Most likely, you’ve scheduled your first visit with your health care team. As for your baby, his or her limbs are getting bigger, fingers are now taking shape, eyes are now evident and ears are forming outside the head. A nose is now present along an upper lip. Your baby’s curved shape is now lessening and is roughly ½ inch long.
Your baby’s lifeline, the umbilical cord, is in place and strong. In most cases, it is comprised of one vein and two arteries. The vein in the umbilical cord delivers oxygen and nutrients from you through the placenta to your baby. The two arteries whisk away waste products from your baby’s blood supply into yours.
App time! Start jotting down comments and all things pregnancy with ME Preg. If you don’t have a Smartphone, begin using your MOM & BABY TRACKING CHART. With so many new and exciting changes taking place from week to week, it’s important to proactively keep track of the most important ones for the health of you and your baby. Watch your pregnancy evolve from a weekly chronicle now in Week 8 to a daily register monitoring your baby’s movements in Week 28. Stay vigilant! Your delivery day will be here before you know it.
If today’s the day for your first visit with your health care team, you can expect an in-depth health assessment and physical exam to be done. Remember to mention any medical conditions which apply to you (or a family member). For some women, their 40-week gestational journey is enjoyed with no significant challenges. However, there are some conditions which could possibly place you in the high-risk category during your pregnancy.
Let your health care team know if this is your first pregnancy and you if are over 35 or under 20. They will also want to know if this pregnancy is a conception by In Vitro Fertilization (IVF) and your Rhesus (Rh) Type (+ / -).
Your will be informed by your health care team if you are Rh-positive or Rh-negative from your blood work at this visit.
Eighty-five per cent of the population is Rh-positive; fifteen per cent is Rh-negative. The challenge arises when an Rh-negative mom is carrying an Rh-positive baby. The placenta keeps the mother’s and baby’s blood separate. If this natural barrier is broken such as during a miscarriage, trauma or delivery, the mother’s Rh-negative blood may be exposed to her baby’s Rh-positive blood. This results in antibodies being made in the mother’s blood which will destroy the baby’s red blood cells. Immunoglobulin (Rhlg) such as RhoGAM® Brand prevents this from happening.
You will be given an injection of Rh immunoglobulin (Rhlg) around 28 weeks if you are Rh-negative. Once your baby has been delivered, and if the baby has Rh-positive blood, another dose of Rhlg should be given. This will prevent mom from making antibodies in response to her baby’s Rh-positive blood cells that may have crossed into her blood stream.
The therapy of Rhlg will need to be repeated for every future pregnancy delivering an Rh-positive baby. For more information on the Rh Factor, Rhlg dosing and how this may impact your pregnancy, consult with your health care team or visit ACOG and RhoGAM.com.
Your personal and family history is important. Tell your team if there is any history of miscarriage(s) (before 20 weeks gestation), intrauterine death(s) between 20 and 40 weeks gestation (stillbirth), incompetent cervix, pregnancy with multiples or blood clots or blood clotting factors or disorders known to you. If you smoke, let your team know.
There are several medical conditions which may affect your pregnancy such as diabetes, Inflammatory Bowel Disease (IBD) and celiac disease. Your weight is important. If you have a high body mass index (BMI > 30) before or during pregnancy, you and your baby will be at greater risk for complications.
Thyroid conditions will need to be monitored during pregnancy. Your health care team will test your thyroid hormone levels if your medical history includes any thyroid conditions and medication for thyroid function. Depending on the results, adjustments to medication may need to be made. A diagnosis of a thyroid condition during pregnancy is based on a careful history, physical exam and laboratory testing. For more information on thyroid function during pregnancy and how it impacts both you and your baby, visit the American Thyroid Association and the National Endocrine and Metabolic Diseases Information Service (NEMDIS).
Hypertension or high blood pressure will need to be monitored. You may be considered hypertensive if your blood pressure is higher than 130/85. If you are hypertensive, your health care team will follow this level closely throughout your pregnancy.
Everyone is aware of the significance of high blood pressure during pregnancy and the need for close surveillance by your health care team. But did you know the risks of low blood pressure can be just as significant? According to Midwife, Lecturer, and Active Researcher Dr. Jane Warland, the University of South Australia, hypotension during pregnancy is responsible for possible poor placental perfusion which increases the risk for preterm birth, low birth weight, Intrauterine Growth Restriction (IUGR), fetal distress during labor, fetal death prior to or during labor and post partum hemorrhage. If your blood pressure is below 90/60, discuss how this condition will be managed with your health care team.
If you have answered “Yes” to any of the above medical conditions, discuss at length with your health care team how your condition(s) could possibly affect your pregnancy and birth plan. Please do not be afraid if you are considered high risk. High risk does not and should not be frightening or worrisome. It simply means you will have additional testing and increased monitoring of you, your expected baby and the placenta and umbilical cord throughout your pregnancy.
Be very open with your health care team about any concerns and anxieties you may be having. This heartfelt communication will help lead to the proactive care you need for a wonderful pregnancy and pregnancy outcome.
If you are determined to be high risk, your health care team may suggest you consult with a Maternal Fetal Medicine (MFM) Specialist or Perinatologist. These specialists are knowledgeable and trained to give the appropriate medical care for a high risk pregnancy. The Society for Maternal Fetal Medicine states that these specialists have expertise in:
For further information and to find a MFM Specialist in your area, please visit MFM Specialists.
Your baby’s first ultrasound may be done at this visit to assess his or her due date. During this ultrasound your health care team is focusing on certain things such as your baby’s heartbeat, the number of fetal sacs, and your baby’s measurements to match his or her gestational age. Your team will also observe the overall picture of your baby and placenta. Request that EPV be measured at this and every ultrasound (visit Week 7 to learn the importance of keeping up-to-date with placental measurements.) Your team will be on the lookout for anything problematic or abnormal. Some conditions that may present themselves during this ultrasound are listed below.
It’s not uncommon to be diagnosed with placenta previa, a pregnancy-related complication where the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix. This can be quite common especially at the first ultrasound, but usually corrects itself by the third trimester. The cervix is your baby’s way out of the uterus at the time of delivery. Placenta previa can be marginal meaning the placenta is next to the cervix, but does not cover the cervical opening, it can be partial, meaning the placenta covers part of the cervical opening, or it can be complete, meaning it covers the entire cervical opening. You can also just have a low-lying placenta which is not a type of previa, but can be similar in symptoms.
As your tummy and uterus enlarge and stretch during pregnancy, the placenta will also stretch with them. Although the placenta doesn’t actually move, in most cases it stretches away from the cervix by the third trimester. The placenta should be near this optimal position by the third trimester for delivery, not blocking the cervix. This condition can be diagnosed with an ultrasound. If you are diagnosed with placenta previa, your medical team will watch this condition carefully. Make sure to follow all of their directions. They may decide the need for limited activities, pelvic rest, bed rest, or hospitalization to closely monitor both you and your baby depending on the gestation of your pregnancy and any other health concerns. Your health care team may also opt for a C-Section delivery if placenta previa is still an issue as you get closer to delivery day.
Any vaginal bleeding during pregnancy should be reported to your health care team immediately, as placenta previa has the potential to cause complications and can be dangerous for both you and your baby. For more information on the symptoms of and treatments for placenta previa, please visit Medline Plus at the National Institute of Health.
Moms either have an anterior or posterior placenta, which means that some have their placentas towards the front of the uterus (anterior) and others towards the back (posterior). If your placenta is towards the front (anterior), don’t be alarmed if you are not experiencing or feeling your baby’s movements early in your pregnancy. In fact with this placental position you may not feel as much movement from your baby even in the third trimester. This is because the placenta serves as a cushion between your tummy and your baby, making it more difficult for you to feel movement. Your health care team may also have more trouble hearing your baby’s heartbeat with this placental position especially earlier in your pregnancy. An anterior placental position towards the front of the uterus can also make an amniocentesis more challenging as the needle inserted to remove the fluid will need to avoid the placenta. An anterior placenta in and of itself poses no risk to the health of you and your baby.
Cytomegalovirus (CMV) is a common virus which poses a major risk to pregnant women who are around babies and young children. Moms who are child care providers, daycare workers, preschool teachers, therapists, and nurses need to take extra precautions as preschoolers are the majority of carriers. CMV is present in saliva, urine, feces, tears, blood, mucus and other bodily fluids. You cannot catch CMV by simply being in the same room with someone, unless bodily fluids are exchanged. Additionally, there is no information to indicate CMV is transmitted in the air (airborne).
The American College of Obstetricians and Gynecologists (ACOG) and the CDC recommend that OB/GYNs counsel women on basic prevention measures to guard against CMV.
CMV is very prevalent among healthy children 1 to 3 years of age as they are at high risk for contracting CMV. Since CMV can be transmitted to an unborn child from a pregnant mother experiencing a primary or recurrent CMV infection, how can you minimize your risk? Here are a few simple preventative steps you can proactively incorporate into your daily routine from Stop CMV – The CMV Action Network:
Some babies born with congenital CMV are symptomatic at birth, others are asymptomatic. Children born with congenital CMV may develop permanent medical conditions and disabilities, such as deafness, blindness, cerebral palsy, mental and physical disabilities, seizures, and death.
Become your expected baby’s guardian today by taking an active role in your personal hygiene and healthcare decisions and prevent CMV. Consult your health care team if you are concerned about the CMV infection during pregnancy, you develop a mononucleosis or flu-like illness during pregnancy, or you feel you may be a candidate for CMV screening or treatment.
If you would like further information on CMV and how it may affect your pregnancy and your baby’s future, please visit Stop CMV. If you would like to proactively pass this vital information via the CDC’s Health-e-Cards to other pregnant moms, please visit the CDC.
Genital Herpes is a chronic permanent viral infection. One in five pregnant women has herpes, either Herpes Simplex Virus (HSV-1) which is responsible for cold sores on the mouth and lips or Herpes Simplex Virus-2 (HSV-2), which is responsible for genital herpes. Although genital herpes can be caused by HSV-1 or HSV-2, most mothers of infants who acquire neonatal herpes are asymptomatic, meaning they have never had an outbreak of genital herpes!
Women with recurrent genital herpes have antibodies which protect the baby from neonatal herpes infections. However, if a mother acquires genital herpes during the last trimester of her pregnancy there is a 30–50 per cent chance of transmitting this infection to her baby. Acyclovir, an anti-viral medication used to treat genital herpes, if taken during the last trimester, may help prevent a neonatal infection.
It is recommended that any woman with an outbreak of genital herpes at the time of delivery should have a Caesarean section. For more information on genital herpes and how it may impact your pregnancy, please visit the CDC and the March of Dimes.
In preventing infections which may prove harmful to you and your baby, Dr. McGregor advises you to see your health care team for any symptoms of a bladder (urinary tract) infection, vaginitis symptoms and an unexplained fever. He also advocates good dental hygiene and care, reporting any vaginal bleeding, discharge or fluid leakage to your health care team, and avoiding membrane stripping to induce labor. Dr. McGregor also encourages moms to be vaccinated for Influenza (Inactivated) and Tdap (Tetanus, Diphtheria and Pertussis) at 28 Weeks if their adult vaccinations are not up to date.
Your urine will be cultured today. If your results are positive for Group B Strep (GBS) or for an asymptomatic bacteriuria, the U.S. Centers for Disease Control and Prevention (CDC) recommends appropriate antibiotic treatment if your urine culture shows over 100,000 colonies per cc. Once you finish your antibiotics, have a test of cure (TOC) to ensure that the infection has cleared completely. Make sure you ask for the results of your urine culture on your next visit.
If your urine is negative for GBS, you will have a rectovaginal swab taken at 35 – 37 weeks gestation and cultured to ensure that you are still GBS negative. If you are positive for GBS at this initial visit or at a later date, discuss with your health care team how GBS will impact your birth plan and the intravenous antibiotics that will be required during labor and delivery.
According to Researcher, James A. McGregor, MDCM, Retired Professor of OB-GYN, Division of Perinatology, University of Southern California, Keck School of Medicine, any infection can be potentially life threatening to your baby. Approximately 1 in 4 pregnant women carry GBS, the most common cause of life-threatening infections in newborns according to the CDC. GBS can not only infect babies during pregnancy, but also during the first few days and weeks of life.
“Women should have accurate information to know how to best protect their babies”, states Group B Strep International’s co-founder, Marti Perhach. For awareness materials and further information, please visit GBS today. If you would like to proactively pass along Health-e-Cards containing vital GBS information to other pregnant moms, please visit the CDC. Your health care team can now download the free “Prevent Group B Strep” App for iOS and Android devices by simply visiting the CDC.
According to the CDC, Listeria (listeriosis) is bacteria found in soil, water, dust, plants, raw meats, processed foods, some prepared vegetables, and in the feces of animals and humans. Most listeria infections affecting pregnant women come from eating contaminated foods. This infection may be passed to an expectant mother’s baby through the placenta, and the mother may not even show any signs of illness. Listeria can lead to miscarriage, stillbirth and premature delivery. In a newborn the presence of listeria may result in blood stream infections, meningitis and possible death. A late neonatal infection may even appear more than 5 to 7 days following delivery. Because of the potentially severe consequences of listeria, it’s important that you, as well as your health care team, are familiar with the prevention, symptoms, diagnosis and treatment of this infection.
The chance of contracting listeria is ten times higher for pregnant women than that of the overall population, and twenty-four times higher for Hispanic women. Symptoms can be as mild as fever, chill, muscle aches, diarrhea and upset stomach, and can take a few days or possibly weeks to emerge. A pregnant mom may not even be aware that she has it. The more serious symptoms of a listeria infection for the pregnant mom may range from headache, stiff neck and confusion to a loss of balance and even convulsions. This is why prevention is vital and that you take appropriate food safety precautions during pregnancy.
It’s important to note that if you have eaten food contaminated with listeria and are asymptomatic, most professionals believe you don’t need any tests or treatment, even if you are pregnant. Although you should inform your health care team if you are pregnant and have eaten the contaminated food, and within 2 months experience flu-like symptoms.
If a pregnant mom does contract listeria, antibiotics are given to treat it. In most cases, the antibiotics also prevent infection of the fetus or newborn. Antibiotics are also given to babies who are born with listeria.
If you experience any symptoms of listeria, consult your health care team immediately. A blood test can be performed to find out if listeria is the cause of your symptoms.
For more information on listeria prevention and how listeria infection can impact both you and your baby during and after pregnancy, please visit the CDC and the NIH.
Toxoplasmosis, considered one of the neglected parasitic infections, is an infection that a mom may pick up from something as simple as cleaning a cat litter box or making a hamburger patty. Toxoplasma Gondi is a parasite so small it is invisible to the human eye and, fortunately, most healthy immune systems will not allow the parasite to trigger an infection. It is estimated that 22.5% of Americans 12 years and older have been infected with toxoplasma. Although usually asymptomatic, symptoms accompanying toxoplasmosis may be similar to those of the flu with swollen lymph glands or muscle aches and pains that last for a month or more.
If you have been recently infected, it is advised you wait six months before becoming pregnant. Usually, if you have been infected with toxoplasma before you became pregnant, your unborn child is protected by your immunity. Your health care team may advise a blood test be drawn to check for antibodies to toxoplasma if you are pregnant. If you become infected during pregnancy, medication is available. You and your baby should be closely monitored during your pregnancy and after your baby is born.
Unfortunately, this infection may possibly result in miscarriage prior to 20 weeks or a stillbirth after 20 weeks. Although on occasion infected newborns may exhibit serious eye or brain damage at birth, the majorities of infected infants do not have symptoms present at birth but may develop serious signs later in life, such as blindness or mental disability.
Don’t eat raw or undercooked meat, especially lamb or pork. Cooked meat should not look pink, and the juices should be clear.
For further information on toxoplasmosis and how it can impact you and your baby during pregnancy and after birth, please visit the CDC and the March of Dimes.
Pregnancy is a time of great expectations and ultrasounds are routine during this time. Your next ultrasound will most likely be scheduled around Week 20; this ultrasound will check the umbilical cord and placenta for structure and growth. Insurance companies usually cover the cost of an ultrasound ordered by your health care team.
Speak with your health care team about adding additional ultrasounds around Weeks 28, 32 and 36. An ultrasound at these times may identify any possible issues with the placenta or umbilical cord, which may pose a problem for your baby during the last trimester of pregnancy. Insurance companies may cover the cost of additional ultrasounds if warranted and ordered by your health care team.
However, just in case you find yourself wanting these additional ultrasounds or another that is not covered by your insurance carrier, just put $10 a week aside to help cover this cost.