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Prenatal Care includes regular visits and education.   Visits allow us to monitor your health as well as that of your growing baby.  You can discuss any questions or concerns you may have and learn more about your pregnancy.

Between 7 and 9 weeks we recommend an appointment to confirm the viability of your pregnancy.  This visit includes a pelvic exam and a transvaginal ultrasound to confirm that you have a pregnancy in your uterus with a viable heartbeat. It is also important to confirm your dating is correct.

Between 10 and 12 weeks you will have your first OB visit. This visit includes a full physical with a breast exam and pap smear if you are due for one.  Your initial OB blood work is drawn.  You will be given a referral for ultrasounds.  You are generally offered an ultrasound for screening for Down syndrome and related conditions between 11.5 and 13.5 weeks.  You will have an anatomy ultrasound between 18-22 weeks.  Additional ultrasounds are ordered on an individual basis as needed.

Between 12 and 28 weeks, you will typically come every 4 weeks. At each visit, you will give a urine sample, which checks for blood, protein, glucose. You will have your weight and blood pressure checked. You will meet with the physician or nurse practioner.  You will have fetal doptone (heartbeat) checked and after 20 weeks your abdomen will be measured to check for growth.  You will have the opportunity discussed any questions and concerns.

After 30 weeks, you typically come to your appointments every 2 weeks, until 36 weeks, after which you come weekly until delivery.

At 36 weeks, you will have your first cervical exam.  We will confirm fetal position and evaluate your cervix for dilatation.  You will be swabbed for Group B strep (GBS). 

After 36 weeks, your weekly appointments start. At the 37 week appointment, you typically aren’t checked internally unless you are having complaints. Usually, starting at 38 weeks you are checked weekly.  If you are having a scheduled c. section, you are typically not checked unless you would like to be.

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At your initial OB visit, we check certain routine blood tests that are recommended for all pregnant women.  This includes:  complete blood count, blood type, Rh factor, antibody screen, urinalysis, urine culture, syphilis, gonorrhea, chlamydia, hepatitis B and hepatitis C, HIV, rubella, thyroid function, testing for sickle cell disease and cystic fibrosis carrier status.  Some women will have early screening for gestation diabetes depending on previously history and weight. 

You will be offered a screening test for Down syndrome and related disorders. This is an optional test. It involves an ultrasound to measure the nuchal translucency (which is the back of baby’s neck) done between 11.5 and 13.5 weeks. We do not do this screening test in our office. It must be done by a specially certified ultrasonographer.  If you are over the age of 35, we typically refer you to the Center for Maternal Fetal Medicine. Occasionally, if you are under the age of 35, you can have this test performed at few other radiology centers.  Please click on the link below to watch a 9 minute informational video on the Nuchal Translucency Screening.

 Nuchal Translucency Screening

If you decline the early ultrasound screening. we can still do blood work to screen for these conditions between 15 and 21 weeks. Between 15 and 21 weeks, you will be offered screening test for spina bifida.

Between 26-28 weeks, you do screening test for gestational diabetes, repeat complete blood count to screen for anemia (which can be common as you enter the third trimester) and have another test for syphilis.  If your blood type is Rh neg, you will have a repeat antibody screen and a Rhogam shot.

 At approximately 36 weeks, you will be swabbed for Group B strep (GBS).  GBS is a type of bacteria that lives in your vagina and rectum.  It does not make you sick, but can make your baby sick when it is passed from mother to baby during labor.   Approximately 20 % of women have GBS.  If you carry GBS, you are given antibiotics during labor to help prevent the baby from becoming infected.

 Results: Your test results will be reviewed with you at your next prenatal visit. If a test comes back abnormal, you will be contacted prior to your next appointment by phone or mail.

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Do not skip meals or go for many hours without eating.

Do not eat fish with high level of mercury, such as shark, swordfish or mackerel.  Do not eat more than one can of tuna each week.

Drink plenty of fluids.

Do not drink alcohol.

Do not use illegal drugs.

Do not smoke. If you need help quitting, talk to your provider.

Do not touch cat feces or litter boxes.

Do not use saunas or hot tubs.  Raising your body temperature may harm your baby.

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Review all of your medications with your provider.  Some of your medications may need to be changed to protect your baby.  Take your medications exactly as prescribed.  See our list of approved medications during pregnancy and lactation.

Medication.pdf

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You are given an early ultrasound for viability in our office between 7-9 weeks.  All other ultrasounds are performed elsewhere, at radiology centers, such as Chesapeake Medical Imaging or the Center for Maternal Fetal Medicine.

You are offered an ultrasound for screening for Down syndrome and related conditions between 11.5 and 13.5 weeks.  You will have an anatomy ultrasound between 18-22 weeks, which checks that the baby’s anatomy has formed properly and will tell you the sex if you want to know.  Additional ultrasounds are ordered on an individual basis as needed.

 If you do not have a medical indication for follow up ultrasound, but would like to see your baby again, you are welcome to have a nonmedical 3D/4D ultrasound.  As these ultrasounds are non-diagnostic, they are not covered by insurance.  

www.motherhoodultrasound.com

www.babytobeimages.com

www.thatsmybabyultrasound.com

www.peekawomb.com

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Nausea and vomiting, breast changes, frequent urination, lower abdominal pain, back pain, heartburn, constipation, varicose veins, leg swelling, hemorrhoids, leg cramps, skin changes, and carpel tunnel can all be normal complaints associated with pregnancy.  Most symptoms related to these complaints are normal. We invite you to discuss any concerns you may have with your provider. 

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Prenatal vitamins are generally recommended to any women who are attempting to conceive or who are pregnant or breastfeeding.  Over the counter vitamins that are labeled as prenatal are acceptable, or you can ask with your provider for a prescription prenatal vitamin.  Make sure your vitamin contains 400 micrograms (mcg) of folic acid to help prevent birth defects. Occasionally, we will also recommend additional iron supplementation, especially in the third trimester.

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The day you reach 40 weeks from the first day of your last menstrual period is your estimated due date (EDD.) Although few women give birth on their exact due dates, the EDD is useful as a guide for checking the baby’s growth and the progress of your pregnancy.  It also is used to plan the timing of prenatal tests.

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Click here to read more 

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Women with uncomplicated pregnancies are encouraged to exercise as part of a healthy lifestyle before, during, and after pregnancy. For most healthy pregnant women, moderate intensity exercise (able to carry on a normal conversation during exercise) that includes aerobic exercise and strength training, can be performed for 30 minutes daily, 5 to 7 days per week. Previously sedentary women should begin with 15 minutes of continuous low-intensity exercise 3 times per week, increasing the intensity, frequency, and duration gradually. Physically-active women can engage in moderate to vigorous physical activity.  Contact sports and physical activities in which balance is particularly important are a concern in pregnancy because of the risk of fetal harm from maternal trauma.

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For healthy patients not having any complications, air travel is generally acceptable up until 36 weeks gestation.  Frequent ambulation is encouraged. We recommend caution if traveling internationally after 24 weeks. Please ask your physician about additional recommendations.

Please see recent update on Zika virus if traveling to South America or the Caribbean.

CDC Zika Virus Travel Information

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Nausea early in pregnancy is a common and normal complaint.  Although, typically referred to as “morning sickness” it can occur at anytime of the day.  We recommend small, frequent meals.  Bland foods are helpful. Staying hydrated with fluids is important even if you have difficulty with solid foods.

            -Eat small amounts frequently

            -Avoid greasy, spicy, fried or oily foods

            - Avoid all sodas except Sprite, ginger ale and 7-UP

            - Avoid cooking if the odor bothers you

            - See medication list for complete list of approved anti-nausea medications

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Historically, physicians advised women against dying their hair while pregnant, because it was thought to be potentially harmful to the fetus. However, today it is believed that hair dyes are most likely safe to use during pregnancy since very little is absorbed through the skin.  It is generally preferable to wait until the end of the first trimester.

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Dental procedures and x-rays are not contraindicated with abdominal shielding.  Lidocaine and other local anesthetics used for dental procedures are safe as well.

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Sexual activity during pregnancy is safe for most women right up until labor, unless your physician has advised against it. Couples may need to try different positions as the woman’s stomach grows.  Women may be advised to limit or avoid sex if they have had preterm labor, more than one miscarriage, placenta previa, infection, bleeding or leaking amniotic fluid.

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Small amounts of caffeine are acceptable. We suggest women who are attempting to conceive or who are pregnant or breastfeeding limit caffeine consumption to less than 200 to 300 mg per day.  An 8 oz serving of coffee has between 100-200 mg of caffeine. An 8 oz serving of tea has between 40 and 120 mg caffeine. A 12 oz Coke has about 50 mg caffeine.

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ACOG (American College of Ob/Gyn’s) believe that there are many questions about this technology that remain unanswered.  Parents should not be sold this service without a realistic assessment of their likely return on investment.  The odds of needing a stem cell transplant are low- estimated at between 1 in 1,000 and 1 in 200, 000 by age 18. 

If you are interesting in learning more about theses services we recommend the following companies:

CBR, Cord Blood Registry.  www.cordblood.com 

Viacord Cord Blood Bank   www.viacord.com

 We are happy to provide cord blood collection services to our patients, however, because blood banking is an elective procedure, we will bill you directly.  Our fee is $250.00.  This fee is billed separately from maternity and delivery fees. Insurance companies do not pay for this service. If you have questions, please call our billing office.

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During pregnancy, it is important to watch how much weight you gain.  How much you should gain depends on your starting weight.  If you are normal weight, you only need 300 extra calories per day during pregnancy. Normal weight women should gain between 25-35 lbs during pregnancy.  See the link below to read more about the complete recommendations from the National Institutes of Health.

 Weight Gain in Pregnancy

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The following represents a compilation of the precautions recommended by FSIS and the CDC. The general recommendations for safe food handling include:

●Do not drink raw (unpasteurized) milk or eat foods that contain unpasteurized milk.

●Wash raw vegetables thoroughly before eating.

●Keep the refrigerator temperature at 40ºF (4.4ºC) or lower; the freezer at 0ºF (-17.8ºC) or lower.

●Eat precooked, perishable, or ready-to-eat food as soon as possible.

●Keep raw meat, fish, and poultry separate from other food that will not be cooked and from cooked foods and ready-to-eat foods.

●Wash hands, knives, and cutting boards after handling uncooked food.

●Thoroughly cook raw food from animal sources to a safe internal temperature: ground beef 160ºF (71ºC); chicken 170ºF (77ºC); turkey 180ºF (82ºC); pork 160ºF (71ºC).

The following additional recommendations were made for individuals at high risk such as pregnant women:

●Do not eat hot dogs, luncheon meats, bologna, or other delicatessen meats unless they are reheated until steaming hot; avoid the use of microwave ovens for reheating such meats since uneven cooking may occur.

●Avoid contamination of utensils and food preparation surfaces with fluid from packages containing hot dogs, luncheon meats, delicatessen meats, raw meat, chicken, turkey, or seafood. Handwashing is also important immediately after handling of any of these products.

●Do not eat prepackaged salads containing ham, chicken, egg, tuna, or seafood.

●Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pasteurized milk.

●Do not eat refrigerated pâtés or meat spreads. However, canned or shelf-stable products are safe and can be eaten by pregnant women.

●Do not eat refrigerated smoked seafood, unless it is cooked as in a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." Such fish products are typically found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. However, canned or shelf-stable smoked seafood may be eaten.

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We strongly recommend several vaccinations during pregnancy.  The flu shot is recommended every fall, it is typically available in our office from September to December.  After 27 weeks, we recommend the Tdap vaccine for pertussis (whooping cough). The Centers for Disease Control and Prevention recommend that pregnant women should receive a dose of Tdap during EACH pregnancy. The CDC also strongly recommends that any adult having close contact with your baby who has not had the Tdap receive this immunization.

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We perform all surgeries and deliveries only at Anne Arundel Medical Center. Please visit the hospital website to find out more about the services offered.  There you will find information about the prenatal classes available.  Please register with your insurance information prior to delivery. 

Anne Arundel Medical Center

The hospital also offers a helpful patient guide.  Please see the link below.

Patient Guide

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We have a triage nurse available Monday-Friday during office hours to answer medical questions.  After hours, please call our main office number (410)571-9700.  If the office is closed and you are having a medical emergency or a pregnancy related issue, you can call the emergency number which will page the on-call physician.  Please attempt to reach the on-call doctor before going to Labor and Delivery.  We typically prefer to speak directly to the patient (rather than your partner, mother etc.)

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Pregnancies complicated by hypertension, diabetes or other chronic medical illness or fetal issues are monitored in conjunction with the specialists at the  Center for Maternal and Fetal Medicine.  They typically see you for ultrasound monitoring and fetal testing, but they do not perform deliveries. They act only has valuable consultants. 

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In the third trimester, if you notice a significant and persistent reduction in fetal movement, we recommend you do a “kick count.”  Lie down in a quiet place, after you have eaten and are well hydrated, and count the fetal movements. You should perceive at least 10 fetal movements within two hours.  If you don’t feel 10 movements please call the office.

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TOLAC stands for trial of labor after cesarean delivery.  The decision for trial of labor after cesarean delivery or elective repeat cesarean delivery should be made by each woman in consultation with your provider. Success rates for women in the United States who attempted TOLAC range from 39 to 70%.  Women who have undergone a prior cesarean delivery are at risk for serious maternal and perinatal complications, and you will be counseled about the risk and significance of these complications.  If you are interested in a TOLAC, we recommend you discuss it with your provider.  In general, we will not induce you if you have had a prior c. section. You need to go into labor on your own.  We recommend scheduling a back up c. section date between 39 and 41 weeks. If you get to your scheduled date without going into labor, we will proceed with repeat c. section. Each patient’s situation is unique and should be discussed with your provider.  Please see the Anne Arundel Medical Center VBAC consent form Feel free to discuss it with your provider.

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For patient’s undergoing a planned cesarean delivery, we are happy to offer you a family centered c. section, which was pioneered at AAMC by our own Dr. Marcus Penn.  Please discuss with your provider if you are a good candidate for this procedure.  See the link below for more information. 

Family Centered C. Section

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Gush of fluid or feeling as if you continually leaking could be your water breaking.

Little vaginal spotting is not uncommon at the end of pregnancy, but if bleeding is heavy or like a period you need to call.

Decreased fetal movement. We recommend if you perceive a significant and persistent reduction in fetal movement to contact our office.

Depending on your history and individual circumstances, we may adjust these recommendations. If you have any of these symptoms we recommend you call our office.  Call the office number, (410)571-9700, 24 hour a day. During the day you may speak with our triage nurse. After hours, call the emergency number that is on the message, this will page the on-call physician and you will be called back.

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For most women ≥ 41 weeks of gestation, we suggest induction rather than expectant management. Induction after 41 weeks is associated with lower perinatal morbidity and less risk of cesarean delivery than expectant management.

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If you have had an uncomplicated vaginal delivery or c. section, we typically see you 6 weeks after your delivery for a postpartum visit. At this visit, we repeat your blood pressure and weight, and perform a pelvic exam.  We also screen for postpartum depression and discuss contraception. Occasionally, you will be instructed prior to leaving the hospital to follow up in the office sooner.

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