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Obstetrical Care


 

Pregnancy & Vaccines

Vaccines are an important part of a healthy pregnancy. Vaccines help protect both you and your baby from diseases like influenza and pertussis.

The providers at our practice strongly recommend the following vaccines during pregnancy:

  • Influenza "flu" vaccine:
    Pregnant women are at higher risk for serious complications from influenza, including hospitalization and death. The inactivated influenza vaccine (aka "the flu shot") can be given at any point during the pregnancy, whenever it becomes available.
  • Tetanus, Diphtheria and Pertussis Vaccine (Tdap):
    This vaccine protects you from tetanus, diphtheria and pertussis or "whooping cough." A woman should get a Tdap shot during every pregnancy, and the best time to receive the shot is during the last trimester, between weeks 27 and 36 weeks gestation. Getting vaccinated during this time provides your fetus with the most protective antibodies right before birth. This is important because newborns under 3 months old are at the highest risk for serious complications and death from whooping cough. Since babies do not get their first pertussis vaccine (called DTaP) until two months of age, being vaccinated with Tdap during pregnancy can help protect your infant during this vulnerable time.

Our office is happy to provide you with a Tdap vaccine and an inactivated seasonal influenza vaccine (when available).

We encourage you to learn more!

For more information, below are links to reputable online resources that we trust to provide evidence-based information on vaccines during pregnancy:

Pregnancy & The Flu

Flu Season is coming. Pregnant women are more severely affected by influenza compared with the general population. Please get your flu vaccine at our office when it becomes available this fall.

Prenatal Testing Options

There are several different options available to pregnant women to test for certain genetic conditions and birth defects, including Down syndrome, Trisomy 18 and open neural tube defects. Down syndrome is caused by an extra chromosome #21 and results in both mental disabilities and physical abnormalities. Trisomy 18 is caused by the presence of an extra chromosome #18 and causes severe mental retardation and birth defects. Most children with Trisomy 18 do not survive the first year of life. The risk of chromosomal abnormalities like Down syndrome and Trisomy 18 increases with maternal age. Neural tube defects occur when the neural tube, which develops into the baby’s spinal cord and brain, does not close completely. This is also known as spina bifida. This leaves an opening along part of the baby’s spine or head and can cause paralysis and other physical or mental problems. Recent studies have shown that prenatal surgery can possibly correct these defects or reduce the rate of paralysis with these defects in certain cases. The risk of open neural tube defects is not affected by maternal age.

The tests available to pregnant women include screening tests and diagnostic tests. Screening tests are non-invasive tests that better identify a woman’s personal risk of carrying a child with one of these conditions. Screening tests most often provide reassuring results and many women choose not to have any further testing if the screening comes back negative or at low risk. Diagnostic tests are invasive procedures that will tell her with certainty whether her child has these conditions. A woman can also choose to not have any testing performed.

Options for prenatal screening include the Sequential Screen, which is the most accurate non-invasive screening test for Down syndrome, Trisomy 18 and open neural tube defects. This test has two portions. The first trimester portion combines an ultrasound measurement of the skinfold at the baby’s neck and blood work. The second portion consists of blood work measuring 4 hormones taken during the second trimester. The risk is calculated after each portion of the test, so there is an option to proceed with diagnostic testing if the first trimester portion is abnormal. The combination of the first and second trimester tests of the Sequential screen detects 95% of fetuses with Down syndrome.

A second trimester only test is also available, called the AFP4. This non-invasive test measures 4 hormones in the maternal blood and detects 81% of fetuses with Down syndrome.

A targeted high-resolution ultrasound performed by the maternal-fetal medicine specialists can screen for birth defects or fetal anomalies, as well as identify placental, uterine or amniotic fluid abnormalities. Fetal ultrasound may not detect all fetal anomalies. Between 50% and 75% of fetuses with Down syndrome will have a visible ultrasound abnormality, so a normal ultrasound does not guarantee that Down syndrome is not present. More than 95% of fetuses with Trisomy 18 and spina bifida will have an ultrasound abnormality.

There is a screening option available that screens for open neural tube defects only. This is a blood test that measures the maternal serum alphafetoprotein level. It is measured during the second trimester, and if it is elevated there is an increased risk of open neural tube defects or other pregnancy complications.

If any screening test comes back abnormal, the results and options are discussed with the pregnant woman. She is referred to the maternal-fetal medicine specialists for further counseling and for diagnostic testing options. Diagnostic testing options depend on the stage of the pregnancy. Amniocentesis is generally performed in the second trimester between 15 and 20 weeks. A needle is passed through the abdomen and uterus into the amniotic sac around the fetus and a small amount of amniotic fluid is withdrawn. The fetal cells in the fluid are analyzed for chromosome abnormalities. Other inherited diseases can be tested for as well, such as cystic fibrosis and sickle cell anemia, if the parents are known to be carriers for the disease. The risk of a major complication from the procedure that could lead to miscarriage is 1 in 200, and is often even lower when done by experienced individuals.

Diagnostic testing can also be performed in the first trimester. Chorionic villus sampling (CVS) is performed between 10 and 12 weeks. This procedure obtains a sample of placental tissue to analyze for chromosome abnormalities. A catheter is passed through the cervix or a needle is used through the abdomen to obtain the tissue. The risk of complication such as miscarriage with this procedure is 1 in 100.

Any woman who has had abnormal screening tests will be given the option to proceed with diagnostic testing to determine if the fetus truly has an abnormality. Because screening tests are not 100% accurate in detecting Down syndrome, Trisomy 18 or open neural tube defects, all women may undergo a diagnostic procedure such as amniocentesis or CVS if they so choose.

OB Visit Intervals

Visit Intervals

In women who are low risk, visits usually occur:

  • every 4 weeks until 28 weeks
  • every 2 weeks until 36 weeks
  • every week until delivery

Frequency of visits may increase if a pregnancy is determined to be high risk.

What to expect at each visit

First Trimester (0-13 weeks)

Every visit will include:

  • Assessment of weight, blood pressure and urine, uterine size, fetal heart rate
  • Each assessment is to ensure the pregnancy is progressing well
  • Time to answer questions

Second Trimester (14-28 weeks)

The second trimester is very similar to the first in terms of routine evaluation of weight, blood pressure, urine and uterine size.

The other important tests that are performed during this trimester are:

  • Downs Syndrome Testing (if desired) (@15-21 weeks)
  • Fetal Anatomy ultrasound – Looks at the development of vital organs, placental location and amniotic fluid level. (@16-20 weeks)
  • Amniocentesis (if desired)
  • Neural Tube Defect testing (MSAFP)
  • Gestational Diabetes testing (@24-28 weeks)

Third Trimester (28-40 weeks)

Prenatal visits still include evaluation of weight, blood pressure, urine, uterine size and fetal heart rate.

The important tests that are performed during this trimester are:

  • Gestational Diabetes testing (if not done in the second trimester)
  • Antibody Screening in women with Rh negative blood type. This done to ensure that she can receive the Rhogam injection.
  • CBC/blood count to check for anemia. Increased iron requirements in pregnancy often result in anemia. Checking for anemia in the early third trimester allows for proper supplementation and counseling.
  • Group B Streptococcus Screening (GBS) (35-37 weeks): This is a swab of the lower vaginal and rectal area to screen for colonization of the GBS bacteria organism. GBS colonization is not harmful to the pregnant woman, but may harmful to the baby if it passes through the birth canal. A baby’s immune system is immature at birth and may be unable to fight off the GBS bacteria. This in turn can cause life threatening infections such as sepsis, pneumonia and meningitis.
  • Ultrasound: May be done to follow up on placenta location, fetal growth in at risk women with intrauterine growth restriction, chronic hypertension, diabetes and women with larger fibroids.

Another goal of Third Trimester screening is to diagnosis fetal malposition and preeclampsia.

  • Detection of a baby presenting in the wrong direction after 36 weeks allows for the possibility to turn the baby to the “head down” position. This is known as an External Cephalic Version.
  • Detection and treatment of preeclampsia is known to improve pregnancy outcomes.

Postdates/Post term Pregnancy (41-42+ weeks)

Approximately 6-8% pregnancies will go past the assigned due date. The risks of going past the due date include:

  • Large or macrosomic baby and potential birth trauma
  • Increases risk of still birth, meconium aspiration and low amniotic fluid
  • Maternal risks include: Increase in labor abnormalities, 3rd and 4th degree lacerations and increase risk of having a cesarean section

Because of the risks or postdate pregnancies most practices will favor induction at 41-42 weeks.

Cesarean Section

A cesarean section is an operation that is performed to deliver a baby through an abdominal incision. There are many reasons why a woman has a cesarean section. Some of these reasons are known in advance of your delivery date, but most are not encountered until labor.

Indications for Cesarean Section

Breech Baby

The breech presentation is when the buttocks or feet rather than the baby’s head is the presenting part in the mother’s pelvis.

Fetal Intolerance of Labor

A fetal monitor is used during labor to monitor your baby’s heart rate. If your baby is not tolerating labor well, the fetal heart rate may be abnormal. If treatments to correct the abnormal heart rate are not successful, your doctor might recommend a cesarean section.

No Progress in Labor

Once you are in active labor (~4cm), you should dilate about 1 cm per hour thereafter. Your labor may not progress normally if your baby is too big for your pelvis, or your pelvis is too small to allow passage of your baby. You may reach 10 cm dilatation, but may be unable to push your baby out because of its size or head position. If your labor does not progress because of these abnormalities, your doctor may recommend a cesarean section.

Infection

If your water bag has been broken for many hours you can develop a uterine infection that can affect your baby's health. If your baby shows signs of infection and you are far from delivery, your doctor may recommend a cesarean section delivery.

Herpes

If you have an active Herpes outbreak at the time of labor, your doctor will recommend a cesarean section to reduce the risk of transmission to your baby. Medication will be prescribed to take at least 4 weeks before your due date to decrease the risk of an active herpes outbreak at the time of labor.

HIV

HIV positive mothers may be offered a cesarean section to reduce the risk of neonatal transmission.

Placenta Previa

Placenta previa occurs when the placenta partially or completely covers the cervix, thus blocking the passageway of the baby. A placenta that attaches to the cervix can bleed if it becomes detached or if you have contractions. There are times when vaginal bleeding is so severe that it threatens the lives of mother and baby. In this case an emergency cesarean section may be performed even if the baby is premature. If a placenta previa has not caused problems with the pregnancy, a cesarean section will be scheduled 2-3 weeks before your due date.

Multiple Gestation

Twins are often delivered by cesarean section if one or both of the babies are not head down.

Previous Cesarean Section

If you have had a cesarean section, you may choose to have another for subsequent deliveries. Your doctor will provide you with statistics about the risks and benefits of attempting a vaginal delivery after a cesarean section. If you are not a candidate for a vaginal delivery after a cesarean section or if you choose to have a repeat cesarean, your doctor will schedule your surgery for 39 weeks or later.

Recovering From a Cesarean Section

Most women stay in the hospital for 3 days after a cesarean section. You will be discharged with prescription pain medicine. During your first week at home you should not participate in any strenuous activity. You may not have an appetite, but you need to drink a lot of water to stay well hydrated.

You should have a bowel movement within the first week after a cesarean section. Unfortunately the narcotic medicine that you are prescribed (Percocet, Vicodin or Lortab) may slow down your bowel function causing constipation. To decrease constipation, you may decrease narcotic use and/or use a stool softener such as:

  • Colace (Docusate): 1 tablet 2-3 times a day
  • Pericolace: (Docusate + Sennosides) 1 tablet 1-3 times a day
  • Laxatives: Milk of Magnesia, Correctal, Fleets enema, Miralax

Your incision will be tender and swollen for 2-4 weeks. As the pain subsides you can increase your physical activity. Refrain from heavy lifting, thus do not lift anything heavier than your baby in its car seat.

Do not drive for 2 weeks or if you have taken narcotic medication.

You should call your doctor if you:

  • Have fever >100.4 on two occasions in the same day
  • Have drainage for your incision
  • Have an increase in vaginal bleeding or pain (even with using pain medication)

Breast Feeding Benefits for Mom & Baby

Making the decision to breastfeed is a personal matter. It's also one that's likely to draw strong opinions from friends and family.

For more information, visit webMD.

Location
A'fina Houston OB/GYN
13920 Osprey Court, Suite A
Webster, TX 77598
Phone: 281-464-9100
Fax: 281-464-8864
Office Hours

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281-464-9100