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Women’s Health of Augusta
Guideline to Prenatal Care

We follow ObGyn convention by assigning weeks from the 1st day of your last menstrual period.  Your due date will be 40 weeks from your last menstrual period.  This will be confirmed by either conception date (if known) and / or by Ultrasound.

We typically see patients every 4 weeks until ~30 weeks, then more frequently until the last month (weeks 36 to 40) where we see patients weekly. 

We check blood pressures, weight and urine (for infection, protein, ketones and glucose) at every visit.  We check hematocrit levels to assess your risk for anemia, which is common in pregnancy. 

Weeks 4 - 12:

You find out that you are pregnant.  We encourage your first visit by 8 weeks (at least). Your first visit (prenatal workup) is the busiest. 

  • General orientation to the practice
  • Physician examination (pap smear if due).
  • Assign due date
  • Discuss prenatal vitamins
  • Discuss any concerns
  • Routine prenatal blood work

We perform a first trimester ultrasound to check growth, viability, number and confirm dates.
           
Normal symptoms include fatigue, breast tenderness and nausea.  While spotting and occasional cramps are not unusual, persistent cramping or bleeding should be reported.

Weeks 12 - 20:

Normal symptoms include some uterine ligament stretching and typically, a resolution of nausea and fatigue as you enter your second trimester.  Typically, most women begin to feel some fetal movement between 16 and 20 weeks.

Website for second trimester: http://www.americanpregnancy.org/duringpregnancy/
fetaldevelopment2.htm

  • We check for fetal heart tones at every visit from 12 weeks.
  • We offer optional tests (between 16 to 19 weeks):
    • Quadruple screen:  A blood test that checks 4 different chemicals in your blood that gives us an approximate risk for neural tube defects (ex: Spina bifida), some chromosomal abnormalities (ex: Down’s syndrome – Trisomy 21), and other anatomic abnormalities (ex: Omphalocele – incomplete closure of the fetal abdominal wall).  If the screening test is ‘positive’, then we may perform an in-depth ultrasound evaluation, offer an amniocentesis and/or refer to a maternal-fetal medicine specialist for a second opinion.
    • Quad Screen: http://www.americanpregnancy.org/
      prenataltesting/quadscreen.html
    • Amniocentesis: http://www.americanpregnancy.org/
      prenataltesting/amniocentesis.html
    • Cystic Fibrosis: A genetic condition that can result in a severe lung disorder.  The blood test determines whether you are a carrier or not.  If positive, we would recommend checking your partner’s carrier status and / or referring to a genetics counselor. 
    • Ultrasound at ~ 20weeks:  To check fetal anatomy and growth. 

Weeks 20 - 30:

Normal symptoms include uterine round ligament stretching and occasional tightening of the uterus (Braxton-hick contractions). 

  • Measure uterine growth at every visit and listen to the fetal heart beat.
  • ~28 weeks:  Screening blood test for Diabetes in pregnancy. 
    • We usually schedule this visit in the morning.  You will have a fasting blood glucose level drawn, a sugary drink administered, and another blood level drawn an hour later.  If this screening test is positive, we then administer a more accurate and more involved 3 hour Glucose tolerance test another day.
  • Diabetes: http://www.americanpregnancy.org/
    prenataltesting/glucosetest.html
  • For women who are Rh- (Ex: A ‘negative’ blood type like A-, B-, O- and AB-): At 28 weeks you get your first Rhogam injection (to decrease the chance of building up antibodies against future pregnancies); the second injection will be administered after delivery.
  • Rh factor:  http://www.americanpregnancy.org/
    pregnancycomplications/rhfactor.html

Weeks 30 - 36:

  • Website for 3rd Trimester:http://www.americanpregnancy.org/
    duringpregnancy/fetaldevelopment3.htm
  • As you enter your third trimester we will give you registration information for your hospital. You can sign up for classes, obtain more information on epidurals, childbirth and breast feeding.
  • We usually see our patients more frequently, every 2-3 weeks.
  • Normal symptoms include uterine cramping (‘braxton-hicks contractions’), back pain, and heartburn.  If you have more than six contractions per hour that is persisting and increasing despite rest and fluids, please notify us.

Weeks 36-40:  Last month!

We increase our visits to weekly.  Discuss delivery management plans.  Repeat Cesarean sections are typically scheduled @ ~ 39weeks.

  • Group B streptococcus Culture:  Typically done around 35-37 weeks, it is a vaginal culture to screen for fairly common vaginal bacteria that can cause serious infections in newborns (ex: pneumonia).  If positive, we will treat with I.V. antibiotics in labor. http://www.americanpregnancy.org/
    pregnancycomplications/groupbstrepinfection.html
  • Weekly cervical checks for dilation, effacement and baby’s positioning.
  • Normal symptoms include lower abdominal pressure, contractions and fatigue.   As your cervix thins, you may have some vaginal spotting.  If you have any vaginal bleeding, a sudden gush of fluid (possible rupture of the membranes), or your baby is not moving, call your doctor.    Labor varies from person to person.  If you have contractions increasing in frequency to every ~ 5 minutes apart, lasting longer each time, with increasing intensity for at least 1 – 2 hours, then please call us. 
  • Website for Epidural Info:              http://pregnancy.about.com/od/epidurals/ss/epidural.htm

Weeks 40 and over:

It is fairly common for patients to go past their due date.  We will increase antenatal surveillance by performing tests (non-stress tests, biophysical profiles by ultrasound) to evaluate fetal well being.  We will further discuss labor and delivery management plans, including possible induction. 

           

           


 

 

 

 

 

 

 

 

 

 

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