03 Aug 2010

Pregnancy Information Sheet

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Congratulations on your pregnancy. The following information is provided as a guide to help you to plan the next few months.
Antenatal care
Your first visit will usually be between 6 and 12 weeks of pregnancy.

At this visit I will take a medical history and perform an examination. We will discuss arrangements for your antenatal care and the birth. I look after women at the Royal Hospital for Women and the Prince of Wales Private Hospital.

Subsequent visits are monthly until 28 weeks, fortnightly to 36 weeks, then weekly until the birth. If your pregnancy is complicated in any way I am likely to see you more frequently. If you would like me to share your antenatal care with your GP I am happy to do so. I’d be delighted if your partner or any other family members attended your visits.

The first visit

At your first visit I will take a complete medical history and perform a general physical examination. I advise that you have a Pap smear performed if you have not had one performed in the previous 24 months.

If your doctor has not already organised your pregnancy “booking” blood tests I will arrange these at your first visit. We will discuss your options for prenatal genetics testing and if you wish to have a nuchal translucency ultrasound scan, a chorionic villus sample (CVS) or amniocentesis test performed then I will arrange these tests for you.

I will give you a complete antenatal care patient information pack at your first visit. With your permission I will write to your GP to confirm the arrangements for your pregnancy care.

Your second visit

At this visit I will provide you with a complete copy of your clinical notes and test results. This will be provided to you both as a paper file and on a USB flash drive. In addition to your notes, the flash drive will contain a variety of patient information material for your use. Please bring the flash drive to each antenatal visit and I will update your file each time.

We will arrange your 18 – 20 week ultrasound at your second visit. The purpose of this ultrasound scan is to confirm your due date, check all of your baby’s internal structures (head, heart, spine etc) and check the location of the placenta (afterbirth).

If you have chosen to continue your pregnancy care with me I will give you my cell phone number to ensure you have direct access to specialist advice and care 24 hours a day.

Common issues and medication use during pregnancy

Constipation is common in pregnancy, and usually can be helped by increasing your fluid and fibre intake. Kiwifruit are often very effective. However if these measures don’t work, bulking agents like Normacol, Metamucil, Fybogel or Agiofibe usually help.

While not essential, it is reasonable to take a multivitamin supplement such as Elevit during your pregnancy.

Women with some medical complications and / or a low intake of dairy foods may benefit from calcium supplementation during pregnancy.

The following medications are all safe in pregnancy (assuming you are not allergic to any of them):

  • Panadol or Panadeine,
  • Penicillin and its derivatives such as amoxycillin,
  • Erythromycin, and
  • Inhalers commonly used for asthma

If you have any queries about medications during pregnancy you can contact the MOTHERSAFE help line (9382 6539) or contact me directly.

Foods to avoid during pregnancy and food preparation advice

Some foods should be specifically avoided during pregnancy because of the risk of contracting Listeriosis. Listeria is a bacterium that causes very mild illness in pregnant woman – occasionally fever, headache and diarrhoea – but may cause miscarriage, premature birth or stillbirth. While Listeria bacteria can be readily killed by heat, they are unusual in that they can multiply in the refrigerator. Foods that you should avoid include:

  • Cold or rare meat
  • Cold cooked chicken
  • Raw or smoked seafood
  • Pate
  • Prepacked or prepared salads
  • Unpasteurised dairy products
  • Soft and surface ripened cheeses including brie, camembert, blue, ricotta and feta
  • Ready to eat food from salad bars, sandwich bars, delicatessens and smorgasbords
  • Soft serve ice cream.

You can eat:

  • Freshly cooked chicken
  • Freshly cooked seafood
  • Hard cheeses, processed cheese, plain cottage cheese and plain cream cheese
  • All canned foods

Some other important food advice includes:

  • Do not eat leftovers that have been refrigerated for more than 12 hours.
  • Thoroughly wash fresh raw fruit and vegetables
  • Thoroughly wash and dry knives, cutting boards, crockery and kitchen appliances after they have been used with raw foods
  • Cover food
  • When heating or cooking food, ensure that it is thoroughly cooked and “piping hot”
  • Make sure food heated in the microwave is cooked and heated right through
  • If you eat ready to eat hot food (takeaways or at a restaurant), make sure it is served and eaten hot.

(Source / further information Food Standards Australia New Zealand, www.foodstandards.gov.au)

Cats and Kittens

Toxoplasmosis is a very rare infection in pregnancy that causes no or minimal symptoms in mothers but can affect unborn babies. Most people are immune toToxoplasma because of symptomless infections that occurred early in their lives. However a cautious approach in pregnancy is sensible. The organism that causes this infection is carried by cats and can be found in their faeces. When you are pregnant you should not get a new kitten and pregnant women should not handle cat litter. If you must work in the garden, please wear gloves.

Problems in early pregnancy (i.e. before 20 weeks)

Please contact me if you have any concerns. I would like you to call me directly if you have any vaginal bleeding, fever, significant fluid loss from the vagina or any abdominal pain that does not respond to paracetamol.

If you have nausea or vomiting, I suggest frequent small meals. Vitamin B6 (pyridoxine) up to 150 mg per day can give you some benefit. If you are unable to keep down fluids please call me.

Problems after 20 weeks of pregnancy

Some lower back discomfort, leg cramps and insomnia is common in the later stages of pregnancy. In the second half of pregnancy painless contractions of the uterus (womb) occur. These are called Braxton Hicks contractions and are not concerning as long as they are not painful.

Do not hesitate to contact me directly if any of the following events occur:

  • Vaginal bleeding,
  • Significant fluid loss from the vagina,
  • A headache that does not respond to paracetamol,
  • A fever,
  • Abdominal pain that does not respond to paracetamol,
  • Regular painful contractions, or
  • A significant slowing down of your baby’s movements

Ongoing tests during pregnancy

I will perform a “dipstick” analysis of your urine at every antenatal visit in order to check for protein and sugar.

At 26 to 28 weeks of pregnancy, I will organise for you to have a blood test to check your iron levels and antibodies. If you are possibly at risk of diabetes in the pregnancy I will arrange a Pregnancy Diabetes Screen (PDS) blood test at the same time.

The iron and antibody check is repeated at 36 weeks.

At 36 weeks I recommend a vaginal swab test for Group B Streptococcus (GBS). This bacterium is a normal and usually harmless vaginal organism but it can rarely cause serious infections in newborn babies. If you are positive for GBS (about 12% of Australian women are) I will offer you some antibiotics in labour in order to reduce the risk of infection for your baby.

I often recommend an ultrasound scan of your baby at around 34 to 36 weeks of pregnancy. I will do this if:

  • Your placenta was low at your 18 – 20 week ultrasound,
  • It is possible your baby is in the breech (or bottom first) position,
  • You are at risk of having a small baby, or
  • We think your baby may be unduly large.

Women with medical complications or multiple pregnancies will have more frequent ultrasound scans.

Childbirth Preparation Classes

It is very important that you attend childbirth preparation classes. Both the Royal Hospital for Women and Prince of Wales Private Hospital provide such classes. Alternatively you may contact the Childbirth Education Association on 8539 7188 for the contact details of other providers.

Contacting me

My philosophy is that if you have chosen me to look after your pregnancy and birth, you should receive a dedicated personal specialist service. With that view in mind I go to a great deal of effort to make myself personally accessible and available to you. I limit my public work and the number of private patients that I book so that I can provide you with a dedicated service.

Aside from times of leave (see below) I will ensure that I conduct all of your antenatal visits personally. If you need to attend the hospital for any reason I will come and assess your situation personally. I am happy for you to contact me on my cell phone although ask that you use some discretion in doing so and reserve such calls for emergencies. Non-urgent matters can be managed if you telephone my consulting rooms. E-mail is an excellent form of communication for non-urgent matters and I will respond to e-mail queries within one working day.

If you have any health problems or concerns that are not directly related to your pregnancy, please contact your GP in the first instance. Your GP will contact me immediately if there are any issues I need to be involved with.

If you have any difficulty contacting me please leave a message on my voicemail and directly contact the Delivery Unit of the hospital you will be having your baby.

When you come to the hospital to have your baby I will come and see you and assess the situation. I will organise to monitor your baby’s wellbeing, continue to review you throughout your labour and I will perform the birth (although rarely babies don’t cooperate and are born before their obstetrician arrives!).

However no one can work 24 hours per day, 365 days per year. It is essential that I strive to maintain the quality of your care by ensuring that I undertake study leave to keep abreast of current trends in obstetrics. I also need to spend some time with my family and take holidays. I endeavour to keep the time that I am not available to a minimum and when I am not available I will ensure that a specialist colleague with a similar approach to care looks after you. I will be personally available at least 95 percent of the time and I will inform you in advance of the dates of any leave and the cover arrangements that will be in place at the time.

After the birth

The average hospital stay for a normal birth is 3-4 days and for a complicated birth or Caesarean section 5-6 days. I will see you daily in hospital until you go home and I will arrange for a paediatrician to see your baby.

Postnatal checks

After you have settled in at home please call for an appointment for your postnatal checks. Generally I like to see you two weeks and six weeks after the birth. At these visits I will check you and make sure you have no questions or concerns relating to your pregnancy and birth.

Once again I offer my congratulations on your pregnancy and I look forward to helping you in the forthcoming months.

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