Your Guide to a Healthy Pregnancy

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