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.

What GBS is and is not

Group B strep is not the same variety of strep that gives you strep throat. Also, GBS is not a sexually transmitted disease.

GBS is a common bacteria that usually does not cause infections in healthy adults. Some women develop a urinary tract infection or infection of the uterus, but few women ever know they have it. GBS doesn’t usually doesn’t come with symptoms.

How GBS is treated

To screen, the doctor will swab your vagina and rectum. The process is painless.

If you happen to have GBS, you will receive antibiotics during labor, not before. That’s because the bacteria can return shortly after an antibiotics treatment. While the bacteria will cause little harm to mom, it could cause great harm to the baby including lung infections, blood infections, and meningitis.

Late onset GBS

It is possible for your baby to acquire GBS after birth through contact with others. If your baby presents any of the following symptoms, talk to your doctor.

• Slowness or inactivity
• Irritability
• Poor feeding
• Vomiting
• High fever

This is one of several articles published as part of a series to discuss what moms-to-be can expect in Connecticut prenatal care from Dr. Garofalo. Check back regularly for more information.

Written by: Sara Lancaster

Creative Commons Image Attribution: Lady in waiting Project 365(2) Day 23 by Keith Williamson

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.

Why you might need special fetal testing

After 32 weeks of pregnancy the doctor will monitor you closely for potential problems, especially if you are at risk for delivering a stillborn baby or have any of the following problems:

• Blood disorders
• Thyroid disease
• Heart disease
• Lupus
• Kidney disease
• Diabetes
• High blood pressure
• Decreased fetal movement
• Too much or too little amniotic fluid
• Fetal growth problems
• Post-term pregnancy
• Multiple pregnancy, if there are complications

Types of special fetal testing

Most special fetal testing will check to see how active the baby is and how the baby is growing. The following is a brief overview of each test.

Fetal movement counts: This testing takes place at home and is up to you to complete. I will give you more specific instructions, but you’ll basically need to relax on your back for awhile and count the number of kicks/movements you feel. You should be able to count to 10 within two hours.

Nonstress test: Using electronic monitoring, we make an assessment of the baby’s health by comparing movements to heart rate.

Ultrasound: I often recommend an ultrasound to determine the size and position of the baby somewhere around 34 weeks of pregnancy. (Learn more about prenatal ultrasounds.)

Doppler ultrasound of the umbilical or other artery: This special ultrasound checks for blood flow and is done when the baby is at risk for anemia.

Biophysical profile (BPP):  Combining a nonstress test and ultrasound, the BPP assesses the health of the baby when you’ve gone past your due date or your baby is not growing the way I would like.

Contraction stress test: Not done often, the contraction stress test measures heart rate when the uterus contracts.

This is one of several articles published as part of a series to discuss what moms-to-be can expect in Connecticut prenatal care. Check back regularly for more information.

Creative Commons Image Attribution: Olga-12 by johnhope14

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.

Diabetes during pregnancy could cause miscarriage, stillbirth, preterm labor, preeclampsia (dangerously high blood pressure), respiratory distress syndrome, birth defects, and macrosomia (a large baby that makes vaginal delivery difficult).

Those most at risk for gestational diabetes include women who:

• Are overweight
• Are aged 25 years or older
• Are Native American, Asian, Hispanic, African American, or Pacific Islander
• Had problems in previous pregnancies such as gestational diabetes, had a large baby, or stillbirth
• Have close relatives with diabetes
• Have polycystic ovary syndrome

If you are considered high risk, then you may be tested early in your pregnancy. Otherwise, at 28 weeks (or so) I ask patients to complete a diabetes screening test. The test is painless, but does require you to drink a sugary drink in a short time frame. We’ll then draw blood and check your glucose (sugar levels). If you do have a high sugar levels, then we’ll do additional testing.

Those who have gestational diabetes will need to monitor their glucose, eat a healthy prenatal diet, exercise, and possibly take medication during their pregnancy. It’s also possible you’ll develop Type 2 diabetes later, which means you have to start getting tested 6-12 weeks after delivering the baby.

Read more about gestational diabetes and other pregnancy concerns in the Prenatal Patient Education section of our website. Also, check back again soon to find out what happens at each prenatal appointment after 28 weeks.

Written by: Sara Lancaster

Creative Commons Image Credit: prenatal yoga by lululemon athletica

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.

Routine appointments typically occur around weeks 16, 24, 30, and 32 of pregnancy.

Your last four appointments (or more if you go past your estimated due date) are also considered routine, but they are slightly more involved since we’ll begin looking for indication of labor. We’ll talk more about the last month in a future blog post.

Why you need routine prenatal appointments

It may seem silly to come in for a routine appointment when little is done, but these appointments are actually very important.

• We could discover early signs of preeclampsia (high blood pressure) and gestational diabetes.
• In our discussions you may mention a discomfort that can be easily treated (e.g., nausea, insomnia, allergies, etc.)
• Statistics show that women who receive the appropriate prenatal care are less likely to have a baby pre-term or with low birth weight.

So, while many of your prenatal appointments are uneventful and do not require any tests, it’s during these routine appointments that I may be able to identify potential problems with your pregnancy. The earlier a problem is identified the better the chance of remedying the problem. That means that if you ever have a problem or possible emergency, don’t hesitate to contact my Connecticut Obstetrics office .

In upcoming blog posts we’ll discuss diabetes screening, a third trimester ultrasound, group B strep screening, and other events that take place at non-routine prenatal appointments.

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.

The Reasons for Conducting an Ultrasound

• See that baby is growing on track and positioned correctly
• Listen to the baby’s heartbeat
• Confirm estimated delivery date
• Determine if you are having multiples
• Diagnose or check for a potential problem such as a birth defect
• Look for reassurance that you will not go into preterm labor. Measuring your cervix helps to rule out this possibility.
• Check the placenta location and the amount of amniotic fluid
• Determine the baby’s sex

Should You Find Out the Sex of Your Baby?

No doctor can answer this question for you—determining the sex of your baby is a personal choice. The excitement, the need to plan, and the hope that knowing the sex will help you bond with baby better are all excellent reasons for determining the sex. However, there’s rarely a medical reason to find out the sex of your baby.

It must be noted that not every ultrasound is successful in revealing a baby’s sex. If the genitals are not obvious, then the technician or doctor may not be able to determine the sex. It’s also possible to predict that the baby is a girl, when in reality it is a boy.

This is the seventh article in a series of articles that discuss what Connecticut moms-to-be can expect in prenatal care. Check back regularly for more information.

To schedule an appointment with Dr. Garofalo, call 203-803-1098 or visit us at Garofalo Obgyn Connecticut website.

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.

We will also use the Doppler to listen for the baby’s heartbeat. Bear in mind that it may be too soon to hear the heartbeat clearly, so do not worry if you don’t. By the way, a Doppler is a small, non-intrusive device that is placed over your abdomen to reveal your baby’s heartbeat. The machine uses ultrasound to convert sound waves.

Third prenatal appointment: Occurs between the 14^th and 16^th week of pregnancy

The second trimester begins at week 14 of your pregnancy. Around now you will hopefully begin to have more energy and less morning sickness. You may also start to appear pregnant.

While you may be feeling more pregnant now, your third prenatal appointment won’t differ much from your previous prenatal appointment.

If your doctor did not conduct tests for the presence of Alpha-Fetoprotein (AFP) in your blood, then you will undergo that testing now, assuming you requested prenatal genetics testing. AFP testing looks for risk of Down syndrome, trisomy 18, neural tube defects, and other birth defects. These tests can be a combination of blood test, ultrasound, and amniocentesis (see our previous post about genetics testing).

As always, your prenatal appointment is an opportunity to ask questions about your pregnancy and upcoming labor and delivery. Arrive prepared to ask questions.

This is the sixth article in a series of articles dedicated to expecting moms here in Connecticut. Visit us often to learn more about prenatal care.

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

Carrier test – A blood or saliva test completed at any time to determine if either parent is a carrier of a genetic defect.

Chorionic villus sampling (CVS) – Between 10-12 weeks, a sample of cells from the placenta is tested to find chromosomal problems.

Nuchal translucency screening – Between 10 and 14 weeks of pregnancy, this special ultrasound and blood test look for signs of Down syndrome, trisomy 18, and heart defects.

Maternal serum screening – Between 15 and 20 weeks of pregnancy, a blood test that measures certain substances to determine if the there is an increased risk of a neural tube defect, abdominal wall defect, Down syndrome, or trisonomy 18.

Amniocentesis – Between 15-20 weeks, a needle can be used to draw amniotic fluid and cells from the sac around the fetus to check for chromosomal problems.

Detailed ultrasound exam – If a screening test shows there is an increased risk, a detailed ultrasound will help to explain the screening. Test can be completed anytime after 18 weeks of pregnancy.

Fetal blood sampling/cordocentesis – Blood is taken from the umbilical cord when the results of an amniocentesis or CVS are not clear.

What Happens When You Decide To Do Genetics Testing

Ultimately, you get to choose what, if any, genetics testing you have done during your pregnancy. Depending on what the doctor finds, you may need additional tests, the doctor may want to monitor the baby more closely, you may need to deliver sooner than expected, or, nothing will be done at all, because you and your baby’s health looks fine.

Other Special Testing During Pregnancy

Not all prenatal testing looks for genetics disorders. You doctor may want you to complete any number of special tests to look for potential problems (tests include fetal movement counts, ultrasound, Doppler ultrasound of the umbilical or other artery, nonstress test, biophysical profile, and contraction stress test).

As published by the American Congress of Obstetrics and Gynecology (ACOG), most obstetricians will request frequent tests if you have any of the following:

• Blood disorders
• Thyroid disease
• Heart disease
• Lupus
• Kidney disease
• Diabetes
• High blood pressure

To read more about genetics and special prenatal testing, visit our library of resources that contains a pamphlets published by ACOG. You may also subscribe to our RSS feed to get our blog updates directly to your feed.

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.

Having practiced obstetrics for over 20 years, I hear many of the same questions from hopeful and expecting moms. With so much information available on the web today, many of my Connecticut patients have trouble sorting through what is credible and what is not. 

To help sift through the pregnancy information and to answer so many of those common pre-natal questions, I thought I would address frequent pregnancy concerns from a medical point of view via a new blog series that covers everything from pre-pregnancy to delivery. 

In each post, I will generally follow published information from the American Congress of Obstetricians and Gynecology (You can find more information from ACOG in our library of detailed pregnancy pamphlets).

And now, without further adieu, here are a few best practices for women who hope to conceive.

Achieve a Healthy Weight and an Active Fitness Level

Pregnancy is not the time to try and lose weight, experiment with your diet, or try a new workout routine. Reach a healthy weight prior to becoming pregnant. If you are overweight, you could have problems with diabetes and high blood pressure (among other risks), and if you are underweight, you could have trouble getting pregnant or deliver a baby with a low birth weight.

Take at least 400 micrograms of Folic Acid Every Day- 1000 micrograms is probably better.

Folic acid is a B vitamin, which is incredibly important for women who are pregnant or hope to become pregnant. While folic acid can be found in citrus fruits, leafy green vegetables, and beans, it’s recommended that you take .4 mg of folic acid every day regardless of your diet. Folic acid has been found to prevent neural tube defects, cleft palette, congenital heart disease, and other birth defects.

See the Doctor for a Pre-Pregnancy Visit

If you hope to become pregnant within the next few months, now is the time to talk to your doctor. Your health prior to pregnancy will impact your health during pregnancy, logically. Before you go to your pre-pregnancy appointment, do the following homework.

• Talk to your family members about their medical history. The doctor will want to know if you or your partner may be carriers of any genetic disorders, among other problems.
• Take an inventory of all the medications and supplements you take. Bring the bottles with you to the appointment if it’s helpful. Keep in mind that even natural remedies can be harmful during pregnancy.
• Confirm that you have all your vaccinations. It’s not safe to receive certain vaccines during pregnancy or one to three months prior to becoming pregnant.

Quit Smoking and Drinking

Aside from obvious health risks involved with cigarette smoking and alcohol drinking, both can also make it harder for some women to conceive. If you hope to become pregnant soon, quit smoking and drinking on your own or seek the help of an addiction counselor to help you overcome an addiction.

For more information about pregnancy and obstetrics in Connecticut, visit the pregnancy information pages of our website or call our office to schedule a consultation with Dr. Garofalo.  203-803-1098.

H1N1 FLU ANNOUNCEMENT

Please listen to this important announcement about the risks and prevention of the Swine Flu H1N1 Virus for pregnant women.