Obstetrics

Your Pregnancy

We like to see you for your initial consultation quite early in pregnancy and our reception staff will endeavor to book this visit for you to be seen at about 9-10 weeks gestation. At this consultation we will obtain a detailed history from you and develop a plan for the care of your pregnancy. We will also perform an ultrasound in order to confirm the wellbeing of your pregnancy and your dates.

A regular schedule of visits will be outlined for you, but there is always scope for additional visits if required. We will usually perform a brief ultrasound at each visit as this is a convenient way of confirming the wellbeing of your baby.

Pregnancy Tests and Procedures

Antenatal screen

This is a routine selection of tests, which are performed in the first few months of the pregnancy. There is a blood test and a urine test. The blood test checks for your blood group and any unusual blood group antibodies, full blood count (to check for Anaemia), Rubella immunity (German Measles) and a check for Hepatitis B and Syphilis. Hepatitis C and HIV may be checked as well as immunity to Chicken Pox and Parvovirus. The urine test is checking for bacteria in your urine.

Nuchal Translucency Ultrasound

This is an optional test, which is offered to all pregnant women. Its purpose is to check for the risk of Down's Syndrome. It is done between 11 and 14 weeks gestation. You will have received written information about this test at the time of your first visit. The decision to have this test or not is a personal one.

Amniocentesis or CVS

These are invasive procedures, which enable the chromosomes or genetic material of your baby to be examined. These tests have a small risk of causing miscarriage and will therefore only be offered in pregnancies where there appears to be an increased risk of chromosome or genetic abnormalities.

Ultrasound

A detailed ultrasound examination of the pregnancy is recommended at around 19 weeks gestation. The main purpose of this examination is to ensure as far as possible that your baby is developing normally. It is not possible to identify all abnormalities on ultrasound, but more than 50% of significant abnormalities will be identified.

Further ultrasound examinations

The above two ultrasound examinations are the only ones that are routinely offered. Sometimes indications arise to perform additional ultrasounds; this will be fully explained if required.

Glucose Test

It is recommended that all pregnant women be checked for pregnancy (Gestational) Diabetes. This usually does not have any symptoms. A blood test is performed between 24 and 28 weeks gestation. Fasting is required for this test. A blood test will be performed after fasting. The pathology staff will give you a drink which contains a standardized amount of glucose (it is sweet!). Your blood test is then performed at 1 hour and 2 hours after this drink. You will be contacted if this test is elevated, and referred to a doctor who specialises in diabetes (An endocrinologist). Your haemoglobin will be checked at the same time to ensure you are not becoming anaemic.

Group B Strep (GBS)

This is a bacteria, which commonly occurs in the vagina. It occasionally causes serious infection in the newborn. One of the recommended approaches to prevent this is to identify pregnancies that are at risk and to treat the mother with antibiotics during labour. There are a number of factors, which identify at risk pregnancies. Some practitioners perform a swab on all pregnant women in late pregnancy. This is an alternative approach. Both approaches are considered acceptable strategies in the prevention of GBS infection in newborns.

Pap smear

If your Pap smear is due it will usually be performed at the time of the 6-week postnatal check up. It is sometimes performed during the first half of pregnancy if there is a specific reason to do so.

Urine Testing

Urine testing used to be performed on all pregnant women at each checkup. Recent studies have demonstrated this to be unnecessary for the majority of women. The purpose of testing urine is to check for changes, which may occur in association with a pregnancy disorder called pre-eclampsia. Under some circumstances, testing of urine is necessary; you will be advised if this applies to your pregnancy.

Induction of Labour

It is generally preferable for labour to begin spontaneously rather than by artificial induction. However, circumstances may arise whereby induction is a better option than continuing the pregnancy. The commonest reason for this is being overdue. In an otherwise normal and healthy pregnancy, induction will usually be considered at some time close to 41 weeks gestation. Individual circumstances, of course, need to be considered in making this decision.

Non-Invasive prenatal testing (NIPT)

NIPT is an optional test, which is offered to all pregnant women. NIPT detects a small amount of the baby’s DNA in the mother’s bloodstream. It checks for the risk of Down’s syndrome and some other major chromosome problems. It can be performed from 10 weeks gestation. In Australia, this test has many brand names and may be known as Harmony, Verifi, Genesyte or Panorama. As for Nuchal Translucency Ultrasound above, you will have received written information about this test at the time of your first visit. The decision to have this test or not is a personal one. NIPT is a very good test for Downs Syndrome but it is important to be aware that there are many other significant abnormalities which are not related to chromosome changes and therefore will not be detected by this test. Hence if you decide to do the NIPT test you should consider having a detailed ultrasound also.

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Vaccines

Flu Vaccine (Influenza)

Pregnant women are at increased risk of developing severe illness if they contract influenza especially in later pregnancy and especially if you have any underlying respiratory problems (eg asthma). The best available evidence demonstrates that the Influenza vaccination is safe for pregnant women, and provides the best protection for you and your baby. The seasonal influenza vaccine, or “flu shot”, is recommended and funded for all pregnant women under the National Immunisation Program. It is can be given at any time during pregnancy and is most easily accessed via your GP.

Whooping Cough Vaccine (Pertussis)

Whooping cough can cause a severe and potentially life threatening respiratory infection in newborn babies. The Boostrix vaccine is safe for pregnant women. It is recommended that the vaccine be given between 28 and 32 weeks gestation in each pregnancy (even if you had it in your last pregnancy). This vaccine not only protects the mother against whooping cough but also the newborn as the mother passes on her antibodies via the placenta. The vaccine is funded under the National Immunisation Program and can be most readily accessed via your GP.

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Special Food Considerations When Pregnant

Listeria Infection (Listeriosis) can be dangerous

Listeria is a type of bacteria, which can be found in some foods. It causes few or no symptoms in healthy people, but can be very dangerous to pregnant women and babies. Hormonal changes during pregnancy have an effect on the mother's immune system that makes the mother more vulnerable to Listeria. Listeria, although rare, can be transmitted to an unborn baby, and may lead to miscarriage, stillbirth, or premature birth. Listeria is destroyed by conventional cooking, but can grow in refrigerated food. Ideally, eat only freshly cooked food and well-washed freshly prepared fruit and vegetables. Leftovers can be eaten if they are refrigerated promptly and kept no longer than a day. It is important not to eat food if there is any doubt about its hygienic preparation or storage.

The following mostly chilled, ready to eat foods should be avoided altogether:

  • soft cheese such as brie, camembert and ricotta - safe if cooked hot.
  • cold meats and pate.
  • avoiding 'ready to eat' foods such as unpasteurised dairy products, pates, meatloaf products (such as pre-sliced chicken loaf), cooked diced chicken (as used in sandwich shops), uncooked smoked seafood, smoked shellfish, previously prepared coleslaw and salads (this is especially important if they have been stored in the fridge for more than 24 hours), prepared salads.
  • raw seafood such as oysters, sashimi, smoked salmon or oysters (canned oysters are safe).

For your health and that of your baby during pregnancy, it is important you select a nutritious diet from a wide variety of food such as vegetables, fruit, dairy foods, bread, cereals, pasta, lean meat, fish, eggs, and nuts. Food safety is also very important. This information will help you make safe decisions when selecting and preparing food for yourself and/or your family. Fish are rich in protein and minerals, low in saturated fat, and contain omega-3 fatty acids. Omega 3 fatty acids are important for the development of the central nervous system in babies, before and after they are born. Nevertheless, eating too much of a good thing when you are a soon-to-be mum or breastfeeding can be bad. That is because some fish contain mercury levels that may harm an unborn baby or young child's developing nervous system.

The following table will help you safely include fish as an important part of a balanced diet. servings * type of seafood

Servings* Type of Seafood
1 serve per week only Orange Roughy (Sea Perch) or Catfish & NO other fish that week
OR  
1 serve per fortnight only Shark (Flake) or Billfish (Swordfish, Broadbill or Marlin) and NO other fish that fortnight
OR  
2-3 serves per week Any other fish and/or seafood
*Serving sizes
  • for women who are pregnant or planning pregnancy, 1 serve =150 grams
  • for children up to 6 years, 1 serve = 75 grams

Safe handling of food

Preventing food-borne illness is always important, but especially during pregnancy when hormonal changes suppresses a woman's immune system, which can make it harder to fight off infections. This can adversely affect the mother and unborn child. Listed below are some key things to remember to help ensure the safety of food you eat.

Food safety tips

  • Keep cold food cold (below 5 degrees Celsius) and hot food hot (above 60 degrees Celsius). The bacteria that commonly cause food poisoning grow very well between 5°C and 60°C. Keep cold foods in the fridge until you are ready to serve, and serve hot foods steaming hot.
  • Cook food thoroughly. Cook poultry, minced meats, sausages and other pre-prepared meats until well done, right through to the centre. No pink should be left visible. Avoid medium rare steaks or runny eggs.
  • Thoroughly wash all raw vegetables before eating them.
  • Observe the 'Use by' and 'Best by' instructions on refrigerated foods.
  • Separate raw and cooked food and don't use the same utensils, especially cutting boards and knives, for both.
  • Keep utensils and kitchen clean.
  • Wash and dry hands thoroughly before handling food.

Folate is important in the early stages

Folate is a B vitamin needed for healthy growth and development. A baby's growth is most rapid in the first weeks of life - often before you even know you are pregnant. Folate is especially important for women at least one month before pregnancy and for the first three months of pregnancy to help prevent birth abnormalities like Spina-Bifida in babies.

Experts recommend women of childbearing age should aim for 400 micrograms (μg) each day. If you are planning to become pregnant, you should take a daily folic acid supplement of at least 500 micrograms (μg). You should continue to take the supplement until the 12th week of your pregnancy. The tablet form of folate is called folic acid and is available from pharmacies. If you have a family history of neural tube defects, you should seek specific advice.

You should also eat a wide range of foods that are naturally rich in folate, such as fresh fruits and green vegetables, or foods fortified with folate. It is easy to find out how much folate is in packaged foods by looking at the nutrition information panel on food packages.

Iodine in pregnancy

It is recommended that all pregnant women ensure adequate iodine intake throughout the duration of pregnancy and especially in the first trimester. Iodised table salt is a good source of iodine. There are also a number of vitamin supplements that contain iodine.

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Maternal Weight

Weight gain in the pregnancy, if excessive may impact on your comfort and mobility in later pregnancy as well as your longer-term health. Assessment of ideal weight gain in pregnancy is best based on a woman's pre-pregnancy body mass index (BMI, a measure of height in relation to weight). In general, leaner women are advised to gain more pregnancy related weight, and heavier women are advised to gain less. Routine weighing of pregnant women at each visit has not been shown to be of benefit in relation to pregnancy outcomes and is therefore not a necessary part of your pregnancy care. We are happy to record your weight at each visit if you wish and provide advice on ideal target BMI weight gain if desired.

Recommended target weight gains in pregnancy are as follows:

BMI before pregnancy Recommended Weight Gain
<20 (low) 12-18kg
20-26 (normal) 11-15kg
26-29 (high) 7-11kg
>29 (overweight) 7kg or less
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Frequently Asked Questions

Vaginal bleeding

If the bleeding is heavy (heavier than a period), you should seek advice straight away unless you have been advised otherwise. If you are less than 20 weeks contact Dr Arrage/Jenkins directly. If you are, more than 20 weeks contact labour ward. Lighter amounts of bleeding if not accompanied by abdominal pain should be reviewed on the next working day. If there is pain, contact either Dr Arrage/Jenkins or labour ward as above.

Thrush

Vaginal thrush or Candida is a common pregnancy problem. It causes a vaginal/vulval itch and sometimes a white/yellowish discharge. It is safe to treat it with any of the over the counter preparations available from your pharmacy. Either vaginal cream or pessaries are satisfactory. If you are using a vaginal cream it needs to be used with the applicator otherwise the treatment will be ineffective.

Heartburn or Indigestion

This can be safely and effectively treated with any of the over the counter preparations. Follow the manufacturer instructions regarding dose and frequency.

Constipation

If untreated, is likely to lead to abdominal discomfort and hemorrhoids. Dietary measures are the best first steps ie. increase fluid intake and dietary fibre (fruit, vegetables, cereals). If this is ineffective, a bulk laxative such as Metamucil or Fybogel will usually work. Other laxatives such as Normacol, Senokot, Coloxyl are also perfectly safe if required. Suppositories and enemas can also be used if necessary.

Haemorrhoids

These are enlarged veins at the entrance of the anus. They occur commonly in late pregnancy and improve dramatically afterwards. Sometimes they cause no problems at all; occasionally they are uncomfortable or even exquisitely painful. Constipation should be avoided. Any of the over the counter haemorrhoid preparations (e.g. Proctosedyl or Rectinol) are perfectly safe to use in pregnancy and will usually assist with the discomfort. If severe pain occurs, an ice pack will often help.

Fetal Movements (FM)

Movements vary greatly from pregnancy to pregnancy. In a first pregnancy, FM will often be first noticed between 18 and 22 weeks. In general, FM are felt earlier in second and subsequent pregnancies compared with first. From approximately 26 weeks, you should notice your baby move every day. If you do not feel any movements on a given day, sit down somewhere quiet for 20 minutes and have something cold to drink. You will probably feel the baby move during this time. If it does not, you should contact the labour ward and speak to a midwife who will probably advise you to attend the hospital to have the baby's wellbeing assessed. There will usually be no cause for concern but it is something, which should always be checked.

Head Cold

These common respiratory infections do not pose any significant concerns for the wellbeing of your pregnancy. If you have a fever, you should treat it with paracetamol, 2 tablets every four hours (maximum 8 per day) and drink plenty of fluids. If fever persists more than 48 hours, seek advice from your GP. Otherwise, symptom relief is all that may be required. Safe options are included on the safe medications list.
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Safe Medications in Pregnancy

Pain relief: Paracetamol +/- codeine e.g. Panadol or Panadeine or equivalent
Cough suppressant: Benadryl or Duratuss
Constipation: all laxatives safe. Try Metamucil or Fybogel first
Heartburn: all antacids safe e.g. Mylanta, Gaviscon, Rennie
Vaginal thrush: vaginal creams and pessaries all safe e.g. Canestan, Nilstat, Monistat
Haemorrhoids: all creams safe e.g. Proctocedyl, Rectinol
Antihistamines: older ones are known to be safe e.g. Polaramine, Phenergan
Throat lozenges: all safe e.g. Strepsils, Difflam
Iron tablets: all safe but may cause constipation
Vitamin supplements: Elevit or Blackmores pregnancy & breastfeeding
Antibiotics: Amoxil, Keflex commonly prescribed and are safe.
Nasal sprays: temporary relief of congestion e.g. Saline, Sinex, Drixine
Dermatitis/skin rashes: hydrocortisone cream e.g. Sigmacort
Dental/minor surgical procedures: local anaesthetic is safe
Other medications: if in doubt or concerned phone us to check

Mothersafe

Mothersafe is a free telephone service in NSW for women concerned about exposure to medications and other toxins during pregnancy and breastfeeding. This includes, prescribed medication or over the counter medicines. They are available Monday to Friday 9am to 5pm.

Call 9382 6539

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Travel In Pregnancy

Many women either choose to travel or need to travel during the course of their pregnancy. We have outlined below a few general points about travel in pregnancy. Please note that this advice is of a general nature only and applies to uncomplicated single pregnancies. In general terms if you are considering taking a vacation before baby arrives, the early second trimester  (say 15-25weeks) is a good time to travel. It is usually a time during pregnancy when you will be feeling really good.

Domestic air travel

Domestic air travel does not pose any specific concerns during pregnancy. You will generally be able to travel up to 28weeks gestation without any special measures (check with individual airline policy). If you are travelling close to or after 28weeks gestation you will need to carry a letter confirming your EDC and stating that you are medically fit for air travel. Our office staff are happy to provide this.

In an uncomplicated single pregnancy there is generally no concern with domestic air travel up to 34 weeks gestation.

International travel

Once you are visibly pregnant it is worthwhile carrying a letter confirming your gestation (EDC letter) and stating that you are medically fit for air travel (again – please check individual airline policy as they can vary widely). Our staff are happy to provide this documentation.

On anything other than short international flights (under 4 hours) it is a good idea to wear full length (thigh high) support stockings. These help to reduce the risk of DVT (blood clots in leg veins). Additional routine measures such as regular mobilisation and maintaining adequate hydration during the flight are also recommended.

It is generally recommended to have completed international travel by 34weeks gestation. Although there is some flexibility around this.

Other travel issues

Eating and drinking

The same recommendations apply when travelling as at other times in pregnancy. Vomiting and diarrhoea type illnesses can be quite common whilst travelling and generally do not pose any significant risk to the health of your pregnancy. The best advice is to ensure adequate hydration and maintain a fairly bland diet until the symptoms resolve. If you reach a point where you are unable to keep fluids down you will need to seek medical advice as you may be at risk of dehydration.

Anti-diarrhoeal medications (such as Imodium) can be safely used in pregnancy if necessary.

Body scanners: do not pose any risk in pregnancy.

Travel insurance

You should ensure that you have travel insurance cover that is appropriate for your stage of pregnancy. This can be particularly important if you are travelling after 24 weeks gestation.

Vaccinations

There are a number of vaccinations which are not recommended in pregnancy. If you are going to an area where vaccination is required, weI suggest that you seek specific advice.

What to do in case of a problem whilst away

Always travel with your antenatal card (record) just in case of a problem. All the information that would be required if there were an unexpected event is contained here. Our contact details are also on the card, so if you not sure what you can contact us.

Please note that all the above advice is of a general nature only and you should seek specific advice regarding the circumstances of your pregnancy.

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