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.

Around 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, which will be performed at Maternal Fetal Medicine.  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 4-6 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 practitioner.  You will have fetal 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 2-4 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 your cervix is checked.  If you are having a scheduled C-section, you are typically not checked unless you would like to be.

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.

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.

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.

OTC Medications during pregnancy

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.thatsmybabyultrasound.com

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.

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.

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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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.

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

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

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.

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

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.

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.

COG (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.

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.

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).  We typically give you this vaccine at your 28 week appointment. 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.
• COVID-19 vaccine development is rapidly progressing. Recommendations will evolve as data is collected about these vaccines and their use in specific populations, including pregnant and lactating women. Please see the most current recommendation regarding these vaccines in pregnancy and lactation: ACOG Practice Advisory.

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

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.)

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.

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.

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.

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.

Painful contractions that you are having trouble talking and breathing through every 5 minutes for 1 hour.

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.

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.

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.

An annual exam is a yearly visit for a general gynecological health check, including a breast exam and pap smear if indicated. An annual exam visit usually does not include discussion of new problems or detailed review of chronic conditions. Annual exams are also called routine check-up, yearly exam, annual pap, and preventive visit.

Please schedule a separate appointment if you have health concerns other than your routine physical exam. Examples are:

• A list of concerns or questions.
• New health care concerns or problems found at the time of your annual exam.
• Ongoing problems that need more attention.

What should I expect during my annual exam?

• General physical exam (including breast exam)
• Pelvic exam (pap smear)
• Update of life and work situation
• Update of family health history (any new serious illnesses in your family?)
• Review of your health history
• Update of current medications, herbs, and supplements (bring list)
• Need for medication refills
• Evaluation of need for health screening tests based on age and personal and family history (such as mammogram, test for sexually transmitted diseases, and colon cancer screening)
• Update on immunizations

A pelvic exam is a way for doctors to look for signs of illness in certain organs in a woman’s body. The word “pelvic” refers to the pelvis. The exam is used to look at a woman’s:

• Vulva (external genital organs)
• Uterus (the womb)
• Cervix (opening from the vagina to the uterus)
• Fallopian tubes (tubes that carry eggs to the womb)
• Ovaries (organs that produce eggs)
• Bladder (the sac that holds urine)
• Rectum (the chamber that connects the colon to the anus)

Do I Need to Do Anything to Prepare for a Pelvic Exam?

For 48 hours prior to the exam, you should not:

• Douche
• Use a tampon
• Have sex
• Use birth control foam, cream, or jelly
• Use medicine or cream in your vagina

What can I expect during a pelvic exam?

You can expect to feel a little discomfort, but you should not feel pain during a pelvic exam. The exam itself takes approximate 10 minutes. If you have any questions during the exam, be sure to ask your provider.

How Is a pelvic exam performed?

During a typical pelvic exam, your provider will:

• Ask you to take off your clothes in private (You will be given a gown or other covering.)
• Talk to you about any health concerns
• Ask you to lie on your back and relax
• Press down on areas of the lower stomach to feel the organs from the outside
• Help you get in position for the speculum exam (You may be asked to slide down to the end of the table.)
• Ask you to bend your knees and to place your feet in holders called stirrups
• Perform the speculum exam. During the exam, a device called a speculum will be inserted into the vagina. The speculum is opened to widen the vagina so that the vagina and cervix can be seen.
• Perform a Pap smear. Your doctor will use a plastic spatula and small brush to take a sample of cells from the cervix (A sample of fluid also may be taken from the vagina to test for infection.)
• Remove the speculum.
• Perform a bimanual exam. Your doctor will place two fingers inside the vagina and uses the other hand to gently press down on the area he or she is feeling. Your doctor is noting if the organs have changed in size or shape.
• Sometimes a rectal exam is performed. Your doctor inserts a gloved finger into the rectum to detect any tumors or other abnormalities.
• Talk to you about the exam (You may be asked to return to get test results.)

What tests are taken during the pelvic exam?

A sample of cells may be taken as part of regular test called a Pap smear, or Pap test, to screen for cervical cancer or cells that look like they might lead to cancer. The sample is placed in a solution and sent to a lab where it is examined. Tests also may be taken to screen for sexually transmitted diseases.

How often should I get a pelvic exam?

A Pap smear is recommended starting when women reach 21 years of age. Women ages 21-65 should have routine screening with Pap test every three years.

Combining a Pap test with a human papillomavirus ( HPV ) test can safely extend the interval between cervical cancer screenings from three years to five years in many women between the ages of 30-65, according to the U.S. Preventive Services Task Force (USPSTF).

Also according to USPSTF guidelines, HPV testing is not recommended for women in their 20s, because people in that age group can have HPV infections that resolve without treatment.

Women over age 65 can stop getting screened if they’ve had at least three consecutive negative Pap tests or at least two negative HPV tests within the previous 10 years, according to the guidelines. But women who have a history of a more advanced precancer diagnosis should continue to be screened for at least 20 years.

Even if are not due to have a Pap test, it is still important to have a regular gynecological exam.

Pap smears are screening for cervical cancer.  Recent advances in screening have led to improved detect requiring less frequent screening than previously done.

A Pap smear is recommended starting when women reach 21 years of age. Women ages 21-65 should have routine screening with Pap test every three years.

Combining a Pap test with a human papillomavirus ( HPV ) test can safely extend the interval between cervical cancer screenings from three years to five years in many women between the ages of 30-65, according to the U.S. Preventive Services Task Force (USPSTF).

Also according to USPSTF guidelines, HPV testing is not recommended for women in their 20s, because people in that age group can have HPV infections that resolve without treatment.

Women over age 65 can stop getting screened if they’ve had at least three consecutive negative Pap tests or at least two negative HPV tests within the previous 10 years, according to the guidelines. But women who have a history of a more advanced precancer diagnosis should continue to be screened for at least 20 years.

Even if are not due to have a Pap test, it is still important to have a regular gynecological exam.

Genital herpes is a sexual transmitted disease caused by the herpes virus.  Please see link below to learn more.

Genital Herpes

First, read the instructions that came with your pill. Generally speaking, if you miss one pill, take two pills the next day. If you miss two pills, take two pills on each of the next two days. If you miss three or more discontinue the pack, use back up birth control and start new pack with next period. It’s best to use a backup contraception method such as condoms for the remainder of the month.

Call our office to schedule an office visit.

It is recommended that young women have their first Gynecologic visit at the age of 15, or when they become sexually active and have questions about contraception and STI’s. Unless there is a medical problem, you should have your first pelvic exam around the age of 21 years or sooner if you begin sexual activity.

To remain effective, you must have a Depo shot every 3 months (12 weeks). You can schedule your next shot up to 2 weeks before your due date or up to 1 week after your due date.

Yes!

Uterine fibroids are benign growths that develop from the muscle tissue of the uterus. They are also called leiomyomas or myomas.  The size, shape and location of fibroids may vary greatly.  They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure.  Fibroids can range in size from small, pea-sized growths to large, round ones that may be more than 5-6 inches wide.  As they grow, they can distort the inside as well as the outside of the uterus.  Sometimes fibroids grow large enough to completely fill the pelvis or abdomen.  A woman may have only one fibroid or many of varying sizes. Whether fibroids will occur singly or in groups is hard to predict.  They may remain very small for a long time, suddenly grow rapidly, or grow slowly over a number of years.

Fibroids are most common in women aged 30-40 years, but they can occur at any age.  Fibroids occur more often in African-American women that in white women.  It is not clear what causes fibroids.  The female hormones estrogen and progesterone appear to be involved in their growth.  Fibroids often shrink when a women enters menopause.

More information about fibroids

Vaginitis is an inflammation of the woman’s vagina. It is one of the most common reasons why women see their health care providers. There are many possible causes of vaginitis.  The type of treatments depends on the cause.

A small amount of clear or cloudy white fluid normally passes from a woman’s vagina daily.  This discharge keeps the tissue moist and healthy.  It is normal for the amount and color of the vaginal discharge to change throughout the menstrual cycle.  The vagina also contains many organisms, such as bacteria or yeast.  A change in the normal balance of either yeast or bacteria can result in vaginitis.  Factors that can upset the normal balance of your vagina include antibiotics, changes in hormone levels due to pregnancy, breastfeeding or menopause, douching, spermicides, sexual intercourse or infection. Vaginitis may cause itching, burning, a bad odor, or a large amount of discharge.

To diagnose vaginitis, your provider will take a sample of the discharge from your vagina.  Some tests can be done in the office and are either done right away or are ready in a few hours. Other tests are sent out to the lab and are ready in a few days.

Treatment depend on the cause of the vaginitis.  Treatment may be a pill or a cream or gel that is inserted into your vagina.  It is important to follow your providers instructions exactly, even if the discharge or other symptoms go away before you finish the medication.  Even though the symptoms disappear, the infection could still be present.  Stopping the treatment early may cause symptoms to return. If symptoms do not go away after the treatment is finished, of if they recur, see your provider.  A different treatment may be needed.