Pregnancy

 By convention, your “pregnancy” begins the first day of your last menses and not at conception. You don’t conceive until 2 weeks after your period begins, for a typical 28 day cycle, so in actuality you have only been pregnant for four weeks when you are “six weeks” pregnant.

We measure pregnancies in weeks in the medical field. Your due date is exactly 40 weeks from the first day of your last menstrual period. Yes, a typical pregnancy is nine months long but measuring in months would be too vague and not a reliable gauge for calculating your due date.

What to expect when you are expecting in your pregnancy:

Appointments and tests schedules

4-6 weeks

After you have two positive home pregnancy tests, you should call us and set up an “OB confirmation visit.” One of our nurses will obtain all the pertinent information about your past medical history and other important items. You will then have prenatal blood tests drawn, which will be discussed at your next visit with the doctor. During pregnancy, your visits will rotate through all of the physicians.

6-11 weeks

The next scheduled appointment will be an exam by Dr. Chacon. A full exam will be done with a PAP smear and cultures. Your blood tests results will be reviewed, and previous pregnancy problems will be discussed. This is a good time to ask questions and inform us of any special concerns you might have. Remember your partner is always welcome to come to any or all visits. Most partners will want to come for the ultrasound visits. Remember also that you can reach us for emergencies 24 hours a day through the office phone number 775-786-7440. Our medical answering service will receive your call and forward your name and phone # to us by a paging Dr. Chacon or the physician on call for him. He will return your call as soon as possible so please stay at the number you gave to the service. For routine, but important questions, call during regular office hours 8-12 and 1:30-5 and talk to our triage nurse.

 11-14 weeks

During this visit we will do the first of two ultrasounds that we feel are appropriate for good obstetrical care. With the first ultrasound, we will measure the size of the baby and listen to the heartbeat. We also do a measurement that screens for some birth defects such as Down Syndrome. This measurement is done with ultrasound and measures a small pocket of fluid underneath the skin on the back of the baby’s neck (“nuchal translucency”) which is done by our perinatology referrals. Studies have shown that some babies with Down Syndrome have an increased thickness of this layer. There is also blood taken during this visit as part of the nuchal transluceny test if you desire to be screened for trisomy like Down Syndrome. Many parents may not want to do these screening tests.
This ultrasound also confirms fetal viability, and measurements of the fetus can help us confirm what is correct due date for the baby’s arrival. At 12 weeks, the chances for miscarriage go down considerably, so that this is a good time for you to be able to tell family and friends that you are pregnant.
Normal symptoms:
As your uterus stretches you may occasionally feel some menstrual type cramps. This is completely normal. If you have bleeding or you experience cramps regularly you need to call us immediately

14-22 weeks

At this point in your pregnancy, we should be able to hear the baby’s heartbeat by placing a small listening device, called a Doppler, on your abdomen. We also measure your abdomen to make sure the uterus is growing appropriately. At this point in the pregnancy (16-19 weeks), there is a second blood test done to check for Down Syndrome and spina bifida. This test, which has become standard practice for many years, checks 4 different chemicals in your blood. These results and other information, such as age, weight, and race, are input into the lab’s computer and a risk assessment for Down Syndrome (DS)and neural tube defects, also known as spina bifida, is given. At this stage in the pregnancy we will refer you to a perinatologist for a full ultrasound to look at the baby’s anatomy and check for growth. During this visit, if you would like, we can determine the sex of the baby. Many birth defects can be seen using ultrasound, but the smaller the problem, the harder it is to see and some issues can’t be seen at all. Of course issues that are genetic, metabolic, and other conditions like Sickle cell anemia, can’t be seen at all. Sample pictures from the ultrasound will often times be given to you to take home and share with family or friends.

22-25 weeks

At this point in your pregnancy, the baby is growing quickly. As with previous visit, we will take a urine specimen for protein, ketones, and glucose. We will also weigh you, check your blood pressure, measure your uterus, and listen to the baby’s heart with a Doppler. When measuring the baby’s growth, we measure from the pubic symphysis to the top or “fundus” of the uterus. This should roughly be the same number of centimeters as weeks in your pregnancy. For example at 24 weeks your fundal height should be 24cm. At this visit we will give you your registration packet from the hospital. Inside the packet you will find all the information you need to sign up for classes on childbirth or breast feeding.
Normal symptoms:
A very common symptom during this point of the pregnancy is “round ligament pain.” The round ligaments are two very small ligaments that go from each side of the uterus to the pelvis floor. They’re about the size and length of your little finger and as the uterus grows they get stretched. This usually presents itself as a sharp pain on one side or the other that gets worse with various movements such as walking or rolling over in bed. Near the end of this stage you may also experience “Braxton-Hicks” contractions also referred to as uterine cramping.

26-28 weeks

During this stage of your pregnancy we perform a test for gestational diabetes. This type of diabetes is when your blood sugar is too high, and it is a special kind diabetes found only in pregnancy. The test involves drinking a very sugary drink, usually given at the previous visit, followed by having blood drawn one hour later. If this blood sugar value is above 140 you need to take an additional test that will clearly tell us if you have gestational diabetes. After this visit, the time between appointments decreases from monthly to every two weeks. Remember, there’s always time for questions – bring a list.
Normal symptoms:
Uterine cramping or “Braxton-Hicks” contractions are very common at this stage in your pregnancy. The more times you have become pregnant, the earlier they begin and the stronger they can feel. Most women have only a few of these contractions in a single day. If you have more than six in an hour, this could be signs of preterm labor and you should call us.

29-34 weeks

During this stage your visits will occur every two weeks unless there is a complication with your pregnancy and we need to see you more often. At every visit, we will check the growth of your uterus and indirectly, your baby, and listen to the baby’s heartbeat. There are no routine labs or tests done during this period. This is also the time when you should be signing up for birthing classes and scheduling a tour of the hospital of your choice if interested.
Normal symptoms:
Back pain is very common at this point in your pregnancy. As the baby grows, their weight puts a lot of strain on your lower back. Massages and heat on your back, NOT on your abdomen, work the best to relieve pain. Heartburn is also common as the baby starts to push up on your stomach. We have a list of safe medicines for this and other common problems available if you have not already received one.

35-40 weeks

What to expect at your visit:
You’re getting very close now! During the final stages of your pregnancy your visits will be every week. Between 35 to 37 weeks we perform a test for the Group B Strep (GBS) bacteria on all women. This bacteria usually doesn’t cause infections in adults, but can cause serious infections in newborns. The test involves a quick vaginal swab and takes about a week to get the results. If you have this bacteria, about 1 in 3 women do, you’ll receive antibiotics in labor to protect the baby. The antibiotics are administered in your IV. They cross the placenta and end up in the baby’s circulation so that they are protected during birth. During the final weeks, we start performing checks to see if your cervix, the opening of the uterus/womb where the baby comes out, is dilating.
Normal symptoms: 
Labor is the obvious sign to look for at this point in your pregnancy. If you have contractions every five minutes for an hour, any vaginal bleeding other than bloody show, a sudden gush of fluid, or your baby is not moving, call us immediately.

Links/Suggested Reading

Pregnancy & Motherhood Links

American Baby Magazine
Baby Zone
www.fitpregnancy.com
www.parentsguidecordblood.org
www.pregnancyguideonline.com
www.womenshealth.gov/pregnancy/

Women’s Health Links

www.cdc.gov/Women
www.healthywomen.org
www.menopause.org/Consumers.aspx
www.nwhn.org
www.womenshealth.gov

Miscellaneous Links

www.acog.com
www.cancer.org
www.cdc.gov/h1n1flu/
www.mayoclinic.com
www.medlineplus.com
www.smokefree.gov