During your first visit, we will review your pregnancy milestones, including your due date and the time schedule for a variety of standard prenatal tests (including blood tests, ultrasounds, and genetic tests). Depending upon your age and medical history, we will order a battery of initial blood tests and discuss options for ruling out chromosomal (or genetic) fetal abnormalities (see below). By the end of the visit you should be armed with an overview for the coming 9 months, answers to your questions, and a good understanding of immediate next steps and expectations.
Basic advice for early pregnancy
Many women, but not all, experience some degree of fatigue or nausea in early pregnancy. The fatigue is typically hormonal, and the best treatment is rest. If you are experiencing nausea, please refer to this morning sickness form. Both of these symptoms generally disappear as the first trimester ends.
During the early weeks, take any over-the-counter prenatal vitamin. If nausea precludes taking vitamins, then three 400ug over-the-counter folic acid pills will suffice. Tiny embryos require minimal calories and nutrients, so there is no need to ‘force feed’ food groups that make you feel ill. The minimal dietary restrictions include avoiding unpasteurized drinks or cheeses, deli meats (edible if they are microwaved before consumption), alcohol, and predatory fish such as swordfish or tuna(mercury content available on the internet).
Sexual activity is safe in early pregnancy, as is travel and exercise. We do suggest that you keep your heart rate below 150 beats/minute.
Warning signs prior to your visit
Although up to 25% of women with healthy pregnancies experience some first trimester bleeding or spotting, please contact us immediately if you bleed, spot, or have abdominal pain. Tubal (ectopic) pregnancy, in which the pregnancy implants in the fallopian tube rather than the uterus, occurs in only 1.5% of pregnancies, but can present with these symptoms. Early diagnosis via ultrasound allows us to treat tubal pregnancies with medication and to avoid surgery or catastrophic tubal rupture.
Our office is open Monday-Friday from 8:30am – 5pm. We can do our best job for you, including obtaining lab tests and ultrasounds, during normal business hours.
24x7 emergency care is available. After office hours, you may reach our answering service by calling the general office phone number 415-379-9600. The Emergency Department for pregnancy-related problems is located at the California campus of CPMC (not to be confused with the general medicine Emergency Department at the Pacific campus) at 3700 California Street (at Cherry).
Genetic testing: thoughts to consider prior to your visit
There are two different types of genetic tests available today. The first evaluates the chromosomes of the fetus to rule out abnormalities such as Down Syndrome, Trisomy 18, or neural tube defects. The second identifies genetic mutations carried by biological parents that might be inherited by the fetus.
Chromosomal abnormalities are thankfully rare, but the probability that your child might have one of the more common abnormalities can be assessed through either statistical (non-invasive) or definitive (invasive) testing.
The State of California sponsors “integrated screening”, which incorporates 6 markers in your blood, a sonogram-generated measurement of the fetal neck thickness, and your age to generate a preliminary (first trimester) and final (mid-second trimester) statistical risk numbers (one out of X) for Down Syndrome, Trisomy 18, and neural tube defects. The test is non-invasive, but provides only probabilities (one out of X) rather than absolute information.
Definitive results (demonstrating that the baby will have normal chromosomes) are derived through either chorionic villus sample (CVS) or amniocentesis. With each of these tests, genetic specialists obtain a sample of fetal cells from either placental tissue or amniotic fluid, and analyze these cells for genetic abnormalities. While some conditions cannot be identified (e.g. autism), either CVS or amniocentesis will definitively rule out multiple trisomies including Down Syndrome, sex chromosomal abnormalities, and neural tube defects. Because the test is invasive, there is a small risk of pregnancy loss or complication.
While most chromosomal abnormalities become more common with advanced maternal age, you may opt for any of the choices above regardless of your age.
Parental mutation carrier screening (“Counsyl testing”) is a relatively new option that tests saliva or blood to determine whether you and your partner carry any of 118 genetic mutations, such as cystic fibrosis, Sickle cell disease, or certain Ashkenazi Jewish diseases. While 1 in 4 adults will carry some type of mutation, the risk of an offspring having a genetic disease is only 6 in 1000 because you and your partner must carry the same mutation and your child must inherit the mutation from both parents. Please review the Counsyl information https://www.counsyl.com/ before we see you. If you opt to undergo Counsyl testing, you will be provided with test kits at your appointment.
We will be happy to discuss all of this, and more, at your visit. We look forward to seeing you!