PRENATAL VISIT CALENDAR (Family members are welcome and encouraged) Every prenatal appointment will include the following: urine sample, blood pressure check, weight check, checking for fetal growth and fetal heartbeat (when applicable). VISITS ARE EVERY 4 WEEKS UNTIL 28 WEEKS. EVERY 2 WEEKS UNTIL 36 WEEKS. EVERY WEEK FROM 36 WEEKS AND BEYOND. 6-8 WEEKS Confirmation of pregnancy (with ultrasound). Review your personal health and pregnancy risk factors Order prenatal labs. Review medications. Discuss first trimester screening, Cystic Fibrosis screening, and non-invasive prenatal testing options. Discuss referral to Maternal Fetal Medicine specialist (MFM). 8-12 WEEKS New obstetric examination (may or may not include an ultrasound). A complete history and physical examination. This includes a PAP and vaginal culture as necessary. Review prenatal panel results. Review results of MFM visit. 16-20 WEEKS COMPLETE OBSTETRIC ULTRASOUND TO BE DONE AT OUR OFFICE AT 18-20 WEEKS UNLESS OTHERWISE SCHEDULED WITH THE MFM. Review additional lab studies. 24-28 WEEKS Review lab results. Review ultrasound results. Order Gestational diabetes screening test and receive instructions (please have this lab drawn 1 week prior to your next visit).Order Tdap vaccination (to be given at your primary MD or pharmacy at between 28-26 weeks). Kick count sheet given at 28 weeks. Register for prenatal classes. Register for the hospital. Begin researching pediatricians. Give Rhogam injection at 28 weeks if RH negative. 28-32 WEEKS KICK COUNT SHEET REVIEWED EVERY VISIT Do Tdap. Review 28 week lab results. Give Rhogam injection at 28 weeks if RH negative. Appointments are now every 2 weeks. This is a good time to start making appointments to interview for a pediatrician. Tour hospital. Register for the hospital if you have not done so already. Prenatal classes if desired. Discuss preterm labor signs and symptoms. Review diabetes screening results. 32-34 WEEKS REVIEW KICK COUNT SHEET Discuss signs of preterm labor. Visits every 2 weeks. Schedule repeat cesarean section if needed. 35-37 WEEKS REVIEW KICK COUNT SHEET GBS CULTURE Discuss GBS culture results. CERVICAL EXAMINATION, if desired. Discuss signs of preterm labor. Weekly visits. 37-40 WEEKS AND BEYOND REVIEW KICK COUNT SHEET CERVICAL EXAMINATION, if desired Signs of labor reviewed. Make a plan for induction if needed (if patient is greater than 41 weeks). All prenatal visits are subject to change due to Dr. Hernandez and Dr. Ashley’s call schedule and any problems that may arise during your pregnancy. There may be additional ultrasounds and lab testing done based upon patient needs. TOLAC/VBAC: Our call group does allow TOLAC/VBAC in certain cases. If you have a history of a prior cesarean delivery and desires a trial of labor after cesarean delivery/vaginal birth after cesarean (TOLAC/VBAC), we will obtain your operative report from your previous delivery and discuss with you if a TOLAC/VBAC is an option for you. AFTER DELIVERY (POSTPARTUM) VAGINAL DELIVERY – please call our office to schedule your postpartum visit for 5-6 weeks after delivery. This appointment includes a physical examination, review of birth control options, discussion of breast feeding, and review of symptoms of postpartum depression. CESAREAN DELIVERY – please call our office to schedule your incision check to be performed 1-2 weeks after delivery as well as your postpartum visit to be scheduled at 5-6 weeks after delivery (4 weeks from your incision check appointment). This appointment includes a physical examination, review of birth control options (if indicated), discussion of breast feeding, and review of symptoms of postpartum depression. All postpartum visits are subject to change due to any problems. OVER THE COUNTER AND RX MEDICATIONS THAT ARE SAFE IN PREGNANCY AND MEDICATION USE IN PREGNANCY Take your prenatal vitamin with DHA daily as directed. CALL THE OFFICE IF YOU HAVE A FEVER OVER 100.4 If you are having severe nausea, please call our office to discuss this with your obstetrician. Please take your vitamins with water. Do NOT take medications of ANY kind unless they are approved by Dr. Hernandez and/or Dr. Ashley (including over-the-counter medications) which includes skin care products, supplements, tanning lotions, and hair dyes. Do not use tanning booths, hot tubs, or saunas. THE FOLLOWING OVER-THE-COUNTER MEDICATIONS MAY BE SAFELY USED IN PREGNANCY. PLEASE FOLLOW ALL THE DIRECTIONS OF THE MEDICATION LABEL FOR THE SAFE ADULT DOSAGE. Mild Headache or “aches and pains” ***NARCOTICS ARE NOT SAFE IN PREGNANCY*** • Tylenol (acetaminophen). Maximum dose 4 grams in 24 hours. • Excedrin Migraine (acetaminophen, aspirin, caffeine). • Caution – call the office if you have a severe or long-lasting pain or headache or • You may need to be seen at the ER if you have “worst headache of your life” type pain neurologist if your headache symptoms worsen. INSOMNIA • Unisom • Benadryl • Vistaril • Tylenol PM • Warm bath, calming tea • Ambien is not safe in pregnancy. HEARTBURN • Tums • Maalox • Mylanta • Zantac • Pepcid • Avoid spicy foods, citrus, tomato sauce, garlic, or other acidic foods. • Avoid eating close to bedtime. NASAL CONGESTION FROM ALLERGIES OR A COLD • Ocean Nasal Spray • Benadryl (diphenhydramine) • Claritin (loratidine) • Cool mist humidifier • Neti pot with saline nasal wash • Sudafed/decongestant (after 14 weeks pregnancy). Ok to take plain Sudafed, found behind the pharmacy counter. 1-2 tablets every 4-6 hours as needed (unless you have high blood pressure). • Call the office if you have a fever over 100.4 or if you have shortness of breath or ear pain SORE THROAT • Gargle with warm salt water 3-4 times per day. • Lozenges that are alcohol free such as Cloraseptic. • Call the office if the pain is severe or long-lasting or if you have a fever over 100.4 • Hot lemon tea (no honey) COUGH • Robitussin or guaifenesin – choose capsules or alcohol free syrups. • Call the office if the cough is long-lasting or if you have a fever over 100.4 NAUSEA • Diclegis – need a RX from your obstetrician. • Reglan – need a RX • Phenergan – need a RX • Zofran – need a RX • OTC Unisom • OTC vitamin B6 • Dry toast or cracker before getting out of bed. • Call the office if you have persistent nausea and vomiting. CONSTIPATION • METAMUCIL • SENNA-S • COLACE • MILK OF MAGNESIA • MAGNESIUM CITRATE • MIRALAX • INCREASE WATER AND FIBER IN YOUR DIET (FRESH FRUITS, VEGETABLES, AND WHOLE GRAINS) • AVOID SEVERE STRANING WITH BOWEL MOVEMENTS GAS PAIN • Gas-X (simethicone) – up to four times per day. HEMORRHOIDS • Preparation-H (cream, ointment, or suppositories) • Chilled Witch Hazel pads (Tucks pads) • Proctofoam • Anusol-HC • Warm bath (sitz bath) – soak your bottom in warm water. • Avoid straining with bowel movements • Call the office if you have excessive bleeding or pain from hemorrhoids MILD TO MODERATE DIARRHEA • Imodium for no more than 48 hours • Drink lots of fluids • Call the office if the diarrhea lasts for more than 2 days, or if you have a fever greater than 100.4, or if the diarrhea is bloody or has mucus. VAGINAL YEAST INFECTIONS • Mycolog-II ointment/cream • Terazol-3 vaginal treatment • Monistat-7 as directed on the label. • DIFLUCAN IS NOT SAFE IN PREGNANCY • CALL THE OFFICE IF THERE IS VAGINAL DISCHARGE WITH AN ODOR OR BLOODY DISCHARGE. BACTERIAL VAGINOSIS INFECTIONS • FLAGYL HERPES GENITALIS INFECTIONS • Acyclovir • Valtrex URINARY TRACT INFECTIONS • MACROBID • AMPICILLIN • AMOXICILLIN Follow the directions on the bottle/package on how often to take the medication. Do not take more than the amount recommended and do not take more frequently than recommended. It is better to take the full dose of the medication but take it less often than to take only a partial dose as it may not work as well. If constipation is problem, try to increase your fluid intake of water. Increase raw/whole fruits and vegetables, and eat more bran (cereals), raisins, prunes, figs, etc. An increase in vaginal discharge during pregnancy is normal. DO NOT DOUCHE! If itching, burning, or a foul odor occurs, please call our office. DENTAL CARE WHILE YOU ARE PREGNANT 1. If dental x-rays are absolutely necessary, they may be taken but only if a double abdominal shield is provided to protect the developing fetus from x-ray exposure. 2. Local anesthetic with preferably lidocaine without epinephrine may be used for anesthetic. No nitrous oxide or “twilight anesthesia”. 3. If antibiotics are necessary, Penicillins may be prescribed (Penicillin G, Amoxicillin, or Ampicillin) may be prescribed, unless the patient is allergic. If allergic, use Erythromycin. No Sulfa or Tetracycline type antibiotics. 4. If pain medication is necessary, Vicodin or Percocet may be prescribed, unless the patient is allergic. No Ibuprofen. 5. Our office recommends that you continue your six month dental cleaning appointments to maintain your dental health. 6. Please have your dental office contact us with further questions. CHOOSING THE HOSPITAL THAT IS RIGHT FOR YOU & HOW TO PRE-REGISTER FOR CHILDBIRTH Often your insurance will dictate the hospital where you must deliver your baby. Only two hospitals in Reno have maternity and childbirth services, Renown Regional Medical Center and Saint Mary’s Regional Medical Center. Renown South Meadows and Northern Nevada Medical Center do not have a labor and delivery departments and neither hospital has obstetricians on call. Please do not go to South Meadows or Northern Nevada FOR ANY REASON DURING YOUR PREGNANCY. We ask that you have picked your hospital by 24 weeks gestation. It is at this time that we will begin sending copies of your prenatal record to the specific hospital. Please do not go back and forth between hospitals as only one hospital will have your prenatal record and to switch between the two may cause a delay in your care. We enjoy working at both hospitals and truly do not have a preference.