Welcome to Trinity Womens Care

Congratulations on your pregnancy!! Our goal is to provide excellent obstetric care. I remember the joy and the fear, the emotional and physical changes during pregnancy. I want to reassure you, to challenge you to be your best and to ensure the health of our two patients - you and your baby.
One important point:
There are NO dumb questions.

Due Date and Timing in Pregnancy
Your due date is determined as 40 completed weeks from your last period. If you are unsure of your last period or have irregular intervals between menstrual cycles, let us know. Ultrasound is often used to confirm or change a due date. It is normal for your baby to arrive anywhere from 37 to 42 weeks.
We will talk about your pregnancy in weeks. Every 13 weeks marks a trimester.

Routine visits are scheduled as follows: 
- Every 4 weeks from 10 to 30 weeks 
- Every 2 weeks from 30 to 36 weeks 
- Every week from 36 weeks to delivery

Pre-Natal Care
We will discuss all of the following at your office visits; however, it is nice to have something to refer to when questions come up.

1. Nutrition/Health Habits
A good rule during pregnancy is to be yourself, but better. Substitute cottage cheese for that doughnut. Eat your greens. A low-fat, low-sugar diet is best. Stop smoking. We recommend gaining five to ten pounds in the first twenty weeks, then a pound per week for the next twenty weeks. Listen to your body. Eat when you are hungry. If you have a limited diet, for example, vegetarianism, make sure you get enough folic acid, protein and iron.

2. Medications
After the first trimester, you may take Tylenol or Sudafed (dose on package) if you have a cold (or you may choose to simply blow your nose). Call us regarding any other medications. In general, keep medications to a minimum.

3. Ultrasound
We generally do an ultrasound in the office in the first trimester to confirm your due date. Another ultrasound is optional; a screening ultrasound is often done at 18 weeks.

4. When to call the office: (Call 372-0006 day or night)
-    Temperature greater than 101 degrees nd/or   chills
-    Nausea and vomiting such that you haven't been able to keep down fluids for 24 hours or more 
-    Vaginal bleeding
-    Marked decrease in the baby's movements (after 24 weeks) 
-    Severe abdominal pain 
-    Burning with urination 
-    Any time you are unsure or have questions

5. Insurance
As you may know, there are two types of insurance plans. PPO plans allow you to see a physician without a referral from a primary care physician. HMO's usually require a referral. You are responsible to know whether your plan requires that you see your primary care physician first and if you must pay a co-pay.
If we are a participating practice in your insurance plan (PPO or HMO), we will be happy to file insurance claims for you as a courtesy. The front office can tell you if we participate with your insurance plan.

If you have any billing questions, call Ann directly at 727-372-4566

�        Headache, body ache, low-grade fever - Tylenol or
         Extra-strength Tylenol

�        Colds -  Sudafed, Tylenol Cold and Sinus, Actifed,
         Dimetapp, Regular Benedryl

�        Cough - Robitussin or Robitussin DM (use sugar-free if
         diabetic)

�        Constipation  - Increase fluid intake, use glycerin
         suppositories and stool softeners such as Colace or  
         Metamucil regularly.  If you are less than 20 weeks
         pregnant, an enema is safe for severe constipation.

�        Diarrhea - Imodium AD or Kaopectate

�        Gas -  Maalox Plus, Mylanta-II, Mylicon

�        Heartburn - Maalox, Mylanta, Zantac, Pepcid AC, Tums,
         Rolaids

�        Hemorrhoids - Anusol HC, Preparation-H,  Witch hazel
         on cotton pads or Tucks, Ice packs

�        Nausea - Emetrol

�        Sore Throat - Chloroseptic spray or lozenges or Cepacol
         lozenges

�        Tooth pain - Extra-Strength Tylenol

�        Yeast infections - Monistat 3 or 7 day (suppositories or 
         cream)

�        Vaccinations:  A flu shot in pregnancy is allowed as this
           is not a live virus.  
               PPD testing for tuberculosis (TB test) is allowed
               Hepatitis vaccination is allowed
�        Hair color and perms are allowed

 Optional Testing In Pregnancy

During your pregnancy, we do a number of routine tests. Blood count, blood type and Rh status, gestational diabetes screening are a few of the tests we use to help insure a good outcome for you and your baby.

There are, however, several optional tests we will offer you during your pregnancy. With the brochures given in the office and our counseling during your visit, this information is meant to help you make an informed decision about optional testing during your pregnancy.

Here's the bottom line: Do the tests if the results will be helpful for you. If the results of the test won't make any difference for you, don't do the test!

1. Triple (or quadruple) Test:
This blood test, done between 15 and 20 weeks gestation, provides screening for two (or three) conditions. 

- Spina Bifida (and associated disorders):  Spina bifida is a condition that occurs during early development of the baby whereby the spinal bones don't close in a complete circle. This allows the spinal cord to be damaged, to varying degrees. Some children with spina bifida have no obvious problems, others cannot walk or control bowel or bladder function.
- Down's syndrome (also called Trisomy 21):  Rarely is this associated with family history; this is a chromosomal abnormality that occurs very early in the baby's development. 
- Cystic fibrosis:  In this condition, children accumulate thick secretions in the lungs and other tissues. Breathing problems and infections are the major symptoms.

Since this is a screening test, it is not a perfect predictor of these disorders.

For spina bifida, 5% of the time the test will tell you the baby has the problem when in truth, the baby is just fine.

For Down's Syndrome, the false positive and false negative results depend upon age. The younger you are, the higher your chance of a false result. Combined false positive and false negative rates can be up to 30%.

If you have a positive test (a test that says the infant may be affected), we recommend genetic counseling, a comprehensive ultrasound at a specialist and possible amniocentesis.

2. Genetic Testing
Since the risk of a chromosomal abnormality increases with maternal age, we offer a referral for testing for Down's Syndrome and other chromosomal abnormalities to our patients who will be 35 years or older at the time of delivery.

Why 35? No, it's not that you suddenly reached some scary risk at the age of 35. A decision was made to offer genetic testing to women starting at age 35 because at that age, the risk that you will have an infant with Down's Syndrome equals the risk that an amniocentesis will cause a miscarriage. Are we comparing apples and oranges here? Absolutely! However, that's the best criteria we've got for offering this testing and more importantly, that's the criteria the insurance companies recognize. (This testing is quite expensive.)

Two options are available to determine if your infant has a chromosomal abnormality:

- CVS (Chorionic Villus Sampling) - In this procedure, a tiny sample of tissue from the placenta (placentas are made up of tissue called chorionic villi) is used to provide cells that will grow in the laboratory and be tested for their chromosomal content. For this procedure, we will you refer to a specialist. At his office, you will receive counseling about the risks of the disorder and the risks of the procedure. The tissue is obtained either through the cervix or with a needle through the abdomen. The benefit of CVS is that it can be done in the first trimester. The risk of miscarriage is higher with this procedure. 
- Amniocentesis:   A needle is inserted into the abdomen at 12 to 20 weeks gestation, amniotic fluid is withdrawn, and the fetus' skin cells which have sloughed off into the amniotic fluid are cultured (multiplied by growth) in the laboratory to be tested for chromosomal content. If you would plan for termination of a pregnancy if the results were abnormal, a second trimester termination is more difficult. The test is much easier to perform than a CVS and the risks are fewer.

Some patients choose to use two screening tests to help them decide whether to go on for amniocentesis or CVS. 

- Nuchal fold thickness:   There is an area at the back of the neck in first trimester embryos called the nuchal fold that is enlarged in fetuses with Down's Syndome. This area can be best seen with ultrasound exam at 11 weeks gestation. This screening is still under investigation, and we do not know the absolute predictability of this test, but we are willing to offer this testing if you are interested.
- Triple Test:   Again, the false positive and false negative results of this test are quite high; yet some of our patients find this a useful aid in deciding whether to undergo amniocentesis.

As always, we are more than happy to discuss this with you at any time.

 

SO YOU THINK YOU'RE IN LABOR!

First, ignore all this if you are less than 37 weeks gestation.  If you are pre-term and have more than 6 contractions in an hour, we want to hear about it!

If you are 37 weeks gestation or greater, call us for these signs of labor:

- Contractions 4 minutes apart (time from the beginning of one contraction to the beginning of the next) for a full hour 
-  Rupture of membranes (a gush of water that continues to trickle out over the next 20 minutes)

It is normal to pass some bloody mucous, but flowing blood can be a sign of trouble.

Be aware of your baby's movements. You should continue to feel movement even during early labor. Call if you perceive a decrease in fetal movement. 

  GROUP B STREP IN PREGNANCY

1. What is Group B Strep (GBS)?
   GBS is one of many common bacteria that live in the human body without causing harm in healthy people. GBS develops in the intestine from time to time, so sometimes it is present and sometimes it is not. GBS can be found in the intestine, rectum, and vagina in about 2 out of every 10 pregnant women near the time of birth. GBS is NOT a sexually transmitted disease, and it does not cause discharge, itching or other symptoms.

2. How does GBS cause infection?
   At the time of birth babies are exposed to the GBS bacteria if it is present in the vagina, which can result in pneumonia or a blood infection. Full term babies that are born to mothers who carry GBS in the vagina at the time of birth, have a 1 in 200 chance of getting sick from GBS during the first few days after being born. Occasionally, moms can get a postpartum infection in the uterus also.

3.How do you know if you have GBS?
   Three to five weeks before your due date, during a regular prenatal visit, your practitioner will collect a sample by touching the inner part of your vagina and just outside the anus with a sterile Q-tip. If GBS grows in the culture that is sent to the lab from that Q-tip sample, a note will be made in your chart and you will be notified so you can share this information when you go into labor.

4. How can infection from GBS be prevented?
   If your GBS culture is positive within the 5 weeks before you give birth, your practitioner will recommend that you receive antibiotics during labor. GBS is very sensitive to antibiotics and is easily removed from the vagina. A few intravenous doses given up to four hours before birth almost always prevents your baby from picking up the bacteria during the birth. It is important to remember that GBS is typically not harmful to you or your baby before you are in labor

5. Do you have to wait for labor to take the antibiotics?
   Although GBS is easy to remove from the vagina, it is not easy to remove from the intestine where it lives normally and without harm to you. While GBS is not dangerous to you or your baby before birth, if you take antibiotics before you are in labor, GBS will return to the vagina from the intestine, as soon as you stop taking the medication. Therefore, it is best to take antibiotics during labor when it can best help you and your baby. The one exception is that occasionally, GBS can cause a urinary tract infection during pregnancy. If you get a urinary tract infection, it should be treated at the time it is diagnosed and then you should receive antibiotics again when you are in labor.

6. How will we know if your baby is infected?
   Babies who get sick from infection with GBS almost always do so in the first 24 hours after birth. Symptoms include difficult breathing (including grunting or having poor color), problems maintaining temperature, or extreme sleepiness that interferes with nursing. Babies who develop GBS infection will be given IV antibiotics.