Your Guide to a Healthy Pregnancy
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Your Guide to a
Healthy Pregnancy
1
Welcome
WE ARE DELIGHTED that you have chosen the
Massachusetts General Hospital Vincent Obstetrics Program
for your prenatal care and the delivery of your baby. Be
assured that your entire obstetrical team will provide you
with the best care possible as you prepare for one of your
life’s most miraculous events – the birth of your child.
We want you to be informed every step of the way and have
compiled educational materials to assist you. We have devised
a system of giving you information just when you need it
the most. This packet contains information that you should
find most helpful now, in the beginning stages of your
pregnancy. As your pregnancy progresses, we will continue to
give you other timely materials and reminders, such as when
to sign up for childbirth classes or what to pack to bring to
the hospital.
You may, of course, supplement our information with books
and videos that are to your liking. Remember, though, your
best source of information is your obstetrical team.
For emergency questions before 8:30 am or after 4:45 pm,
please call 617-724-BABY (2229).
Welcome to our Mass General health care family.
Michael F. Greene, MD
Chief of Obstetrics
2
Your Obstetrical Team and Services
Your obstetrical team is made up of many Education is the cornerstone of our care. We want
experienced professionals who firmly believe that you to be as informed as possible so you can make
each childbearing experience is unique. Working in knowledgeable decisions in partnership with
partnership with you to ensure that your individual members of your healthcare team. Mass General
needs and preferences are met can be any of the collaborates with Isis Parenting to offer classes,
following practitioners: workshops and/or private sessions to help you
• obstetricians • m
aternal-fetal prepare to welcome your new baby into your
medicine fellows family, call 781-429-1500 or visit the website at
• obstetrical residents
www.isisparenting.com for more information or to
• nurses • c ertified nurse
schedule a class.
midwives
• ultrasonographers
• genetic counselors • T
his is a teaching hospital; therefore,
• anesthesiologists
medical students and residents on Labor
• nutritionists
• social workers and Delivery are a part of your care team,
• pediatricians
• nurse practitioners supervised by the attending physicians.
• neonatologists
• hi-risk obstetricians • Any research projects that you may be asked to
participate in are entirely voluntary.
1
Frequently Asked Questions
Please Note: If you have questions about exposures 3. Can I paint?
to medications, drugs, chemicals, x-rays, infections Paint fumes are usually non-toxic if the area is
and possible risks during pregnancy, you may call the well-ventilated.Water-based latex paints are acceptable.
Pregnancy/Environmental Hotline at 1-800-322-5014 If you have a question about the type of paint you
or 1-781-466-8474. Sponsored by the Genesis Fund, are using, ask the manufacturer or call us.
the hotline is open Monday through Friday from
4. What about my hair care?
9 am to 4 pm. All calls are confidential and free of
You may perm and color your hair during
charge.You can also visit the website www.thepeil.org,
pregnancy as there is no danger to your baby.
for additional information.
5. W
hat if I need dental work?
1. How frequent are my appointments?
It is not necessary to delay your dental work until
The following is a general schedule for an
after your pregnancy. If your dentist needs to take
uncomplicated pregnancy:
x-rays, just be sure to properly shield your abdomen.
• From the beginning of your pregnancy through Local anesthetics are permitted. If your dentist has
28 weeks you will have a monthly appointment. any questions, please ask him/her to call us.
• From 28-36 weeks, you will have an 6. Am I allowed to travel?
appointment every two to three weeks. Travel poses no specific risks during pregnancy,
• From 36 weeks until delivery, you will have a but you should take some minor precautions.
weekly appointment. Use your seat belt throughout your pregnancy.
During long trips, take time out to stand and move
Routine prenatal visits are usually 15 minutes long.
about. Consider access to obstetrical care. Although
You will have your blood pressure, weigh, urine and
travel does not cause premature labor, there is the
the status of your baby checked. Bring along your
possibility that you may deliver far from home. Most
list of questions to your appointment so that we can
airlines have restrictions in the last month of pregnancy,
address them during your visit.
so check with the carrier. Drink lots of fluids!
If we anticipate a longer visit for prenatal diagnostic
7. What is a midwife?
testing, we will let you know in advance so you
At Mass General Hospital, you have the choice
can plan accordingly. We make every effort to keep
of having either an obstetrician or nurse midwife
appointments running on time. If you are going to
as your healthcare provider. Mass General
be late, please call the office to arrange an alternate
midwives are certified by the American Midwifery
time.
Certification Board and provide modern obstetrical
Unexpected emergencies do arise that we need care to women during pregnancy and delivery. They
to address immediately, which may cause delays in are trained to recognize abnormalities at every stage
the schedule. Please bear with us. of pregnancy, labor, delivery and postpartum.
2. Can I garden? Midwives write prescriptions for medications and
Yes, as long as you feel comfortable doing it. prescribe and administer analgesic medication and
You should wear gloves and wash your hands local anesthetics. If necessary, they can perform and
thoroughly after working with the soil. repair episiotomies.
2
Frequently Asked Questions
Our midwives practice in collaboration with our 10. What is a genetic counselor?
obstetricians. In the event of medical or obstetrical Genetic counselors are health care professionals
complications, the midwives consult, collaborate and certified by the American Board of Genetic
refer to the appropriate physician specialists. Many Counseling. They work with your obstetrical
problems can be co-managed by a nurse midwife/ team to provide in-depth genetic information and
obstetrician team so even if a problem develops, a counseling to expectant parents who may have
midwife will continue to be involved in your care. questions or concerns based on their individual
history, such as: diseases that run in families or
8. Will I have my own obstetrician or midwife
specific ethnic groups; couples who have had a
delivering my baby when the time comes?
child with a birth defect; couples with a history of
After spending the vast majority of your pregnancy
stillbirth or more than one miscarriage; pregnant
caring for you, your provider would like nothing
women older than 35. Genetic counselors may
more than having the privilege of delivering your
also discuss the effects of medications, drugs and
baby. However, this is not always possible as we do
alcohol on pregnancy as well as the effects of
not control the timing of when you go into labor
maternal medical conditions such as diabetes,
or deliver. Babies are born 24 hours a day, seven days
seizures, high blood pressure and radiation therapy.
a week and this means the labor unit never closes,
making it necessary for obstetricians and midwives 11. Will I need genetic testing?
to rotate coverage. As the labor unit is always staffed Prenatal diagnostic testing is always your choice.
by both an obstetrician and a midwife, we try to Your obstetrician or nurse midwife assists you
respect your choice of provider type. Although we with deciding which, if any, testing is most
suggest you remain with your chosen provider for appropriate for you.
all of your prenatal visits, you may schedule some of
12. Can I exercise?
your visits with other providers. As Mass General is
Before beginning any exercise program, talk with
a teaching hospital, obstetrical residents are a part of
your obstetrician or nurse-midwife to make sure
your health care team.
you do not have any obstetric or health conditions
9. What is a high-risk pregnancy? that would limit your activity. Ask about any
Women who begin their pregnancy with existing specific exercise or sports that interest you.Your
medical problems such as diabetes, hypertension, provider can offer advice about what type of
heart problems or known fetal abnormalities require exercise routine is best for you.
the care of a maternal-fetal specialist, or a high-risk
Heart rate
obstetrician. Usually, these women will have their
The extra weight you are carrying will make
medical information communicated to us by their
your body work harder than before you were
referring primary care physician or obstetrician
pregnant. Exercise increases the flow of oxygen
prior to their first visit. There are also non-medical
and blood to the muscles being worked, and
situations, such as substance use, spousal abuse or
away from other parts of your body, therefore,
psychosocial problems, which may also make a
it is important not to overdo it. Try to exercise
pregnancy high risk. Having a baby when you are
moderately so you don’t get tired quickly. If you
older (35 years+) does not automatically make you
are able to talk normally while exercising, your
a high-risk patient if you are otherwise in good
heart rate is at an acceptable level.
health. 3
Conditions, either inherited or acquired, which could affect your pregnancy may not be obvious either by
the way you feel or by physical examination. Early prenatal screening may provide important information
about your health and that of your unborn child. Although we strongly recommend you have any prenatal
screening that your healthcare team feels is necessary, the decision to take any test is yours.
FIRST AND SECOND TRIMESTER SCREENING TESTS
Commonly Performed Performed Only in
on all Women Selected Situations
Blood Type Cervical Cultures
Complete Blood Count
Hepatitis B Surface Antigen Sickle Cell Screening
HIV/AIDS Ashkenazi Carrier Screening
PAP Smear Tay-Sachs Screening
Rubella (German Measles) Screening Thalassemia Screening
Screening for Chromosomal Disorders Amniocentesis/CVS
Syphilis Screening Ultrasound
Tuberculosis (TB) Screening
Urine Culture Cystic Fibrosis
THIRD TRIMESTER SCREENING TESTS
Commonly Performed Performed Only in
on all Women Selected Situations
Hematocrit Biophysical Profile (BPP)
Syphilis Screening Blood Type
Diabetes Test Non-Stress Test (NST)
Group B Streptococcus (GBS) Culture Rhogam If RH Negative
Ultrasound
4
Prenatal Screening Tests
Amniocentesis Diabetes Test
This diagnostic test offered to women over age 35 or The Glucose Loading Test (GLT), usually performed
with a family history of genetic abnormalities. A thin at 26 to 28 weeks, is a blood test performed one
needle passed through the mother’s abdomen into hour after taking a flavored glucose drink. It screens
the uterus obtains a sample of amniotic fluid. Cells for diabetes which may arise during pregnancy.
from this fluid are grown in a genetic laboratory There is no fasting preparation for this test. An
for two weeks. The chromosomes are then studied elevated GLT indicates the need for further testing.
for Down’s syndrome and other chromosomal
Group B. Streptococcus (GBS)
abnormalities. We provide genetic counseling at
GBS is a common bacterium that normally lives
the time of amniocentesis and again in more detail
in the vaginal or gastrointestinal tracts of about
should an abnormality be detected. In the third
25 percent of healthy adult women. Although rare, it
trimester, this test can also be administered to analyze
can become an issue when it is found in the vagina
for chemicals that indicate fetal lung maturity.
during delivery, where it can cause serious infections
Ashkenazi Jewish Carrier Screening for both mother and baby. Women are screened for
Distinct ethnic groups are known to have an GBS between the 35th and 37th weeks of pregnancy.
increased risk for particular genetic diseases. In the A swab sample is taken from both the vagina and
Ashkenazi Jewish (Eastern European) population, rectum; test results are usually available within
several inherited diseases are known including 24 to 48 hours. Positive tests may result in antibiotic
Cystic Fibrosis, Tay-Sacs disease, Canavan disease and treatment during labor.
familial dysautonomia. There are a number of other
Hematocrit
disorders that occur more often in the Ashkenazi
This blood test determines anemia.
Jewish population for which carrier testing is also
available. Interested couples can have a blood test to Hepatitis B
learn about their chances of having a child affected This virus can cause illness which may or may not
with one of these conditions. be obvious. It infects the liver and can cause liver
damage that may persist for long periods of time.
Biophysical Profile (BPP)
Even if you have never had symptoms of Hepatitis B,
The BPP uses ultrasound to observe amniotic fluid
if it is in your blood, you can pass the disease on to
volume and fetal activity, muscle tone and breathing. It is
your infant at birth. Infants who are born to women
performed in certain circumstances in the third trimester.
with Hepatitis B in their bloodstream should receive
Blood Type treatment at birth to prevent serious liver damage.
This test determines your blood type. For women
HIV/AIDS
whose blood type is RH negative, an injection of
HIV, the virus that causes AIDS, is a sexually
Rhogam is given at 28 weeks of pregnancy and
transmitted disease which may take years for
again postpartum if your baby is RH positive. These
symptoms to occur. Therefore, many people who
injections prevent antibody formation which could
are infected with the HIV virus don’t know it.
affect future pregnancies.
A pregnant woman who has been exposed to
the HIV virus can pass it on to her baby. Certain
behaviors put a woman at risk for contracting
the virus, such as: using injection drugs; having
5
unprotected sex (sex without a condom); receiving a Screening for Chromosomal Disorders
blood transfusion prior to 1985. A blood test, which The blueprint of the body is ‘written’ in DNA,
is offered to all patients, and encouraged, determines and genes correspond to words. These words
if you have been exposed. are grouped together into chapters of varying
lengths called chromosomes. We get one set of 23
Non-Stress Testing (NST)
chromosomes from each parent, for a total of 46.
This test assesses fetal well-being by monitoring the
When a baby is conceived with an abnormal number
fetal heart rate. Testing may take up to 40 minutes.
of chromosomes, there can be varying degrees of
Rubella (German Measles) Screening problems after birth. Examples of chromosomal
This disease can cause birth defects if a pregnant disorders are Down syndrome, Trisomy 13 and
woman contracts it during early pregnancy. Once a Trisomy 18. Screening for these disorders may
person has had rubella, he or she cannot get it again. involve ultrasound and a maternal blood sample
This test indicates whether a person has ever had the at a certain time in pregnancy to determine the
infection or has ever been vaccinated against it. probability for the baby to have one of these
disorders. There are many options of screening
For more information about preventing infections for chromosomal disorders including early risk
during pregnancy, visit the Center for Disease Control assessment (ERA), quad screening and cell free
and prevention at www.cdc.gov/features/pregnancy DNA testing.
Syphilis Screen
Syphilis is an infection which can be present without
causing any symptoms and can be passed from a
pregnant woman to her unborn child. This is one of
the maternal infections that can be harmful to the
baby. The blood test screens for this.
Tuberculosis (TB) Screening
This screening is a simple skin test that detects the
presence of TB, a highly contagious, serious infection
most commonly located in the lungs.
Ultrasound
This is a diagnostic test which uses sound waves
to produce an image of the fetus before birth. We
recommend this test for specific indications, such as
vaginal bleeding, the question of twins or assessment
of fetal growth.
6
Nutrition during Pregnancy:The Basics
How Much Weight Should I Gain? Calcium • 3 to 4 Servings/day
Guidelines depend on your pre-pregnancy weight and A twin pregnancy should get 4-5 servings/day
height or Body Mass Index (BMI). Ask your doctor or One serving is:
a registered dietitian for your BMI value. • 1 cup milk or calcium-fortified juice or soy milk
• 1.5 to 2 oz hard cheese
Underweight BMI 28-40 pounds total
• 1 cup yogurt
Healthy BMI 25-35 pounds total
• 1 to 1.5 cups pudding or ice cream
Overweight BMI 15-25 pounds total
• Dark green vegetables also have calcium but it is
Obese BMI 11-20 pounds total
harder to absorb.
Twins or Multiples 37-54 pounds total
Folic Acid
How Much Extra Do I Need to Eat?
• All women able to become pregnant should take a
• An extra 300 calories per day during the second
supplement with 400 mcg of folic acid daily
and third trimesters. Typically this is just one extra
and eat folate from foods.
snack each day.
• 600 mcg per day during pregnancy
• F
or a twin pregnancy an extra 450-500 calories per
• Food sources of folate:
day is needed during the second and third trimester.
• Fortified cereals and breads
WHAT you eat is more important than simply • Legumes
HOW MUCH you eat. Try eating something every • Orange juice
three to four hours à three meals and two to • Spinach
three snacks every day • Asparagus
Protein • 3 to 4 Servings/day • Broccoli
One serving is: Iron • 27 mg/day
• 3 oz meat/fish/poultry Most women will take a supplement of 30 mg per
• 1 cup dried beans day after the 12th week. (Ask your OB or registered
• 3 to 4 T nuts or peanut butter dietitian for more information)
• 2 eggs
Iron content of foods:
• 4 to 6 oz tofu or soy protein
• >5 mg per serving: 3 oz liver*,
• ½ cup cottage cheese
1 oz iron-fortified cereals.
Try adding some protein into every meal and snack. • 3 to 5 mg per serving: 3 oz beef, 1 cup
A few ways to add protein rich snacks to your day are: legumes
• Trail mix of cereal and nuts or seeds • 1 to 3 mg per serving: 4 to 5 pieces dried
• String cheese with fruit or crackers fruit,
• Carrot sticks or apple slices with peanut butter 1 egg yolk, 3 oz fish or chicken.
or cottage cheese
*Limit the amount of liver to occasional use so you do
• Whole grain crackers or pita bread with a bean
not get too much vitamin A. It is okay to eat unlimited
dip or hummus.
amounts of beta-carotene, the form of Vitamin A in fruits
and vegetables. Choose a variety of brightly colored fruits
and vegetables every day.
7
Water What About Fish?
• Two liters of water every day is the goal à Fish is a great source of protein and omega-3 fatty
four bottled waters at least acids that are an important part of a healthy diet
• Try adding lemon, lime or berries to give your during pregnancy. However, fish and shellfish do
water more flavor. contain some mercury that can be harmful to the
developing baby when eaten in high amounts.
What Are the Food Safety Basics?
• Avoid swordfish, tilefish, king mackerel, and shark
• W
ash your hands often – after using the bathroom,
completely – these fish have the highest level of
before cooking, before eating, after handling any
mercury.
raw meat
• Limit tuna steaks or canned tuna fish to 6 oz per
• A
void cross contamination – keep utensils or cooking
week – that is 1 can of tuna/week
equipment used for raw meat separate from those
for other foods • Limit all other fully cooked fish/shellfish to 12 oz
per week (white fish, farm raised freshwater fish,
• Cook all meat, poultry and seafood until well-done
wild/canned salmon, shrimp, scallops, clams, crab)
160° F hamburgers/pork
3 oz is the size of a deck of cards
170° F steaks
180° F poultry Those are the basics for a healthy, safe and nutritious
145° F seafood pregnancy. For more information consult your OB
• R
eheat leftovers or ready-to-eat meats (hot dogs/ and registered dietitian!
deli meat) until steaming hot
• H
eat refrigerated smoked-fish (ex: lox, nova-lox…)
until steaming hot
• Wash fruits and vegetables under running water
• Avoid the following completely:
Pâté
Raw eggs or raw egg products
Raw sprouts
Unpasteurized juices/ciders
Unpasteurized milk or cheeses (Brie, Feta,
Camembert, Blue cheese, Queso Fresco ...)
Hard cheeses, yogurt and cream cheese are allowed
8Medications in Pregnancy
It is difficult to advise a woman about the safety of Antibiotics
medications in pregnancy since there might be Penicillins and Ampicillin are permitted anytime
long-term drug effects of which we are unaware. In during your pregnancy if you were not previously
general, medications that have been around longer allergic. Sulfa drugs are allowed up until the third
have been tested more thoroughly and should trimester, except in rare instances. Erythromycin is
be preferred over newer ones. We recommend an alternative if you are allergic to penicillins.
avoiding any unnecessary drug or medication during
Stool Softeners
pregnancy, especially during the first 20 weeks when
You may use Metamucil, Colace, Senokot or Milk of
your baby’s organ systems are forming.
Magnesia.
It is important, however, if you have preexisting
Antacids
medical conditions for which you were taking
Tums are fine and a good source of calcium.You
medication prior to your pregnancy, that you speak
may also use Mylanta, Maalox, Gelusil, Riopan and
with your primary care doctor or obstetrician before
Rolaids. Do not use Alka Seltzer as it contains aspirin.
you stop taking it. There may be serious problems for
you and your baby if you inappropriately stop taking Flu Vaccine
a medication. The flu vaccine is recommended and safe at any time
during pregnancy.
It is ultimately your choice if you wish to take
medications for headaches, cold and flu. Each Tdap Vaccine
woman has to weigh the benefits versus the risks. For The Tdap vaccine is recommended in the third
your convenience and consideration, listed below trimester of each pregnancy to protect the newborn
are a number of medications that with reasonable, from pertussis (whooping cough).
necessary and sparing use are permitted in pregnancy. Please check with your healthcare provider
Pain Relievers before taking any medications if you have questions
Acetaminophen (Tylenol) will help headache and or concerns.
minor discomforts. Avoid aspirin and ibuprofen
(Advil).
Cold and Flu
Actifed, Sudafed and Chlortrimethon can be taken
for congestion, and Robitussin DM can be taken for
cough suppression. If you have high blood pressure or
are taking blood pressure medication, consult us before
using cold preparations. If you are diabetic, please
ask your pharmacist for cough syrup which does not
contain sugar.
9Minor Discomforts and Their Remedies
Abdominal Cramping Heartburn
It is common in early pregnancy to feel cramping Due to slower digestion and regurgitation, you may
similar to menstrual cramps.You may also feel a experience a burning, acidic feeling in your mid-to-
bloated sensation. Later on in your pregnancy, there lower chest. Sitting upright and elevating your head
may be lower pelvic/groin discomfort on either off the bed with pillows provide relief. Mild antacids
side. This is caused by the stretching of the round like Mylanta, Maalox and Tums, used in small
ligaments and muscles that support the enlarging quantities, also bring relief.
uterus. A heating pad and rest can help.
Hemorrhoids
Backaches Hemorrhoids are dilated veins which protrude into
Late in your pregnancy, the weight of your growing or out of the rectum.You can experience itching
uterus causes changes in your posture which may or burning around the anus or have a spot of blood
cause backaches. Make a conscious effort to stand on the toilet tissue after moving your bowels.
straight and tall.You should wear low-heeled shoes. Having regular, soft bowel movements may reduce
Rest, a back massage and heat will help. hemorrhoids.Vaseline petroleum jelly, Anusol or
Tucks pads may decrease the itching and burning.
Flu, Colds and Common Illnesses
When flu and colds occur in pregnancy, get extra Hip Pain or Pelvic Bone Pain
rest, drink plenty of fluids and take acetaminophen The hormones of pregnancy can loosen the ligaments
(Tylenol) for fever or discomfort. A vaporizer helps in your hips and pelvis in expectation of delivery.
moisturize the air and eases a sore throat or nasal This loosening allows the pelvis to accommodate the
congestion. Early in pregnancy, it is best to avoid passage of the baby during labor, but, in the meantime,
any unnecessary medication. Sudafed decongestion may create pain. Rest and heat help.
tablets or Robitussin DM may be used in moderation
Leg Cramps
for relief of cough. If you have a fever of over 101 degrees
Cramps in your legs tend to occur in mid-pregnancy
or if your symptoms persist, please call us. If you
for unknown reasons. Leg cramps also tend to occur
have a medical condition, such as hypertension or
at night, often waking you up. A simple exercise of
diabetes, which existed before your pregnancy, call us
flexing your toes vigorously towards your knees may
before using any medication.
help to relieve them. Maternity support hose can
Other common illness, such as a sore throat or rash, also help aching legs, but they must not be too tight.
can be treated by your primary care physician. Balance periods of rest with exercise during the
If you or your physician have any questions concerning day. Leg cramps are not usually caused by a calcium
medications or treatment at your stage of pregnancy, deficiency. If a specific area of tenderness or redness
please call us. develops, call us.
Headaches Nasal Congestion/Nose Bleeds
Headaches are quite common in all stages of Nasal congestion can be bothersome and may make
pregnancy. Rest, stress reduction and acetaminophen you think a cold is coming on. Usually, however,
(Tylenol) help. Do not take products containing it is due to an increased blood supply in the nasal
aspirin or ibuprofen. membrane. As a result, nosebleeds may occur. Try
using ice and compression. If nosebleeds persist, call us.
10Pressure Under the Rib Cage may occur in the middle of their abdomen. These are
Pressure can occur as the rib cage expands to related to hormone changes and will, in most cases,
accommodate the growing uterus. It often feels like fade after delivery. Whether you develop stretch
a sore spot or bruised area, especially under one rib. marks on your breasts and abdomen is determined
Sitting in a straight-backed chair with a pillow behind by your skin type, heredity and total weight gain
your lower back helps relieve the pressure and facilitates during pregnancy. No creams will prevent them.
breathing. A warm bath or a heating pad may help.
Swollen Feet, Ankles and Hands
Shortness of Breath You can help relieve swelling by resting on your
Shortness of breath often occurs in the last few left side and elevating your feet several times a day.
months of pregnancy and is most likely related to the Remove rings which become too snug. Hands tend
normal hormonal changes of pregnancy.You may find to be the most swollen in the morning. Some women
that you need to take more time to do your usual develop numbness and tingling in the fingers.
activities.You should rest more frequently and may
Vaginal Discharge
need to stop some overly strenuous activities. If this
Most pregnant women experience an increase
becomes excessive, you should notify your physician.
in vaginal discharge. It is usually a white, creamy
Skin Changes discharge.You should maintain good hygiene.
Dry, Itchy Pigment, Stretch Marks However, you should not douche during pregnancy.
To relieve dryness and reduce itchiness of your skin, If persistent itching or irritation occurs, or if your
use a moisturizer. Some women develop brownish discharge changes in any way, such as color, amount
discolorations on their face or skin, or a brown line or odor, you should tell us.
11Bleeding in Early Pregnancy
Any Bleeding During Pregnancy Needs to be About 15 to 20 percent of all pregnancies end
Reported Promptly to Your Healthcare Provider. in miscarriage. A miscarriage can be the body’s
However, some bleeding is common during the first response when, for some reason, the pregnancy is
three months (12 weeks) of pregnancy and may or not developing normally. Most early miscarriages
may not be a sign of a problem. It can range from cannot be prevented. Remember, heavy lifting or
slight brown spotting, to bright red bleeding. It may intercourse will not affect a healthy pregnancy and
last from a day to weeks and may be accompanied will not bring on a miscarriage.
by mild cramping or low backache. Many times,
Treatment
the bleeding stops on its own and the pregnancy
Your healthcare provider will examine you to
continues normally.
determine the cause of the pain and/or bleeding.
Note: mild, low abdominal cramping without The following examinations and tests may
bleeding is common in the early weeks of pregnancy. be ordered:
Causes • Pelvic exam
Most women fear that bleeding means they are • Blood pregnancy test
miscarrying.There are other reasons for bleeding in • Ultrasound
early pregnancy: the hormonal changes of pregnancy;
If your blood type is RH negative, a vaccination
implantation bleeding, when the fertilized egg attaches
of Rhogam may be necessary. (See Prenatal
itself to the lining of the uterus; cervical bleeding.
Screening Tests).
Sometimes, no cause for vaginal bleeding can be found.
12Phone Numbers etcetera
Charlestown HealthCare Center 617-724-8135
Chelsea HealthCare Center 617-884-8561
Obstetrics and Gynecology (Mass General West) 781-487-3860
Obstetrics (Boston,Yawkey 4F) 617-724-2229
North End Health Center 617-643-8040
Revere HealthCare Center 781-485-6450
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