The Center for Women

 

Physicians & Surgeons for Women

 

 

4139 Boardman-Canfield Road • Canfield, OH 44406 • 330.702.1281

923 Columbiana-Canfield Road • Columbiana, OH 44408 • 330.892.8185


 

 

Prenatal Visits

FIRST TRIMESTER  |  SECOND TRIMESTER  |  THIRD TRIMESTER




FIRST TRIMESTER

7-8 Weeks
Prenatal VisitsWe routinely see you for a pregnancy confirmation visit. At this visit, you will meet with the nurse practioner / nurse midwife, she will obtain your medical history and review routine prenatal care. Prenatal labs are drawn at the visit and patients will be given a packet of papers. Health history forms, genetic screenings and consent forms are to be filled out prior to coming back for your New OB appointment.

Prenatal Vitamins
A prescription will be given to you for prenatal vitamins to be taken daily through the entire pregnancy. Check with your physician / midwife / nurse practitioner before taking vitamins, herbs and other supplements not prescribed for you. They can be harmful during pregnancy. Natural products may not be safe to take in pregnancy.

Prenatal Labs
Prenatal lab work includes: blood type, Rh factor, complete blood count, Rubella Titer (German Measles exposure), Hepatitis B Virus and Syphilis screening. HIV test is optional, but recommended by ACOG.

Rh Factor
If your blood type doesn't have the Rh factor, you are Rh negative. Most people are Rh positive. Negative Rh factor can become a problem when the mother's negative blood comes in contact with Rh positive from the fetus. This means the mom produces antibodies to fight the Rh factor. An Rh negative mother can only become sensitized if the father is positive and the fetus is positive. If the mother and father are both negative, there is no chance the baby will be positive, and no risk to the mother. If the father is Rh negative, documentation is needed for confirmation.

An Rh negative woman can become sensitized any time her blood mixes with Rh positive blood:

  • Miscarriage
  • Induced Abortion
  • Ectopic Pregnancy
  • Blood Transfusion
  • Amniocentesis
  • Chorionic Villus sampling
  • Bleeding anytime during the pregnancy

A blood test called an antibody screen can show if the mother has the antibodies of the Rh positive blood. If the mother doesn't have the antibodies, a blood product called Rhogam will be given by injection to prevent sensitization.

If the mother has not been sensitized by 28 weeks, she will receive the Rhogam injection then. This will last for the rest of the pregnancy.

After the delivery, if the baby is Rh+, the mother will be administered another shot of Rhogam in case any of the baby's positive cells came in contact with her negative cells. If the baby is Rh negative, no injection is given.

Rhogam will be given earlier than 28 weeks for:

  • Miscarriage or Ectopic Pregnancy
  • Induced Abortion
  • Vaginal Bleeding
  • Amniocentesis or Chorionic Villus sampling

This prevents the mother from developing antibodies that could affect a future pregnancy of an Rh positive fetus.

Genetic Screenings will be offered at different points in the pregnancy. These include:

  • Cystic Fibrosis
  • Down's Syndrome
  • Spina Bifida

7-8 Weeks
A first trimester ultrasound is done at the office to confirm the expected due date.

10 Weeks
A New OB visit is set up with your physician or nurse midwife. At this visit we do your pap smear and routine bacterial cultures. The practitioner will discuss further the offered screenings for Down's Syndrome and Spina Bifida.

If AMA or at risk, early genetic testing may be offered at this visit.

11-13 Weeks
Ultrascreen done (testing for Down's Syndrome and Trisomy 13, 18). See genetic screening section.

 

 



SECOND TRIMESTER

12-16 Weeks
Routine Visit, which includes:

  • Blood pressure screening.
  • Urine dip stick to check for leukocytes (often found when bladder infections are present), glucose (often common when gestational diabetes is present) and protein (often present when there is elevated blood pressures).
  • Fetal Heart Rate is heard. A reassuring fetal heart rate is between 120-160 beats per minute. This rate can change at every visit.

15-20 Weeks
Screening for Spina Bifida is done with blood work at this visit if you desire.

  • Measure Uterine Growth, also known as fundal height. This measurement starts after 20 weeks in gestation. This is tested through blood work only, for a hormone level known as AFP (alpha fetal protein).

18-20 Weeks
Routine visit, as listed above, as well as OB Ultrasound. This anatomy scan will indicate the sex of the baby if you wish to know. The scan also reassures us of the baby's development.

22-24 Weeks
Routine visit

Glucose given at this appointment for gestational diabetes screen at 26-28 week visit.

26-28 Weeks
Routine visit as well as the diabetes screen.

A bottle of high glucose concentrated drink will be given to you at the prior appointment. You will need to drink this exactly one hour prior to getting your blood drawn. Written instructions will be provided with this drink.

Rhogam is given at this appointment if indicated (see section on Rh factor).

The end of the second trimester is nearing. Planning for delivery is essential. Consider:

  • Childbirth, infant care and breastfeeding classes are offered at both hospitals. To schedule, please call:
      – St. Elizabeth Hospital — (330) 480-3151
      – North Side Hospital — (330) 884-2912
  • A pediatrician for the baby
  • Consider your options for pain management in labor
  • Desired way to feed the baby (breast vs. bottle)
  • Discuss Circumcision if the baby is a boy

 

 



THIRD TRIMESTER

Plan ahead:

  • Route to the hospital
  • Phone number to reach midwife/physician
  • Pack a bag for the hospital stay as well as comfort measures you will bring from home for your labor or stay thereafter.

28-36 Weeks
Routine visits every 2 weeks
If there's any decrease in fetal movement, notify your practitioner right away.

36 Weeks
Routine visit as well as a vaginal culture for Group Beta Strep (GBS) is done. GBS is a normal bacteria that is found in 1-30% of pregnant women. However, in pregnancy, it is best to treat a positive culture with antibiotics during labor so that the baby has no complications from the bacteria.

37-40 Weeks
Routine visit and cervical exam (checking the cervix for dilation) every week.

Labor Precautions:

Monitor for signs of labor or reasons to go to the hospital:

  • Contractions that are regular, you can time and are 5-10 minutes apart for an hour
  • If your water breaks (persistent leaking of fluid or a large gush of fluid)

Warning signs that need to be reported:

  • Severe swelling that does not improve with rest or sleep
  • Sudden severe headache
  • Unusual changes in your vision
  • Severe pain under your right breast
  • Vaginal bleeding
  • Change in baby movements that are significantly less

 

 


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