Redlands OB/GYN Associates

Go to our Pregnancy Calculator to see how far along you are in your pregnancy. 1. Summary of Prenatal Visits 8-12 weeks History and physical exam including Pap smear. "Quick Peek" ultrasound. Order prenatal labs, review first trimester prenatal screening. Discuss prenatal issues (see Pregnancy Information page). Orientation to the practice staff and website. 12-16 weeks Discuss prenatal lab results. Listen for fetal heart tones. 16-20 weeks Listen for fetal heart tones and check uterine size. Prenatal screening blood tests drawn if desired. (Amniocentesis may be done for patients over the age of 34).
Information for Cord Blood Banking is discussed. 18-22 weeks An obstetric ultrasound may be ordered about this time. The ultrasound will usually be done at outside facility depending on insurance. Please have a very full bladder for the ultrasound. 24-28 weeks Listen for fetal heart tones and check uterine size. One hour glucose test and hematocrit is done. (You will drink a glucose solution and blood will be drawn one hour after drinking the glucose. Fasting is not necessary but is advised.) Patients who are interested in taking childbirth education classes should register for these classes with Redlands Community Hospital. 28 weeks Listen for fetal heart tones and check uterine size. A Rhogam shot is given to patients who have Rh negative blood type. Review information about warning signs of premature labor and fetal movement counts. 30-32 weeks Listen for fetal heart tones and check uterine size. Check for the baby's position. Take Labor & Delivery Tour. Register at Redlands Community Hospital. Follow this link for the Redlands Community Hospital Registration Form. 34-36 weeks Listen for fetal heart tones and check uterine size. Check for the baby's position. Obtain Group B strep culture of the vagina and rectum. Discuss Labor and Delivery. Discuss Maternity Leave. Discuss information about when to call. 36 weeks Maternity Leave begins for normal pregnancy. Click here for Forms. 37-39 weeks Listen for fetal heart tones and check uterine size. Check for the baby's position. Check for cervical dilation (about 38 weeks). Discuss management plan for delivery on an individual basis. 40 weeks Listen for fetal heart tones and check uterine size. Cervical examination. Check for the baby's position. Discuss management plan for delivery on an individual basis. This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 2. Medications and Pregnancy Tylenol and Extra Strength Tylenol are safe at any point during the pregnancy in usual doses. We do not recommend other pain relievers such as Advil, Aleve, Motrin or aspirin. Over-the-counter antacids are safe in pregnancy. Either the liquids such as Maalox or Mylanta, or tablets such as Tums, Rolaids or Zantac are acceptable. Remember that these are usually safe in the normally prescribed dosages and overuse or prolonged use may be harmful to you or your baby. For nausea and vomiting of early pregnancy ("morning sickness"), the over-the-counter sleeping pill Unisom often has an anti-nausea effect, although it may make you sleepy. You may take 1/2 to 1 tablet at night, and this often has a residual effect into the next day. You may also take a 1/2 tablet in the morning if necessary. Vitamin B-6 50 mg twice a day (also known as Pyridoxine) may also be helpful for "morning sickness." Over-the-counter cold medicines are fine during any stage of the pregnancy. However, we do not recommend cold syrups that have alcohol in them or combination cold preparations which have Advil or aspirin in them. The following are suggested medications for specific conditions: Headaches - Tylenol Fever - Tylenol Congestion - Saline nasal spray or Sudafed (not before 3 months) Cough - Robitussin Sore Throat - any throat lozenge or Tylenol Muscle Aches - Tylenol Runny Nose - Any over-the-counter antihistamine such as Claritin Constipation - Prune juice, fresh vegetables, water, Metamucil, Colace Diarrhea - Imodium Yeast Infections - Monistat Most antibiotics are also safe during pregnancy. Avoid the tetracycline family, and the quinolone family (such as Ciprofloxacin, Levofloxacin and others). However, feel free to check with us if you need to take any prescription medication just to be sure. You can also ask the pharmacist to check the pregnancy category of any medications that you need to take. In general, Category A and B medications are safe, if you really need to take them. Avoid Category C medications unless you have a medical condition that can only be treated with those medications. Avoid Category D medications unless a life-threatening situation exists. And finally, you should absolutely not be exposed to any Category X medications if you are or may become pregnant. Always notify us if you have a fever of 101º F or higher, or if your symptoms persist after trying the above treatments. This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 3. Benefits of Breastfeeding BENEFITS TO MOTHER AND FAMILY Convenience: no mixing or measuring formula Effective, free postpartum contraception for 3 to 6 months (98% to 99.5% effective if you continue to not have periods) Free source of nutrition Produces no waste Promotes postpartum healing Minimizes medical expenses Reduces parental absences from work due to child's illnesses Lowers risk of ovarian cancer and pre-menopausal breast cancer in mother Enhances mother-baby relationship BENEFITS TO INFANTS Superior nutrition Better brain development Reduced risk of necrotizing enterocolitis (a life-threatening intestinal infection) especially in premature infants Reduced risk of sudden infant death syndrome Increased resistance to other infections such as otitis media (ear infections) and diarrheal disease Fewer allergies Fewer stomach upsets Lower risk of cancers Emotional security and improved developmental outcome This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 4. Exercise and Weight Gain during Pregnancy If you have been exercising--that's great. Continue to do so. If you have not been exercising--start slowly. Try walking for 10 minutes five times per week. Gradually increase to 30 to 40 minutes per day. GUIDELINES TO EXERCISE IN PREGNANCY: Regular exercise, at least three times per week, is preferable to intermittent exercise Exercise in the supine position (lying on your back) should be avoided after the first trimester, since this position is associated with decreased cardiac output in pregnancy A pregnant woman should stop exercising when fatigued, and should not exercise to exhaustion, keeping in mind that oxygen availability for exercise decreases during pregnancy Some weight-bearing exercises may be continued throughout pregnancy at intensities similar to those maintained prior to pregnancy. Non weight-bearing exercise, such as swimming or cycling, pose less risk of injury Women who exercise during pregnancy should be particularly careful to ensure an adequate diet In the first trimester, pregnant women should pay particular attention to avoid becoming too hot during exercise by wearing appropriate clothing and drinking adequate fluids If any of the following conditions occur during pregnancy, exercise may need to be restricted: pregnancy-induced hypertension, pre-term rupture of membranes, pre-term labor during prior or current pregnancy, incompetent cervix, cerclage, bleeding in pregnancy, intrauterine growth restriction Bottom Line: You may exercise throughout your pregnancy. Walking, running, swimming, aerobics, and moderate weight training are all acceptable. We do not recommend contact sports or sports where you are likely to fall such as snow skiing, water skiing, or horseback riding beyond the first trimester. You may have sex throughout the pregnancy if your pregnancy has been uncomplicated. Source: American College of Obstetricians and Gynecologists
WEIGHT GAIN IN PREGNANCY The usual weight gain in pregnancy is 25 to 35 pounds for the entire pregnancy. Most of this weight gain comes in the second and third trimester at a rate of about 1 pound per week. Weight gain is variable in the first trimester. You may even lose some weight as your appetite may be decreased. If you are overweight, you do not need to gain as much weight.
This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 5. Prenatal Genetic Screening FIRST TRIMESTER SCREENING: First Trimester screening is a screening test for Down Syndrome and Trisomy 18 performed between 10 and 14 weeks of pregnancy. It involves nuchal translucency ultrasound and serum screening. These data are then combined to give a new individual risk for Down Syndrome and Trisomy 18. The detection rate for Down Syndrome is 83% and for Trisomy 18 is 80%. Integrated screening involves a first sample of blood and a nuchal translucency ultrasound between 10 and 14 weeks of pregnancy and a second blood specimen between 15 and 20 weeks of pregnancy. It screens for Down Syndrome, Trisomy 18 and open neural tube defects. These data are combined to give a new individual risk. Of the available screening tests, this method has the highest detection rates for Down Syndrome and Trisomy 18, 93% and 90%, respectively. AFP TESTING: AFP is a protein made by the baby and secreted into the amniotic fluid and mother's blood stream. Elevated levels of AFP can be found in certain conditions such as spina bifida, anencephaly (failure of brain and skull development), abdominal wall defects, fetal death, twin gestation, or inaccurate dating of the pregnancy. An elevation of the AFP, even with a normal amniocentesis, can be associated with a higher risk of problems in the third trimester. Some of these include placental separation (abruption), preterm labor, poor fetal growth, pregnancy induced hypertension, increased risk of stillbirth, and a lack of amniotic fluid. Low levels of AFP have been associated with a higher risk of chromosome problems such as Down Syndrome. Screening of the mother's blood allows us to check for the possibility of some of these potential problems. The blood test that is drawn is called the triple screen or “tri-screen”. It includes an AFP, an estrogen level, and a hCG level. The tri-screen is more accurate at predicting a chromosome problem compared to the AFP alone. The majority of babies born with Down syndrome are born to women over the age of 35, even though the risk of Down syndrome is 1:270 live births. An amniocentesis is usually recommended for women who will deliver by the time they are 35 or older. For those younger than 35, the tri-screen will be positive in 60 - 65 percent of Down syndrome babies. The AFP will be elevated in greater than 90 percent of cases involving brain, spinal cord, or abdominal wall defects. If a tri-screen or AFP is abnormal, an ultrasound is recommended. An amniocentesis may also be recommended since the tri-screen is only a screening test. The amniocentesis could determine if a problem really exists. A normal triple screen does not necessarily guarantee a normal baby The tri-screen and amniocentesis are both optional tests. A decision whether to have the test or not is usually a personal choice. A woman who would not have an abortion may still want to consider the testing in order to help prepare herself, her family, and her doctors for the birth of a baby with special needs. Most chromosomal abnormalities other than Down syndrome are not detected by the tri-screen. An amniocentesis or other procedure called a chorionic villous sampling (CVS) are the only nearly 100% accurate tests for Down syndrome as well as other chromosomal problems. If you choose to have this test done, the blood work should be drawn between 15 and 20 weeks, along with other prenatal laboratory work. The results are usually back in our office in approximately one to two weeks. If you are 35 or older and are going to have an amniocentesis, the tri-screen is done a few days before your amniocentesis. This will help us determine if you will be at risk of any of the third trimester problems mentioned previously. CYSTIC FIBROSIS TESTING: A. What is Cystic Fibrosis (CF)? CF is an inherited disease that affects more that 25,000 American children and young adults. Symptoms of CF vary but include lung congestion, pneumonia, diarrhea and poor growth. Most CF does not affect intelligence. Although there is no cure for CF at this time, scientists are making progress in improving treatment and in searching for a cure. In the past many people with CF died at a very young age. Today many are living into their 20’s and 30’s. B. Is there a chance my baby could have Cystic Fibrosis? You can have a child with CF even if there is no history in your family. CF testing can help determine if you are a carrier and at risk to have a child with CF. If both parents are carriers, there is a 1 in 4 (25%) chance, with each pregnancy, that they will have a child with CF. Carriers have on normal CF gene and one altered CF gene. People with CF have two altered CF genes. Most people have two normal copies of the CF gene. C. What testing is available for CF? There is a blood test that can be done to find out if you or your partner is a carrier. A National Institutes of Health (NIH) consensus statement developed by a panel of experts representing medical, legal, ethical and public perspectives recommends that CF carrier testing be offered to any couple planning a pregnancy and to any individual with a family history of CF. It is important to understand that CF carrier testing does not detect all CF carriers. If the test shows that you are both CF carriers, your unborn baby can be tested to find out if baby has CF. D. How much does it cost to have Cystic Fibrosis carrier testing? Cost and insurance coverage for CF carrier testing vary depending upon the laboratory used and your insurance policy. The average cost for CF carrier testing runs between $450 - $1,000 per person. This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs.
6. Group B Strep Infections and Screening Group B streptococcus (GBS) is a type of bacteria that causes illness in newborn babies. GBS is the most common cause of life-threatening infections in newborns. It is the most common cause of sepsis (blood infection) and meningitis in newborns. GBS is a frequent cause of newborn pneumonia. In pregnant women, GBS can cause bladder infections, womb infections, and stillbirth. Many people carry GBS in their bodies but do not become ill. These people are considered to be "carriers." Adults can carry GBS in the bowel, vagina, bladder, or throat. One of every five pregnant women carries GBS in the rectum or vagina. A fetus may come in contact with GBS before or during birth if the mother carries GBS in the rectum or vagina. People who carry GBS typically do so temporarily- that is, they do not become lifelong carriers of the bacteria. GBS carriage can be detected during pregnancy by taking a swab of both the vagina and rectum for special culture around 35-37 weeks of pregnancy; cultures collected earlier do not accurately predict whether a mother will have GBS at delivery. A positive culture result means that the mother carries GBS- not that she or her baby will definitely become ill. Women who carry GBS should not be given oral antibiotics before labor because antibiotic treatment at this time does not prevent GBS disease in newborns. An exception to this is when GBS is identified in urine during pregnancy. GBS in the urine should be treated at the time it is diagnosed. Carriage of GBS, in either the vagina or rectum, becomes important at the time of labor and delivery- when antibiotics are effective in preventing the spread of GBS from mother to baby. Most GBS disease in newborns can be prevented by giving certain pregnant women antibiotics through the vein during labor. Any pregnant woman who previously had a baby with GBS disease or who has a urinary tract infection caused by GBS should receive antibiotics during labor. Pregnant women who carry GBS should be offered antibiotics at the time of labor or membrane rupture.
This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 7. Symptoms of Premature Labor Occasional, mild, irregular contractions (so-called Braxton-Hicks contractions) are normal in the second half of pregnancy. However, it is not normal to have frequent contractions prior to 37 weeks (3 weeks before your due date). The following is a list of warning symptoms of premature labor: Regular uterine tightening or contractions occurring 4 or more times per hour. This may feel as though the baby is "rolling up into a ball." Your uterus may become tight or hard. You may also perceive contractions as a rhythmic low backache. Contractions may feel like severe menstrual cramps. An unusual rhythmic or persistent pelvic pressure. A large amount of mucus or watery discharge leaking from the vagina. This is especially concerning if the discharge has a red, pink, or brown color. Any vaginal bleeding should be immediately reported to a nurse or doctor at our office. If you have any of these symptoms prior to 37 weeks, you should stop any strenuous activity, rest on your left side, and push fluids. Try to drink at least 4 large glasses of water as soon as you can. If the symptoms persist despite fluids and rest for one hour, you should call the office to speak with a nurse or a doctor. After office hours, you should call the office, and a doctor will return your call. You may need to come to the office or to the hospital for evaluation.
This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 8. Measures for Well-being and Prevention of Preterm Labor Rest two to three times a day lying on your left side. Drink 2 to 3 quarts of water or fruit juice each day. Avoid caffeine drinks. Filling a quart container and drinking from it will eliminate the need to keep track of numerous glasses of fluid. Empty your bladder at least every two hours during waking hours. Avoid lifting heavy objects. If other small children are in the home, work out alternatives for picking them up, such as sitting on a chair and having them climb up on your lap. Avoid prenatal breast preparation such as nipple rolling or rubbing nipples with a towel. This is not meant to discourage breast feeding but to avoid potential increase of uterine irritability from nipple stimulation. Pace necessary activities to avoid overexertion. Sexual activity may need to be modified or eliminated if you have premature labor signs. Find pleasurable ways to help compensate for limitations of activities and boost spirits - massages, manicures and pedicures. Try to focus on one day or one week at a time rather than longer periods of time. If on bed rest, get dressed each day and rest on a couch rather than becoming isolated in the bedroom.
This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 9. When to Call the Doctor? If you are 37 weeks or more (within 3 weeks of your due date), you should call if any of the following occur: Consistent, regular, painful contractions which have been occurring every 5 minutes (from the start of one contraction until the start of the next contraction) for at least one hour. Each contraction should last 30 to 60 seconds or more. OR contractions occurring every 10 minutes for at least one hour if you live more than 30 minutes from the hospital, if you have a history of a fast labor, or if you were dilated 3 or more centimeters at your last visit. Vaginal bleeding. A small amount of spotting is normal for a day or two after a vaginal examination. Any other vaginal bleeding should be immediately reported to a nurse or a doctor at our office. Rupture of membranes. If you break your bag of waters, or if you think you might be leaking amniotic fluid, you should call right away. You will need to come to the office or to the hospital for evaluation. Decreased fetal movement. The baby should move at least 12 times a day. This should continue right up to the baby's birth. If you think that your baby is not moving that much, lie down on your left side after eating and count fetal movements. You should feel at least 4 in an hour. If you still don't feel at least 4 movements in an hour, call immediately. You will need to come to the office or to the hospital for fetal monitoring. Follow this link to the Fetal Movement Record form. HOW DO I CONTACT DR. HAGE? During our office hours (8:00 am to 5:00 pm Monday-Thursday, Friday 8:00 am to 1:00 pm), you may call the office (909-748-6065) to speak with a nurse or Dr. Hage. After office hours you may also call our office for emergencies. A practioner will return your call. The nurse or doctor will help you decide whether you should go to the hospital. DURING OFFICE HOURS, EXCEPT IN AN EXTREME EMERGENCY, PLEASE DO NOT GO DIRECTLY TO THE HOSPITAL WITHOUT SPEAKING TO AN OFFICE NURSE OR DOCTOR.
This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 10. Umbilical Cord Blood Banking Umbilical cord blood, traditionally discarded at birth, contains special cells called "stem cells" which can be used in the treatment of nearly 70 life-threatening diseases including certain cancers, such as leukemia, and immune and genetic disorders. Researchers are now looking to cord blood for answers to Stroke, Heart Disease, Diabetes, and Muscular Dystrophy, to name a few. We encourage our expecting moms to visit following web sites to get more information about cord blood banking and learn why preserving your baby's umbilical cord blood at the time of birth may be one of the most important decisions you can make for your baby's and your family's future.

Redlands OB/GYN recommends PacifiCord located locally in Irvine, CA. Visit their web site at www.pacificord.com. 
Other cord blood banking facilities are:
Cord Blood Registry at www.cordblood.com
ViaCord at www.viacord.com
This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 11. Things to Avoid During Pregnancy SMOKING, ALCOHOL, and RECREATIONAL DRUGS All of these increase the risk of miscarriage, bleeding, smaller babies, premature babies, developmental delays, and other serious complications. Once you know that you are pregnant, it is best to stop completely. Talk to us if you need help. FISH that may contain mercury or other contaminants Shark, swordfish, king mackerel and tilefish are all high in mercury. Other fish, such as striped bass, bluefish, salmon, and fish from local rivers and lakes may contain high levels of PCB's and other industrial pollutants. Limit all fish , including canned tuna, to less than 12 ounces each week. Shellfish, if cooked properly, is not considered harmful. CAT LITTER and SOIL These may contain toxoplasmosis, a harmful parasite. Your cat is safe, but the feces (poop) may not be. Do not change cat litter while pregnant. When gardening, wear rubber or leather gloves and wash fruits and vegetables well. HOT TUBS and SAUNAS If you are sweating, it's too hot for the baby. Otherwise warm baths are very soothing. HERBS
Many can be harmful to the baby or start labor. This is a partial list: Black/blue cohosh, buckthorn, cascara, ephedra, feverfew, mandrake, mugwort, senna, tansy, and yarrow. Consult an herbalist or check www.pregnancytoday.com for a complete list. FOODS THAT MAY CONTAIN BACTERIA or PARASITES Raw meats, raw fish, and raw shellfish (sashimi, ceviche, raw oysters, carpaccio); unpasteurized juice; soft cheeses (Brie, feta, goat, camembert, gorgonzola, and Mexican soft cheeses); some deli meats (Salami, liverwurst, and hot dogs may be contaminated. Hot dogs should be well cooked). CAFFEINE Limit your intake of caffeine; it may reduce calcium that is available for the baby. ARTIFICIAL SWEETENERS Not enough is known about their effects on pregnancy. Occasional or moderate use is considered safe. PEANUTS and PEANUT BUTTER If you have a family history of peanut allergies, it may be wise to limit your intake or avoid completely.

This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs. 12. Travel and Sexual Activity During Pregnancy TRAVEL & PREGNANCY You may travel by any means including air travel up until one month before your due date if your pregnancy is uncomplicated. After 36 weeks, we recommend that you remain within one hour of a hospital. If you are being monitored for premature labor, travel is not recommended. SEATBELT USE We recommend that you wear your seatbelt whenever you are riding or driving in a car. Even in the third trimester, it is fine to have the shoulder strap go across the uterus. SEXUAL ACTIVITY Sex is safe and does not harm the baby. It's normal to have more interest in sex, less interest in sex or mixed feelings and thoughts about sex. Open communication is important to your relationship. As pregnancy progresses, be creative with position changes. Gentle hugs or caresses can be a sweet substitute for intercourse. Do not have sex if you have vaginal or abdominal pain, blood or fluid leaking from your vagina, have been diagnosed with placenta previa, or have been advised against it by one of us.
This information is provided as a resource only and is not intended to be a recommendation or a substitute for consultation with Dr. Hage regarding your health and needs.

Pregnancy Information

Wednesday, November 10, 2010