIFs are found in approximately 3 - 5% of pregnancies and are usually benign. They are more commonly found in the left cardiac ventricle than in the right ventricle. EIFS have been associated with fetal chromosome abnormalities, particularly Down syndrome. In the case of an isolated EIF of the left ventricle, the risk for a chromosome abnormality is approximately twice the patient's age-related risk. This risk increases with the addition of other ultrasound markers and other risk factors, such as advanced maternal age or an abnormal serum screening test. The risk for a chromosome abnormality when the EIF is in the right ventricle of the heart or if multiple EIFs are seen is four times your age-related risk. EIFs have not been found to affect cardiac function, and in the absence of other anomalies and chromosome abnormalities, EIFs are considered normal variants.

Chromosomes are the inherited structures in the cells of our bodies. There are 46 chromosomes in each cell, arranged in 23 pairs. Chromosome abnormalities involving a missing or extra chromosome are not inherited or caused by an exposure during pregnancy. Instead, they result from a chance mistake in cell division at the time of conception. This error is a random event that can occur in anyone's pregnancy, but it does occur more often as we age.

Individuals with Down syndrome have an extra #21 chromosome, thus three rather than two copies of chromosome 21. It is this extra genetic material that causes the features of Down syndrome, including mental retardation, a characteristic facial appearance, and other health problems.

When an EIF is identified on ultrasound, there is the option of additional testing. Detailed ultrasound, to look for additional complications and/or birth defects, may be recommended depending on the amount of detail that was obtained on previous ultrasounds. Amniocentesis to test for chromosome abnormalities in the baby, is also an option.

It is important to remember that EIFs are usually normal variants that would have no negative effect on the baby.

Source: The Harvey Institute for Human Genetics