Your pregnancy visits:
Throughout your pregnancy you will have a number of antenatal consultations. You will generally be seen for the first time when you are between 8-10 weeks gestation. This visit will take around 40 minutes and will involve a full history and physical examination as well as a brief ultrasound scan preformed in the rooms to check on the pregnancy. Please be sure to bring a referral from your local doctor and any test results or ultrasound scans that you may have already had.
Future visits will be spaced throughout the pregnancy based on the health of you and your baby. Most women will have a further 10-12 appointments, please see below:
14 weeks (after the 12-13 week ultrasound scan)
18 weeks
22 weeks (after the 20-21 week ultrasound scan)
28 weeks (time for the pregnancy diabetes test)
31 weeks, 33 weeks and 36 weeks
37 weeks
38 weeks, 39 weeks, 40 weeks and sometimes 41 weeks
Initial tests:
Dating ultrasound: The expected due date can be confirmed by an early ultrasound 7-10 weeks gestation.
Dr Cohen is happy to perform a dating ultrasound during your first appointment.
Testing for chromosomal abnormalities: Depending on your preference you may wish to test for chromosomal abnormalities in your pregnancy.
There are screening tests and diagnostic tests available to you. In general women have a screening test and if this is low risk then they can be reassured.
Screening tests available include:
Combined maternal serum screening:
This test involves a blood test at 9 to 14 weeks coupled with an ultrasound at 11 to 14 weeks. This test will pick up 90 plus percent of Downs syndrome cases.
NIPT (Non Invasive Prenatal Testing)
There are a number of laboratories offering this test to women in Melbourne.
NIPT will pick up 98 % of cases of Downs syndrome with a lower false positive rate. This means that women and their families are less likely to be made anxious while they wait for a diagnostic test.
VCGS:
http://www.vcgs.org.au/perceptNIPT/
Dorevitch:
http://www.dorevitch.com.au/IamaPatient/MyTesting/NoninvasivePrenatalTesting(NIPT).aspx
Melbourne Pathology:
https://nipt-n1.apps.sonichealthcare.com/prod/
Diagnostic tests include amniocentesis and chorionic villus sampling. If need be Dr Cohen will discuss these tests with you.
Routine test arranged in pregnancy:
Blood group and antibodies. (If you are Rh negative you will require anti D at 28 and 34 weeks of pregnancy.)
Full blood count: to check that you are not anemic and that you have adequate platelets (the sticky part of the blood that forms clots)
Screening for important infections: Hepatitis B and C, HIV, syphilis.
Screening for immunity to infections: rubella and varicella (chicken pox)
Screening for deficiency in iron stores
Screening for low vitamin D.
A urine culture to screen for asymptomatic bacteria of pregnancy. ( A cause of premature birth if not treated)
A 12-14 weeks ultrasound is encouraged to screen for early fetal malformations.
Screening for gestational diabetes:
For most women a glucose tolerance test (GTT) is recommended at 26 plus weeks of pregnancy to screen for gestational diabetes. In some women who are at increased risk for diabetes a GTT is performed earlier in the pregnancy and if normal repeated at 26 weeks.
Mid trimester ultrasound
This is the most important ultrasound in which we screen for structural malformations which would include heart and brain malformations.
http://www.wum.com.au/midtrimester-ultrasound
Screening for fetal growth and well being.
Dr Cohen will perform an ultrasound each time he sees you. This includes an assessment of the fetal heart rate, amniotic fluid level and measurement of the fetal abdominal circumference, a good indicator of fetal growth and well-being. If there are any concerns regarding your baby’s growth or well being a formal ultrasound may be requested.
Group B Streptococcus (GBS)
Dr Cohen does not routinely screen for GBS, following the protocol endorsed by RCOG and Monash medical center. Women are given antibiotics during their labor if GBS was found in the urine screen at booking or if they have any risk factors for neonatal infection. Risk factors for infection would include premature delivery or prolonged rupture of the membranes. Of course if a women requests screening Dr Cohen is happy to facilitate this.
Vaginal birth after previous caesarean section VBAC
Dr Cohen encourages VBAC. VBAC is facilitated by awaiting spontaneous labor when ever possible and induction of labor when needed, for instance prior 42 weeks. During labor the fetal heart rate is monitored continuously. This is important as the rare event of scar separation is first reviled by changes in the fetal heart rate. In general VBAC is only encouraged for one previous caesarean section, however if you have had two caesarean sections the risk of scar separation is ~ 1:100 and Dr Cohen will support you to try for a vaginal birth.
Breech presentation at term (37 plus weeks)
If your baby is in the breech presentation and there are no contraindications then Dr Cohen will advise you to have an ECV (external cephalic version). ECV is very safe. Under ultrasound guidance your baby is gently encouraged to rotate to the head down position by gentle pressure on your abdomen. ECV is successful in 50-70 percent of the time. If ECV is unsuccessful or if you do not want to attempt ECV then there are two options for the birth of your baby. Vaginal breech birth, particularly if your baby is in the frank breech position is very safe. Elective caesarean section or caesarean section once your labor has commenced (allowing your baby to choose their own birth date.)
Term ruptured membranes:
In about 5-10 % of women the waters break prior to active labor starting. There are two options in this scenario. Induction of labor or awaiting spontaneous labor.
Dr Cohen is happy for you do elect to do either (as long as there is no contraindications to waiting such as meconium stained liquor or known GBS colonization). In general Dr Cohen recommends induction of labor after approximately 24 hours of membrane rupture to prevent both neonatal and maternal infection. Antibiotics will be given to women after 18 hours of membrane rupture.
Water birth
Water immersion during labor and birth in the bath is a safe and an effective method of pain relief during labor and birth.
Water birth is available at Jessie Macpherson private hospital. There are inclusion and exclusion criteria for water immersion and water birth, which Dr Cohen will explain this during your pregnancy.
Healthy diet and exercise during pregnancy:
Maintaining a healthy diet is vitally important for your babies growth and development:
https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-diet
Doing regular (at least four times a week) exercise will greatly benefit both you and your baby:
https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-exercise
