Between 35-37 weeks of pregnancy, every expecting mother should receive a group B streptococcus (GBS) screening. This requires a doctor to take a cell sample using a Q-Tip swab from your vagina and rectum to determine whether or not you are one of the 10-35% of women with the bacteria present in their digestive, urinary, or reproductive tracts.

It’s important that you receive the GBS screening, because there is a risk of passing the bacteria to your baby during delivery. GBS can cause serious problems in a newborn, even death.

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The third trimester of pregnancy begins around week 28. With only three months left in your pregnancy, your prenatal appointments will pick up in frequency.  Instead of visiting the doctor every month, you’ll have an appointment every two weeks from week 28 through 36 and then every week throughout the rest of your pregnancy.

Many of the appointments during the third trimester are routine appointments, which means your vital signs and fundal height will be taken but little else will be done. The exceptions to this are the diabetes screening already discussed here on the blog, the group B strep screening that we’ll discuss in our next blog post, and special fetal testing that you may need or want. Read more…

Join me on Thursday, October 27 at 7:30 pm at Norwalk Hospital for a free educational seminar to discusss Minimally Invasive Surgery for the treatment of Pelvic Prolapse, Uterine Fibroids and Endometriosis.  To register call 1-866-NHB-WELL.

There are two varieties of diabetes: Type 1 and Type 2. Type 1 Diabetes results when your body does not produce

Exercise during pregnancy is recommended for all women, especially those with gestational diabetes.

insulin (this usually begins at an early age). Type 2 Diabetes results when your body does not respond to insulin and therefore produces more of it than usual. This type tends to begin later in life as a result of obesity and family history.

In terms of pregnant women, both types of diabetes are cause for concern. If you have diabetes before becoming pregnant (pregestational diabetes), then you should speak with your doctor as soon as possible about precautions to take throughout your pregnancy.

But even if you don’t have diabetes before pregnancy, you could develop it during (gestational diabetes). In fact, the American Congress of Obstetricians and Gynecologists says gestational diabetes affects between 2-10% of pregnancies. Read more…

At my office we call many of our prenatal care appointments “routine appointments.” At these appointments no special tests are completed.

For a routine prenatal appointment, you come into the office so we can take your weight, temperature, and blood pressure. We’ll also measure where the top of your uterus ends (also called height of fundus) and listen for the baby’s heartbeat. Of course, this is also an opportunity for you to ask questions that you may or may not have asked during the expectant parent programs at Norwalk Hospital. Read more…

The fourth prenatal appointment typically occurs between the 18^h and 20^th week of pregnancy. In my experience, most expecting couples look forward to this appointment the most. The reason for this anticipation is the anatomic scan, also called an ultrasound.

It must be noted that some doctor’s offices will administer an ultrasound earlier in the pregnancy (around 12 weeks) to determine the expected delivery date and confirm a healthy pregnancy. However, the ultrasound conducted after 18 weeks of pregnancy tends to reveal more information, including the sex of the baby or babies.

How an Ultrasound Works

Using what’s called a transducer either in the vagina or over the abdomen, the device converts sound waves into images of your uterus and growing baby. These images can be viewed on a computer or television screen in the room during the ultrasound. The process is painless and typically lasts about 20 minutes.

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Weeks 10-16: What to Expect at Your Prenatal Appointments

Throughout the course of your pregnancy, you will see your doctor about 14 times, assuming all tests are reassuring that your baby is developing just fine. After your initial prenatal appointment and until week 28 you should plan to see the doctor once a month. Here’s what you can expect at your second and third prenatal appointments.

Second prenatal appointment: Occurs between the 10^th and 12^th week of pregnancy

You’ll soon realize that almost every prenatal appointment starts with a nurse measuring your weight, temperature, and blood pressure and with a urine sample. The urine test looks for bacteria and high levels of sugar and protein in your system, which could indicate diabetes, urinary tract infection, kidney disease, or preeclampsia (high blood pressure). Preeclampsia typically occurs later in pregnancy if it occurs at all.

During the second prenatal appointment the doctor will discuss all the results of the pap, blood, and urine testing completed at your first prenatal appointment. In my office, this is when we discuss the results of the cystic fibrosis test (if administered), the Rh factor test, and the notes from your genetics counseling visit. If you choose to have a nuchal translucency screening (also called an NT scan) to test for the possibility of Down syndrome, this will be administered during your second appointment.

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Details of a Genetics Testing Consultation

In the last post, I mentioned that I often talk with my patients about their options in genetics testing during the first prenatal appointment, but it actually goes much further. The genetics testing consultation is a separate appointment altogether.

If you were my patient, here’s what we’d discuss in this special consultation:

• A detailed health history of both mom and dad to find out if you are at risk of having a baby with a disorder.
• An overview of the tests available to you, the risks of each, and the reasons you may or may not want to proceed with each test.
• Options available to you should you discover that your baby may have a genetics disorder.

Understanding Genetics Disorders

You may remember that genetics are the traits passed from both parents to the child. The mother’s egg and the father’s sperm each have 23 chromosomes, which pair up within each cell of the fetus. Each of the 46 chromosomes contains a number of paired genes, some recessive and some dominant, which define a number of traits. These traits range from the color of the baby’s eyes to blood type.

A genetics disorder can result from a missing or damaged chromosome or gene or when inherited from a parent. Disorders could include Huntington’s Disease, Tay-Sachs disease, cystic fibrosis, hemophilia, Down syndrome, and others.

Types of Tests Available to You

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Between six and eight weeks have passed since the first day of your last period. You’re pregnant, and it’s time to visit your obstetrician. Of course, you’ll have scheduled your appointment as soon as you found out you were pregnant (we discussed this in our last post, “What to Do When You Find Out You’re Pregnant”) to ensure there’s no delay in your prenatal care.

The first prenatal appointment lasts a bit longer than most of the other appointments—you’ll see your obstetrician once a month until week 28; two times a month between weeks 28-36; and, weekly after week 36. This first appointment takes more time, because of the background information your doctor needs to discuss with you.

At my office, we ask our patients to access the digiChart Electronic Medical Record Portal available through our website two or three days before the first appointment. Once on the site, you would carefully answer a series of questions that will help us determine your due date and identify any potential risk factors.

During the appointment we’ll discuss that information and I’ll take time to answer your questions and to go over important prenatal care issues. More specifically, we’ll cover the following.

Dietary recommendations and restrictions during pregnancy

A healthful diet will make a difference in fetal development and your overall well being. We will discuss the importance of protein, calcium, grains, seafood, fresh fruits and vegetables as well as the avoidance of unpasteurized dairy products, unpasteurized juices, cold cuts, and seafood containing PCBs and Mercury.

Prenatal vitamins

I will prescribe prenatal vitamins (if you’re not already taking them), which are paramount to your baby’s health.

Genetics consultation

While not all screening and diagnostic tests will be completed during the first prenatal visit, we will discuss your options for various first and second trimester diagnosis and molecular genetics testing for autosomal recessive traits such as Tay-Sacks, SMA, Fragile-X, Cystic Fibrosis, etc. Specific prenatal genetic tests to cover include:

• NT scan

• CVS

• Amniocentesis

• APF test

• Genetic ultrasound

It’s important to note that each genetics test is optional. I offer my patients a formal genetics counseling visit to discuss the nature of these tests, so that each pregnant couple can decide if testing is right for them.

Prenatal education

I am affiliated with the Norwalk Hospital here in Connecticut and I recommend their prenatal education program to all my patients. Programs begin as early as the first trimester and include hospital tours, childbirth classes, infant CPR, and more. Prenatal education will be discussed at your first appointment, but you can also learn more on the Norwalk Hospital website.

Coverage arrangement

It’s important that you have an alternative physician to serve as backup in the event that your obstetrician is not available when you have questions or need to see him/her. In my office, we discuss this at the very start to ensure your prenatal care is completely covered.

Physical exam and testing

At this first prenatal appointment we will complete pap, blood, and urine tests. We will be looking for abnormal cervical cells, certain infections and sexually transmitted diseases (including HIV), the Rh factor, anemia, and proof that you have immunity against rubella and chicken pox, among other potential health issues. If any of the tests cause concern, we may proceed with diagnostic testing to rule out any potential problems.

Influenza vaccine

Not only will an influenza vaccine prevent the likelihood of you getting the flu, but there are a number of other medical benefits for your baby. Studies show that an influenza vaccine will decrease the chances of premature birth, low birth weight, and your baby needing to be hospitalized. During your first prenatal visit we’ll talk more about influenza prevention.

This post is the fourth article in a series of articles dedicated to expecting moms here in Connecticut. Visit us every two weeks to learn more about prenatal care.

Dr. John Garofalo, M.D., is an obstetrician and gynecologist located in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to http://www.garofaloobgyn.com/. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

Those of you who have followed my blogs for a while know that I’ve written about pelvic prolapse a few times — once about daVinci surgery and another time regarding a clinical study that was set up to see if synthetic mesh inserted through a vaginal incision is beneficial in the repair of pelvic organ prolapse. Pelvic organ prolapse is a relatively common condition caused by the weakening of pelvic muscles and ligaments that support organs such as the bladder and uterus. When this weakening occurs, these organs can slip out of place, often pushing into or through the vagina. Pelvic organ prolapse can be uncomfortable and it can interfere with bowel movements, urination and sexual activity.

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