Prenatal Care involves initial visit to assess risks, initial laboratory tests and physical exam. For normal pregnancies visits are monthly until the 7th month, then twice a month until the last month when visits are weekly.
We provide care for normal and most high-risk pregnancies. You and your family are an integral part of the decision making process during your pregnancy, and the birth of your child. The delivery may be a vaginal or c/section. We will provide you with necessary information and help guide you through all the important decisions to insure you have a safe pregnancy. Our main goal is to help you have a healthy baby while also providing a good experience.
We will refer you for ultrasound services, as needed. You will generally get 1 ultrasounds during your pregnancy. The ultrasound (the one you have been waiting for) is the anatomy scan where we look at all the baby’s organs and parts to make sure everything looks normal. Occasionally other ultrasounds will be indicated but this would be determined by necessity. A screening ultrasound for Down’s syndrome called the Nuchal Skin Fold/Nuchal Translucency or First Trimester Screen may be indicated. Another ultrasound could be done around 28-30 weeks just to check the baby’s growth and position.
High-risk pregnancies are complicated especially by one of the following problems.
Diabetes: There are two kinds of diabetes in pregnancy. The first is pre- pregnancy meaning that you already have diabetes prior to becoming pregnant. There are some differences however when you are pregnant. You will need to keep good control of your blood sugar. You will still see us in the office and be delivered by BCWH. The other type is “Gestational Diabetes” which is diabetes that develops in pregnancy. We screen every pregnancy for this between 26-30 weeks. If you have an abnormal test, you have gestational diabetes. At that point you will have a dietary evaluation and you will frequently test you blood sugars. Most women can control their blood sugar with their diet and weight control. If blood sugar is not well controlled with diet, then we will start a pill or as a last resort insulin injections.
High Blood Pressure: High blood pressure (hypertension) is a common complications in pregnancy. Women who have elevated blood pressure prior to the 20th week generally have what is called Chronic Hypertension and occasionally require treatment with oral medication. Women who develop hypertension after the 20th week of gestation have what is called pregnancy-induced hypertension. If you develop this we will want to watch you closely to make sure you do not develop Preeclampsia. This is achieved with frequent visits for blood pressure checks and checking the urine for protein as well as blood work. Occasionally if you do develop Preeclampsia it could mean that your baby will need to be delivered before natural labor. Hypertension related to pregnancy generally resolves after delivery.
Advanced Maternal Age: If your age is over 35, you are considered as having advance maternal age and are at increased risk for certain complications of pregnancy. Patients who are older when they become pregnant are at a greater risk for certain birth defects such as Down’s syndrome. They also are more likely to have other medical problems that complicate pregnancy such as hypertension, diabetes, thyroid disease etc. Additional ultrasounds and a referral to a specialist will be recommended.
Thyroid disease: There are two types of thyroid disease, Hyperthyroidism (too much thyroid hormone) and Hypothyroid (too little thyroid hormone). Hyperthyroidism is relatively rare in pregnancy and can be treated with medications. Hypothyroidism is much more common and is treated with replacement thyroid hormone. If you have hypothyroidism we will check your thyroid level at least every 2-3 months to be sure that you have enough of this hormone.
Multiples: Multiple pregnancies are considered high risk because they are at increased risk for certain complications such as preterm labor/delivery, preeclampsia and diabetes. We monitor twin pregnancies very closely with ultrasound and consultation with the perinatologist, if necessary. If you have triplets or greater you will be managed by the high risk doctor, the perinatologist.
Delivery & Postpartum care
The physicians at BCWH have privileges to do deliveries at Anderson Mercy hospital. Early in you OB care, you will get information about the hospital, and we will discuss your signs of labor and anticipated delivery as delivery time gets close. You will be routinely seen about one month after delivery for postpartum care unless you have problems.
We offer full service gynecology, and can take care of most gynecologic issues. We offer the latest office procedures for contraception, as well as abnormal pap management and abnormal bleeding management. We also perform surgery at Southwest Regional Medical Center, and Clermont Mercy hospitals ranging from minimally invasive surgery to complete hysterectomy.
Abnormal vaginal bleeding is a common problem that has many different causes. We will take a detailed history and based on your age and history will decide what testing you need. Generally you will have an ultrasound, blood count and thyroid check or other testing, if necessary. Then we will discuss a treatment plan with you in detail. Treatments for this problem can be medical with hormones/birth control or with a minimally invasive surgery occasionally it will require major surgery.
Abnormal Pap Management
The Pap smears in our office are done according to recommended guidelines. Management is also by standard guidelines. If you have an abnormal Pap a Colposcopy is often recommended.
Colposcopy -- This a procedure done in the office to evaluate abnormal pap smears. It is a very detailed examination of the cervix. After the speculum is placed, vinegar is applied to the cervix and the cervix and vagina is evaluated with a special microscope. The vinegar makes abnormal cells easier to see. If there are any abnormalities a biopsy will be taken of that area. This procedure is generally not considered painful, other than some mild menstrual type cramping.
This is a comprehensive exam to review your entire medical history focusing on any gynecologic issues. We will discuss prevention, screening and treatments. Screening tests that we offer are typically dependant on your age. We can do the Pap test and screen for sexually transmitted infections . We can also send you for health maintenance screening for blood sugar, cholesterol , vitamin D level, thyroid, osteoporosis screening (dexa) and mammogram.
Birth Control -- We offer comprehensive contraception services in the office.
Implant contraceptive rod in arm
Implanon is the most effective method of birth control unless you use abstinence. With a small amount of anesthesia, it is then inserted in the arm much like started an IV. Side effects of abnormal uterine bleeding similar to "the shot" are common.
“The shot”, Depo-Provera, is very effective and is given every three months. It works differently than the pill in that there is no estrogen with this method. It is often associated with abnormal bleeding especially in the first 6-9 months but eventually you may cease to have cycles at all. This type of contraception has been associated with reversible bone loss.
The IUD, Mirena or Paragard IUD's are devices that are placed in your uterus by a doctor in the office. The Mirena IUD uses progesterone for contraception and lasts for up to ten years. Placement is similar to a pap smear but a little more uncomfortable. We use with a local anesthesic. If you have complications or want the IUD out prior to it’s life expectancy, we can take it out at any time in our office. We have information about these IUD's in the office. You should be on your period on the day of insertion.
Oral Contraceptives (birth control pills)
There are many different choices on the market. They ALL provide contraception when taken correctly. These have a daily dosing schedule.
We usually do this using a laparoscopy, a two small holes in you abdomen, but you come to the hospital and must have general anesthesia (“going to sleep”).
“The Patch” this works similarly to “the pill” but has some different side effects and weekly dosing schedule.
“The Ring”, Nuvaring is more effective than the pill and has much lower side effects because of a lower dose of hormones. The ring is inserted vaginally by you and lasts for one month. You insert the ring; it’s easier than a tampon. This is a great contraception for those who have trouble remembering to take a pill every day.
Infertility is defined as being unable to become pregnant after trying for one year. An in-depth history and physical will be done and special testing. Referral to an infertility specialist may be done when indicated.
Menopause occurs when you no longer have eggs in your ovaries. There are many changes in hormone levels and changes in your body. Hormone replacement therapy is not right for everyone, but will definitely benefit some. We treat each patient on a case-by-case basis making decisions with you based on your symptoms, medical issues and family history. We will also evaluate and treat you for osteoporosis/osteopenia (low bone mass).
There are also many other gynecologic issues that we care for that were not mentioned, but we welcome you to discuss any issues or questions you may have at your appointment, if it is something that we do not take care of we could certainly point you in the right direction.
Your vaccination history will be discussed and suggested vaccination schedule recommended.
Surgery -- We can handle many problems that required surgery in the past with medicines or less invasive procedures.
We do several office procedures. Colposcopy to evaluate abnormal Pap smears. Endometrial Biopsy to evaluate abnormal uterine bleeding. Appropriate biopsies of the vagina and perineal area. Incision an drainage of certain lesions.
Many GYN surgeries are done including removal of the uterus, tubes and ovaries.
LEEP surgeries to remove the inner part of the cervix for severe abnormal Pap smears. Endoscopic procedures with the use of a long tube with a lighted camera to inspect and treat problems in the uterus (hysteroscopy) or laparoscopy (endoscopy in the abdomen) for evaluation and pelvic abnormalities or for tubal ligation.
These are just a small sample of the surgical procedures we provide
our patients. Please feel free to call the office if there is a
procedure you have specific questions about.