ABOUT YOUR FIRST OBSTETRIC OFFICE VISIT
Lexington OB GYN Associates strive to keep our patients’ appointments on schedule. Please arrive 15 minutes prior to your scheduled appointment to allow adequate time for you to complete any required forms. You will need to bring your insurance card and a picture identification card. If you are more than 30 minutes late for your appointment, you may be asked to reschedule. Patients who routinely miss appointments may be discharged from the practice.
OVERVIEW OF OBSTETRIC PRENATAL VISITS:
You will meet with a registered nurse that will review your past history and provide comprehensive educational counseling. The physician will review this information, perform a physical exam and answer any questions you may have regarding your pregnancy.
- 8-30 weeks = monthly visits
- Cervical checks are usually performed toward the end of pregnancy, (38 or 39 weeks) or earlier if you are having a potential problem (i.e. premature onset of labor or amniotic fluid leak).
PRENATAL SCREENING TESTS:
Cystic Fibrosis Screening – Cystic Fibrosis (CF) is one of many recessive disorders that can be screened for either prior to pregnancy or in early pregnancy. Cystic Fibrosis is a genetic life long illness causing problems with digestion and breathing. It occurs in 1/2500 births and it is usually diagnosed in the first few months of life. Cystic Fibrosis carrier testing can be done to see if a couple is at an increased risk for having a child with Cystic Fibrosis. The test is done with a sample of blood or saliva. It does not detect all CF carriers. If the mother is found to be a carrier, additional testing is done on the father to determine if the child will be at risk for having Cystic Fibrosis. If one parent is a carrier and the other parent is not a carrier, it’s unlikely that the child would have Cystic Fibrosis, but could have a chance of being a carrier
Chorionic Villus Sampling (CVS) – Is an optional test for early diagnosis of chromosomal anomalies such as Down Syndrome. It can be performed as early as 9 weeks. Women that are at an increased risk for chromosomal abnormalities may consider this test. You will be given an appointment with a perinatologist (high risk obstetrician), for this procedure. CVS is performed by inserting a small catheter or tube with the guidance of an ultrasound into the uterus to retrieve a sample of the placenta. There is a higher risk of miscarriage following CVS than after amniocentesis.
Nuchal translucency is a screening test done by ultrasound at 10-13 weeks. It is a measurement of the space behind the fetal neck. Fetuses with a thickened nuchal translucency may be at risk for chromosomal abnormalities such as Down syndrome (Trisomy 21). Blood testing can be done in conjunction with the nuchal translucency to increase the accuracy in detecting chromosomal abnormalities. This blood test does not screen for neural tube defects, so an AFP blood test can also be considered at 16-18 weeks of pregnancy. Women that are at normal or increased risk for chromosomal abnormalities may consider this test. This test is optional and you will be given an appointment with a perinatologist for this testing.
Cell – Free Fetal DNA screening – These are non-invasive screening blood tests which quantify the fragments of fetal DNA floating in the mother’s blood to more accurately determine the fetal risk of chromosomal disorders such as Down syndrome (Trisomy 21), Edward syndrome (Trisomy18), or Patau syndrome (Trisomy 13) from as early as 10 weeks. It may be used to identify other rare conditions resulting from an extra chromosome or missing piece of chromosome (microdeletion). Some insurance companies may not cover the cost of this test, so all patients should check with their own insurance carrier. Counsyl, Harmony, InformaSeq, Maternity21, Progenity and Panorama are examples of these tests.
Alpha-Fetoprotein Screening – is offered between 16 and 19 weeks of pregnancy. A sample of blood is taken from the mother’s arm to determine the level of this protein, which is present in the fetal spinal cord fluid. This test detects 95% risk for neural tube defects, such as spina bifida or anencephaly (absence of skull). There is a possibility that this test will give a false positive result. If your result comes back as positive, we will schedule an appointment for you with a perinatologist for further evaluation. The Alpha Fetoprotein test is optional, but is covered by most insurance companies. It can be done in addition to other screening tests for genetic or chromosomal anomalies.
Alpha-Fetoprotein Tetra Screening test combines alpha- fetoprotein (AFP) that is naturally produced by the fetus with three other hormone tests. Abnormal levels may indicate a problem with the fetus. High levels of AFP may indicate that the fetus has a neural tube defect (i.e. anencephaly or spina bifida). Low levels of AFP may indicate Down syndrome or other chromosomal abnormality. The Tetra screen combines the maternal serum alpha-fetoprotein (MSAFP) with three substances normally found in the bloodstream of pregnant women:
- Human chorionic gonadotropin (HCG), a hormone produced in the placenta
- Unconjugated Estriol (uE3)- an estrogen produced by both the fetus and placenta
- Dimeric Inhibin A (DIA)
Combining these four tests increases the sensitivity of Down syndrome detection to almost 80%. Factors that can cause a false positive result include miscalculation of fetal age or a twin pregnancy. A referral to the perinatologist is needed when the risk is estimated to be greater than 1 in 300.
Ultrasound – is the use of sound waves to create a picture of the fetus while still in the uterus. It can be utilized to determine fetal age, size, position and rate of growth and evaluate the placenta and amniotic fluid. A screening ultrasound is routinely done around 20 -24 weeks gestation to screen for placenta and fetal anomalies. Additional ultrasounds are done as indicated based on the individual needs of each patient.
Gestational Diabetes Screen – this is a blood test that is taken one hour after you finish a Glucola drink that will be provided when you check-in for your regular visit. It is recommended that you do not eat any concentrated sugars for eight hours before this test. This is not a fasting test. You may eat, but just not anything high in sugar.
Non-Stress Test – this test is used to check the well being of the baby. This is not a routine test. It is done when there is a suspected fetal or maternal problem. For instance, a women complaining that she HAS NOT felt her baby move enough, she develops gestational diabetes or high blood pressure during her pregnancy. At the 28th week visit the nurse will go over an information sheet that allows the mother to keep a record of how often her baby moves in a twenty-four hour period. If the mother detects that the baby is not moving adequately she should IMMEDIATELY notify the office, or if it is after office hours, notify the physician on call.
Biophysical Profile – can be done with or without a NST to evaluate fetal well-being. It utilizes ultrasound to assess fetal movement, muscle tone, breathing, and amniotic fluid volume.
Group B Strep Screening (GBS) – this is a vaginal culture performed on the mother to detect if the mother is positive with group B strep bacteria. Approximately 20% of pregnant women are colonized with group B strep. If group B strep is detected, the mother will be given IV antibiotics when she is in labor or if she has ruptured membranes. These antibiotics are given to the mother to decrease the chance that the baby will develop a Group B infection. This treatment does not guarantee that the baby will not develop this infection. If your baby develops a fever during the first few weeks of life you must notify your pediatrician so they may culture your baby for group B strep.