May we take this opportunity to congratulate you if you have just become pregnant. This is an important transition in your adult life and Dr Rahimpanah hopes he could be of assistance in easing this process.
His experience, training, professionalism and friendly demeanour will make this journey, a joyful and pleasant one for you. He is always more than willing to answer your queries and concerns during this period. You will be able to discuss different stages of you pregnancy and anticipation and mode of delivery freely.
You will be seeing Dr Rahimpanah from early pregnancy 4th weekly until 28 weeks, then fortnightly until 36 weeks and weekly then after. However, he will be available to discuss any issues at any time in between, as they arise.
He delivers at Sydney South West Private, Liverpool Hospitals. Being a senior consultant at tertiary hospital will allow you to access the highest level of care regardless of what stage of pregnancy you may be at.
Here under are some common issues, questions and concerns which may apply to you and your pregnancy:
· Working during pregnancy
It is safe to continue working during pregnancy depending on the job.
· Nutritional supplements
- Pregnant women (and those intending to become pregnant) should be informed that dietary supplementation with folic acid, before conception and throughout the first 12 weeks, reduces the risk of having a baby with a neural tube defect (for example, anencephaly or spina bifida). The recommended dose is 400 micrograms per day.
- Iron supplementation should not be offered routinely to all pregnant women. It does not benefit the mother’s or the baby’s health and may have unpleasant maternal side effects.
- Pregnant women should be informed that vitamin A supplementation (intake above 700 micrograms) might be teratogenic and should therefore be avoided. Pregnant women should be informed that liver and liver products may also contain high levels of vitamin A, and therefore consumption of these products should also be avoided.
- All women should be informed at the booking appointment about the importance for their own and their baby’s health of maintaining adequate vitamin D stores during pregnancy and whilst breastfeeding. In order to achieve this, women may choose to take 10 micrograms of vitamin D per day, as found in the Healthy Start multivitamin supplement. Particular care should be taken to enquire as to whether women at greatest risk are following advice to take this daily supplement. These include:
- women of South Asian, African, Caribbean or Middle Eastern family origin
- women who have limited exposure to sunlight, such as women who are predominantly housebound, or usually remain covered when outdoors
- women who eat a diet particularly low in vitamin D, such as women who consume no oily fish, eggs, meat, vitamin D-fortified margarine or breakfast cereal
- women with a pre-pregnancy body mass index above 30 kg/m2.
· Food hygiene
Your midwife or doctor should give you information on bacterial infections such as listeriosis and salmonella that can be picked up from food and can harm your unborn baby. In order to avoid them while you are pregnant it is best to:
- keep to pasteurised or UHT milk, if you drink milk
- avoid eating mould-ripened soft cheese, such as Camembert or Brie, and blue-veined cheese (there is no risk with hard cheese such as Cheddar, or with cottage cheese or processed cheese)
- avoid eating pâté (even vegetable pâté)
- avoid eating uncooked or undercooked ready-prepared meals
- avoid eating raw or partially cooked eggs or food that may contain them (such as mayonnaise)
- avoid eating raw or partially cooked meat, especially poultry.
Toxoplasmosis is an infection that does not usually cause symptoms in healthy women. Very occasionally it can cause problems for the unborn baby of an infected mother. You can pick it up from undercooked or uncooked meat (such as salami, which is cured) and from the faeces of infected cats or contaminated soil or water. To help avoid this infection while you are pregnant it is best to:
- wash your hands before and after handling food
- wash all fruit and vegetables, including ready-prepared salads, before you eat them
- make sure you thoroughly cook raw meats and ready-prepared chilled meats
- wear gloves and wash your hands thoroughly after gardening or handling soil
- avoid contact with cat faeces (in cat litter or in soil).
· Prescribed medicines
Few medicines have been established as safe to use in pregnancy. Prescription medicines should be used as little as possible during pregnancy and should be limited to circumstances in which the benefit outweighs the risk. Always consult your doctor before commencing any medications.
· Over-the-counter medicines
Pregnant women should be informed that few over-the-counter medicines have been established as being safe to take in pregnancy. Over-the-counter medicines should be used as little as possible during pregnancy. If in doubt, discuss with your doctor.
· Complementary therapies
Pregnant women should be informed that few complementary therapies have been established as being safe and effective during pregnancy. Women should not assume that such therapies are safe and they should be used as little as possible during pregnancy.
· Exercise in pregnancy
a. Beginning or continuing a moderate course of exercise during pregnancy is not associated with adverse outcomes.
b. The potential dangers of certain activities during pregnancy, for example, contact sports, high-impact sports and vigorous racquet sports that may involve the risk of abdominal trauma, falls or excessive joint stress, and scuba diving, which may result in fetal birth defects and fetal decompression disease.
· Sexual intercourse in pregnancy
Sexual intercourse in pregnancy is not known to be associated with any adverse outcomes.
· Alcohol consumption in pregnancy
Pregnant women and women planning a pregnancy should be advised to avoid drinking alcohol in the first 3 months of pregnancy if possible because it may be associated with an increased risk of miscarriage.
If women choose to drink alcohol during pregnancy they should be advised to drink no more than 1 to 2 units once or twice a week (1 unit equals half a pint of ordinary strength lager or beer, or one shot [25 ml] of spirits. One small [125 ml] glass of wine is equal to 1.5 UK units). Although there is uncertainty regarding a safe level of alcohol consumption in pregnancy, it is safest not to drink alcohol at all.
Women should be informed that getting drunk or binge drinking during pregnancy (defined as more than 5 standard drinks or 7.5 units on a single occasion) may be harmful to the unborn baby.
· Smoking in pregnancy
At the first contact you should discuss smoking status with your doctor. You may be provided with information about the risks of smoking to the unborn child and the hazards of exposure to secondhand smoke. You can ask any concerns may have about stopping smoking.
Pregnant women should be informed about the specific risks of smoking during pregnancy (such as the risk of having a baby with low birthweight and preterm birth). The benefits of quitting at any stage should be emphasised.
Advise women using nicotine patches to remove them before going to bed.
Women who are unable to quit smoking during pregnancy should be encouraged to reduce smoking.
· Air travel during pregnancy
Pregnant women should be informed that long-haul air travel is associated with an increased risk of venous thrombosis, although whether or not there is additional risk during pregnancy is unclear. In the general population, wearing correctly fitted compression stockings is effective at reducing the risk.
· Car travel during pregnancy
Pregnant women should be informed about the correct use of seatbelts (that is, three-point seatbelts ‘above and below the bump, not over it’).
· Travelling abroad during pregnancy
Pregnant women should be informed that, if they are planning to travel abroad, they should discuss considerations such as flying, vaccinations and travel insurance with their midwife or doctor.
Management of common symptoms of pregnancy
· Nausea and vomiting in early pregnancy
1. Women should be informed that most cases of nausea and vomiting in pregnancy will resolve spontaneously within 16 to 20 weeks and that nausea and vomiting are not usually associated with a poor pregnancy outcome. If a woman requests or would like to consider treatment, the following interventions appear to be effective in reducing symptoms:
- P6 (wrist) acupressure
2. Information about all forms of self-help and non-pharmacological treatments should be made available for pregnant women who have nausea and vomiting.
1. Women who present with symptoms of heartburn in pregnancy should be offered information regarding lifestyle and diet modification.
2. Antacids may be offered to women whose heartburn remains troublesome despite lifestyle and diet modification.
1. Women who present with constipation in pregnancy should be offered information regarding diet modification, such as bran or wheat fibre supplementation.
In the absence of evidence of the effectiveness of treatments for haemorrhoids in pregnancy, women should be offered information concerning diet modification. If clinical symptoms remain troublesome, standard haemorrhoid creams should be considered.
· Varicose veins
Women should be informed that varicose veins are a common symptom of pregnancy that will not cause harm and that compression stockings can improve the symptoms but will not prevent varicose veins from emerging.
· Vaginal discharge
Women should be informed that an increase in vaginal discharge is a common physiological change that occurs during pregnancy. If it is associated with itch, soreness, offensive smell or pain on passing urine there may be an infective cause and investigation should be considered.
1-week course of a topical imidazole is an effective treatment and should be considered for vaginal candidiasis infections in pregnant women.
Women should be informed that exercising in water, massage therapy and group or individual back care classes might help to ease backache during pregnancy.
Screening and tests
Screening and tests
Early in your pregnancy you should be offered a number of tests.
Your doctor should tell you more about the purpose of any test you are offered. You do not have to have a particular test if you do not want it. However, the information these tests can provide may help your antenatal care team to provide the best care possible during your pregnancy and the birth. The test results may also help you to make choices during pregnancy.
· Ultrasound scans
You should be offered an ultrasound scan between 10 weeks 0 days and 13 weeks 6 days to estimate when your baby is due and to check whether you are expecting more than 1 baby. This scan may also be part of a screening test for Down's syndrome.
You should be offered another scan, normally between 18 weeks 0 days and 20 weeks 6 days, to check for physical problems in your baby. This is called the anomaly scan. Your doctor or midwife will give you more information about the scan and what the results may mean for you so you can decide whether you want to have the scan or not. If the scan shows a possible problem, you will be referred to a specialist to discuss the options available to you. It is important to realise that no test is 100% accurate.
· Screening tests for Down's syndrome
Down's syndrome is a condition caused by the presence of an extra chromosome in a baby's cells. It occurs by chance at conception and is irreversible.
Early in your pregnancy you should be offered information and screening tests to check whether your baby is likely to have Down's syndrome. Your midwife or doctor should tell you more about Down's syndrome, the screening tests you are being offered, what the results may mean for you and the decisions that you may need to think about. You have the right to choose whether to have all, some or none of these tests. You can opt out of the screening process at any time if you wish. Screening tests will only indicate that a baby may have Down's syndrome. If the screening test results are positive, you should be offered further information, support and more tests to confirm whether or not your baby has Down's syndrome.
Between 11 weeks 0 days and 13 weeks 6 days, the screening test for Down's syndrome should be the combined test (an ultrasound scan and blood test).
· Blood tests
You should be offered 2 tests for anaemia: one at your booking appointment and another at 28 weeks. Anaemia is often caused by a lack of iron. If you develop anaemia while you are pregnant, it is usually because you do not have enough iron to meet your baby's need for it in addition to your own; you may be offered further blood tests. You should be offered an iron supplement, if appropriate.
Blood group and rhesus D status
Early in your pregnancy you should be offered tests to find out your blood group and your rhesus D (RhD) status. Your midwife or doctor should tell you more about them and what they are for. If you are RhD-negative, you should be offered an anti-D injection to prevent future babies developing problems.
Early in your pregnancy, and again at 28 weeks, you should be offered tests to check for red-cell antibodies. If the levels of these antibodies are significant, you should be offered a referral to a specialist centre for more investigation and advice on managing the rest of your pregnancy.
Inherited blood conditions
Inherited blood conditions, such as thalassaemia and sickle cell disease, mainly affect people whose family origin is African, Caribbean, Middle Eastern, Asian or Mediterranean, but these conditions are also found in the North European population. At your first appointment, your midwife or doctor should give you information about inherited blood conditions, offer advice and support, and ask some questions about your and your partner's family origins to find out whether you are at risk of being a carrier or having a baby with an inherited blood condition. If you are a carrier of an inherited blood condition, the father of your baby should also be offered advice, support and screening without delay.
· Testing for infections
Your midwife or doctor should offer you a number of tests, as a matter of routine, to check for certain infections. These infections are not common, but they can cause problems if they are not detected and treated.
Asymptomatic bacteriuria is a bladder infection that has no symptoms. Identifying and treating it can reduce the risk of developing a kidney infection. It can be detected by testing a urine sample.
Hepatitis B virus
Hepatitis B virus is a potentially serious infection that can affect the liver. Many people have no symptoms. It can be passed from a mother to her baby (through blood or body fluids), but may be prevented if the baby is vaccinated at birth. The infection can be detected in the mother's blood.
HIV usually causes no symptoms at first but can lead to AIDS. HIV can be passed from a mother to her baby, but this risk can be greatly reduced if the mother is diagnosed before the birth. The infection can be detected through a blood test. If you are pregnant and are diagnosed with HIV, you should receive specialist care.
German measles (rubella)
Screening for German measles (rubella) is offered so that, if you are not immune, you can choose to be vaccinated after you have given birth. This should usually protect you and future pregnancies. Testing you for rubella in pregnancy does not aim to identify it in the baby you are carrying.
Syphilis is rare in Australia. It is a sexually transmitted infection that can also be passed from a mother to her baby. Mothers and babies can be successfully treated if it is detected and treated early. A person with syphilis may show no symptoms for many years. A positive test result does not always mean you have syphilis, but your healthcare team should have clear procedures for managing your care if you test positive.
· Screening for medical conditions
Gestational diabetes is a type of diabetes that develops in the later stages of pregnancy. Some women are more likely to develop gestational diabetes. You should be given information about gestational diabetes and offered a test if:
you are overweight (body mass index above 30 kg/m2)
you have given birth to a very large baby before
you have had gestational diabetes before
you have a parent, brother or sister with diabetes
your family origin is South Asian, black Caribbean or Middle Eastern.
Gestational diabetes usually improves with changes to diet and exercise. Tablets or insulin therapy may be needed to control diabetes if lifestyle changes do not work. Women with gestational diabetes may have more monitoring and interventions during both their pregnancy and their labour. If you are at risk of gestational diabetes and it is not detected and controlled, this may lead to a larger than normal baby which may mean a small risk of difficulties during the birth.
(Extracted from “Antenatal Care: NICE Guideline”.
http://guidance.nice.org.uk/CG62/NICEGuidance/pdf/English) with some modifications