OB FAQ's
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| I am scared because I am bleeding during the first trimester. What do I do now? |
The first trimester is the first 12 weeks of your pregnancy. During this time amazing changes are taking place in your body. This is the period of time that the placenta will make a solid connection to your uterus, the organs will develop in the baby, and you might feel the most sick. This is also the most common time for miscarriages and bleeding. Not all bleeding occurs because a miscarriage is about to happen. Sometimes you will bleed if you have a vaginal infection. Other times bleeding occurs because you have reached a certain stage in your pregnancy. Examples are implantational bleeding, which occurs when the placenta forms its first attachment with the uterus, or bleeding when the hormones supporting the pregnancy stop coming from the ovary and start coming from the placenta. Implantation bleeding happens around four weeks and hormone bleeding comes at around eight weeks. Usually this is very light spotting or bleeding, and goes away in a few days. Also, this bleeding is rarely associated with really painful cramping.
Unfortunately, about 25% of pregnancies will end during the first trimester, and these are called miscarriages. Miscarriages can occur for a variety of reasons, but usually have nothing to do with your activities or lifestyle choices (such as exercise or what you ate). The most common reason miscarriages occur is because a genetic defect was present in either the egg or the sperm. There was enough correct information to start the pregnancy, but then the genetic code had an error and the pregnancy could not develop any further. Miscarriages will usually begin with moderate bleeding that continues to get heavier and is accompanied by very painful cramping.
Any light spotting and bleeding should be reported during office hours. We will probably order an ultrasound and you may need to come in to get a shot if you have a certain blood type. This is not an emergency and can be taken care of during office hours so please do not call the after-hours physician. Heavier bleeding, especially with cramping, needs to be evaluated on the same day. If your heavier bleeding occurs during office hours please call us and our nurse will tell you what to do. If you begin bleeding heavily after office hours, or on the weekend, please go to the emergency room at North Kansas City Hospital for an examination. The physician who sees you in the ER will call us once they have seen you. Again, you do not need to call the after-hours physician, just head to the ER and they will call us after they have seen you.
Many people who experience bleeding during the first trimester go on to have a very healthy pregnancy, so do not lose hope if you begin to bleed. We understand that it is very scary to see bleeding and hope this information will help you to understand some of the reasons it occurs.
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| The ultrasound showed my baby has Choroid Plexus Cysts. What is that and should I worry? |
Finding a Choroid Plexus Cyst (CPC) on a routine ultrasound is a relatively common phenomenon and is usually associated with a normal pregnancy. Most CPC’s are diagnosed between 15 and 17 weeks of gestation and will disappear between 24 and 28 weeks without apparent long term complications. We will order another ultrasound after 28 weeks to demonstrate resolution of the cyst. It is important to remember these cysts do not cause developmental or structural abnormalities. There are no implications for infant development or IQ. |
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| When will I get an ultrasound? |
Ultrasounds are lovely because they allow us to see the earliest growth of the newest member in the family. However, they are also a medical tool used to detect potential problems. Most insurance plans will cover one routine ultrasound during a pregnancy. We have chosen to order this test at 20 weeks, midway through your pregnancy. At this point all the major organ systems have developed and are large enough that problems can usually be detected. Also, the sex organs have developed well enough so you can find out if your baby is a boy or girl. This is the only routine ultrasound allowed by most insurance providers. Any additional ultrasounds ordered will be based on medical problems occurring in the pregnancy. If your pregnancy is healthy you will only have one ultrasound. |
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| What can I do for swelling? |
| Swelling in the third trimester of pregnancy is quite common and usually occurs as a result of compression against the major blood vessels that feed the legs, by the uterus. Simple things to do to try and reduce the swelling including elevating your legs, laying on your side, and decreasing the amount of salty foods you eat.
Swelling can, however, also be a sign of pre eclampsia-a hypertensive disorder of pregnancy. If you happen to develop pre eclampsia, the swelling is also significant in the hands and face. Your blood pressure will be elevated and you may also have signs of headaches, spotty or blurred vision, and upper abdominal pain. Should you have these findings, it is important to report to your doctor immediately. |
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| What can I use for heartburn? |
| Heartburn, called reflux, is a common finding in the third trimester of pregnancy. Fortunately, it is usually easy to correct. Try Tums or Mylanta first and elevate your head about 30 degrees when sleeping. If you continue noticing problems or are frequently taking antacids, it is also safe to take Pepcid and Zantac. |
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| Which over the counter medications are safe during pregnancy? |
| It is a common misconception that you should not take any medication during pregnancy. There are, in fact, a number of medications which are considered safe to take during pregnancy. The table below will serve as a guide for your reference; |
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Colds and Coughs |
Pain/Headaches |
Sudafed, Dimetapp, Tylenol Sinus, Claritin, Benadryl,
Robitussin, Robitussin DM |
Tylenol or Tylenol ES (acetaminophen)
Maximum of 4 grams daily. Avoid Motrin, Advil, Excedrin, Aleve and Aspirin
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Nausea |
Heartburn, Indigestion, Gas |
Small frequent meals. Bland food.
Ginger Ale, Vitamin B6 25mg + ½ Unisom tablet (not capsules) 30 minutes before meals and at bedtime. |
Tums, Rolaids, Mylanta II, Riopan Plus, Maalox, Zantac, Pepcid, Prilosec OTC
DO NOT USE: Pepto-Bismol
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Hemorrhoids |
Constipation |
Preparation H (cream or suppositories)
Anusol, Tuck Pads, Witch Hazel
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Metamucil (wafers or powder), FiberCon, Citrucel, Milk of Magnesia, Colace
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Insomnia |
Yeast Infections |
Benadryl 25mg caps 1 to 3 at bedtime
Unisom 25mg tabs (NOT caps) 1 at bedtime
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Monistat 3 or 7 (It is best to consult your doctor before you self prescribe) |
Sore Throat |
Diarrhea |
Cepacol, Chloraseptic
Any cough drops
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Imodium (as directed)
BRAT diet (bananas, rice, applesauce and toast) |
Artificial Sweeteners |
Yeast InfectionsToothache/Dentist |
NutraSweet and Splenda
DO NOT USE: Sweet and Low (pink pkg)
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Orajel. The dentist may use novacaine and take x-rays with a lead shield |
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| What can cause me to have bleeding after sex? |
This can happen on occasion for anyone but is more common in pregnancy. The cervix has an increased blood flow and can be inflamed by the pregnancy, which makes bleeding occur more commonly. It could also be caused by a mild infection. If you are spotting lightly, either brown or red and not requiring a pad, then rest, increase fluids and avoid intercourse. If painful, having enough bleeding for a pad, or accompanied by contractions or loss of a large amount of fluid, then contact your physician. |
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| I am having a vaginal discharge. Is it an infection? |
An increase in vaginal discharge is actually quite common in pregnancy. It occurs due to the elevated estrogen levels resulting from the pregnancy. However, both yeast infections and bacterial vaginosis occur more commonly during pregnancy. With these infections you often have discharge accompanied by irritation or odor. You should notify your doctor to arrange evaluation in the clinic should this occur. Also, if you are noticing copious or persistent clear discharge, often times requiring a pad, you should notify your doctor or proceed to labor and delivery for evaluation being that you may have ruptured your membranes. |
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| I lost my mucus plug, now what? |
It is common toward the end of pregnancy to have an increase in discharge or even a large glob of mucus that may be blood tinged. This is normal as the cervix softens and prepares for labor. After 36 weeks, this is not a significant observation and you do not need to call should this occur. It is not a true sign of labor and does not mean that labor is coming soon. Labor will be accompanied by regular painful contractions and/or loss of fluid and/or vaginal bleeding. |
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| What can I do to improve constipation in pregnancy? |
This is one of the most common problems in pregnancy and is partially due to the increase in progesterone as well as the decreased motility of the intestine as it is pushed higher in the abdomen to make room for the uterus. Prenatal vitamins also contain iron, which contributes to constipation. You should increase water intake, increase exercise or activity, increase fiber, fruits, and vegetables. You can also buy Metamucil, which is fiber or Colace, which is a stool softener, both available without a prescription. |
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| What is round ligament pain? |
This is most common in the second trimester of pregnancy (14 to 26 weeks) and is usually a sharp low abdominal or groin pain that may be on one or both sides of the abdomen. It is short in duration and most likely to happen with abrupt movement such as moving from a sitting to a standing position. Walking or rolling over in bed may also cause this pain to occur. The round ligaments help support the uterus, and as the uterus grows in pregnancy these ligaments stretch causing discomfort. To minimize the pain, we recommend rest or making movements more slowly. If accompanied by fever, bleeding, nausea or vomiting, or pain does not go away with rest; you should contact your physician. |
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| What can I do for postpartum depression? |
This is very real and a common problem. It is characterized by very intense feelings of sadness, anxiety, or despair after childbirth, which may interfere with a mother’s ability to function. There is an increased risk of harm to both mother and baby if you are experiencing true postpartum depression. This is different from the “baby blues” which is a period of mild depressive mood changes starting within two or three days after delivery and lasting up to two weeks. If you are experiencing these feelings, you should contact our office. If you have a previous history of postpartum depression, a history of generalized depression, or a recent stressful life event, you are at a greater risk for postpartum depression. |
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| How can I treat morning sickness? |
Morning sickness can occur at any time. Although it is called morning sickness, some people will experience it in the afternoon or during the evening. This is the most common symptom of pregnancy. Eating frequent small meals (bland or dry foods such as crackers) will often help. Over-the-counter medications such as vitamin B6 (25 mg three or four times a day), Dramamine, or Emetrol are safe and also are found to be effective by many people. Your physician may also prescribe medications such as Reglan, Phenergan, or Zofran to help control your nausea. Occasionally, morning sickness will become more serious and hospitalization with IV fluids will become necessary. This will typically resolve by 14 to 16 weeks. |
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| Are headaches common in pregnancy? |
Headaches are common, especially in the first 18 weeks of the pregnancy. These are frequently due to an expanded blood volume and elevated hormone levels. Headaches after 24 weeks can be a sign of elevated blood pressure and should be checked by your doctor. |
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| Is it true that hair coloring and perms are safe? |
It is safe to use color or perm solutions on your hair while pregnant as long as there is no formaldehyde in these products. This has been removed from most products but check with your stylist or the package labeling. Your hair may respond to the products differently while being pregnant. |
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| Is it safe to eat fish while you are pregnant? |
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| How long can you work while pregnant? |
Most women are able to work until the onset of labor. There are rare occupations that may call for reduced activities in the third trimester. Complications of pregnancy such as preeclampsia or growth restriction of the baby may necessitate reduced work schedules. |
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| What are the guidelines for traveling while pregnant? |
Traveling is generally okay throughout the pregnancy until 36 weeks in most cases. Most physicians agree that after 36 weeks one should limit themselves to being no further than two hours away from their delivering hospital. There are circumstances such as preterm labor, which would necessitate discontinuation of travel at an earlier point in the pregnancy. |
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| How long can I fly while being pregnant? |
Most airlines will allow you to fly indefinitely through the pregnancy. Some will require a note from your physician as you progress further into the pregnancy. Physicians agree that between 34 and 36 weeks one should discontinue flying on a regular basis. |
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| When can I return to regular activities after my baby is born? |
During the first two weeks after delivery, regardless of caesarian or vaginal birth, you should allow your body some recovery time. Try to stay at home resting and caring for the baby. Try to avoid any strenuous household activities such as vacuuming, laundry, or cooking large meals. It is fine to move about the house, and you can go up and down stairs during the course of the day. After the first two weeks you should feel comfortable driving, running errands, and beginning light physical exercise. Gradually increase your activities day by day. By the six week mark you should be back to all regular activities. |
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| Should I stop nursing if my baby has Thrush? |
If your baby develops thrush and is breastfeeding you will need to take some precautions to try to limit yeast infection of the nipple. You should limit the amount of time you wear your bra and try to wear loose and airy clothing. You should also wash, dry, and iron all of your nursing bras to remove the yeast from the fabric. If your nipples are already infected you will need to be treated with medication in addition to following the above suggestions. Infected nipples are generally tingly, painful, redder, and may have raised red spots around them |
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