Advanced Care Ob/Gyn Infertility

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Medical Professionals You’re Pregnant!!! Any Questions?

Well, now you are pregnant, with that positive sign there, your mind is filled with millions of questions.

But that is ok; your health care provider will be more than happy to answer any questions that you may have. They really have heard most of them before.

Here are the most frequently asked questions by the new mom’s who come into our office. What is the first thing that I should do when I see that positive pregnancy test?

The best thing to do is to call and schedule your first appointment with your OB/Gyn. Setting up your first prenatal appointment quickly insures that you will be getting the care you need for you and your baby. On your first visit to our office you will be given the time to ask all of the questions that you might have with patience and reassurance. We will re-enforce the importance of keeping all of your appointments with us.

What is the anticipated schedule of prenatal visits?

For a low risk, normal progressing pregnancy you should anticipate a visit schedule typically as follows:

*Weeks 4-28: One visit per month (every four weeks) *Weeks 28-36: Two visits per month *Weeks 36-delivery: One visit per week

Some women with a chronic medical condition or a “high risk” pregnancy should anticipate more frequent visits as directed by the provider, these additional visits will help to better monitor both mom and baby. Keeping your prenatal appointments is the primary thing that you can do to help insure an uneventful pregnancy and delivery.

What are some of the things that will happen at my first prenatal care visit?

Your first prenatal visit in our office will consist primarily of getting to know you and your partner, this will include getting as much of your family medical history as you can provide. A complete physical including a pelvic exam will be performed by the provider. Vaginal cultures to insure no evidence of infection is present will always be done. Your questions will be answered; you will be given a prescription for prenatal vitamins as well as orders for a complete prenatal blood panel and an obstetrical ultrasound. We realize that the most important question you have is, “when will I have my baby.” An estimated date of delivery (EDD) will be given to you. The excitement and the countdown to this wonderful time now begins.

What are some important things that I should know about my pregnancy?

One of the most important things to remember is to keep all of your scheduled prenatal appointments. Monitoring your well being and the growth and well being of your baby on a regular routine basis is the best way to establish that your pregnancy is progressing safely. Do not drink any amount of alcohol. If you do smoke, now is the time to quit. Illegal drug use can have a catastrophic outcome for your baby. If these habits are a difficulty for you, please let the provider know so that information and help can be given to you.

Are there any medications that I can take during pregnancy that are safe?

It is best to assume that no medications should be taken during pregnancy; however, there are times when you may have no other option. In this case make that call to our office and we will be sure to have a provider give you the best advice for you and your baby. There are certain medications that can definitely not be taken

Medical ProfessionalsMedical Professionals 3 Submitted by Salvatore Carfagno, DO, FACOOIs Your Cycle Normal? in the first three months (12 weeks) of pregnancy. It is best to let our providers make these decisions for you.

Life is filled with surprises! What to do if you are unfortunate in experiencing nausea, vomiting, or hyperemesis?

Your period should not be one This is probably one of the most prevalent symptoms of of these surprises. early pregnancy. Keep in mind that your body is changing in many ways, your hormones are raging with all of the Heavy Menstrual Cycles demands of this new life forming and it is the reason

In this edition, I will be discussing the issue of heavy for these symptoms. menstrual cycles. For most women, their menstrual Although it is called, cycle occurs about once every 28 to 30 days. The period “morning sickness”, it can may last three to seven days. The flow is described as last all throughout the day moderate. Menses start somewhere around eleven to for some women. In most fourteen years old. This monthly gift will continue until cases it lasts just a few weeks fifty-one. and by your second trimester it subsides and is gone. These Unscheduled Bleeding symptoms, however distressful to you, do not mean that

Bleeding outside of your normal cycle day or heavy anything is wrong with your baby. Some of the best scheduled cycles are considered abnormal. remedies for the symptoms of morning sickness are to:

Unscheduled bleeding is vaginal bleeding at times l. Eat more small meals. other than your normal menses. This may be patterned 2. Avoid greasy, fried or spicy foods. or totally irregular in nature. This can be spotting to 3. Avoid lying down after a meal. period like in flow. If the flow is excessive, it may result 4. Keeping dry crackers or cereal nearby to snack on in anemia (low hemoglobin). can also help with these symptoms. Heavy Cyclic Bleeding In severe cases, there are medications that can be taken to

Heavy cyclic bleeding (plain old heavy periods) is alleviate this distress; however, we suggest trying when a woman has regular periods with heavy flow and non-medication therapies first. possibly longer duration with more bleeding days. This We realize that there will be many more questions as your may be associated with cramps or pelvic pain. Pain may pregnancy progresses. The best thing to do is to write them become severe enough and or bleeding profuse enough down and bring them with you on your next office visit. to change what you do on a daily basis. To be more Writing them down insures that you will not forget your specific, pain and/or bleeding can keep a woman from important questions and leave the office without all of your her doing her normal, everyday activities. Women may answers. We are always happy to answer any questions that become fearful to leave their home, as they worry about you may have and all of the staff is very educated and happy bleeding through clothing in public. This can force a to take this time with you. Be comfortable in knowing that woman to lose work time, kid time, husband time etc. if you have a question we will do our best to get your answer The cost of sanitary products and replacement clothing as quickly as possible may also play a role in how this affects a person. You have the positive pregnancy test in your hand, now

Evaluating Heavy Periods is the time to pick up the phone and schedule your first

In this article, I will be concentrating on heavy periods prenatal visit with us. or menses. The evaluation of this problem starts with a detailed history. The history can provide direction for selecting diagnostic testing. It can sometimes be difficult for a woman to keep an accurate record of her period. I find it helpful to use a menstrual diary. The patient is given a copy of this and asked to complete and return to the office with it. Initial lab testing includes complete blood count, thyroid hormone and a pregnancy test. An ultrasound of the pelvis will enable a noninvasive way to view the uterus and ovaries. If one is over the age of thirty-five, a tissue biopsy of the endometrium or a D&C may be needed. The pathological report will exclude diseases such as endometrial cancer or hyperplasia. If testing revels a diagnosis of benign heavy menses (hypermenorrhea) then a treatment plan can be made.

Medical and Surgical Treatment Options

Treatment options shall be separated into medical and surgical categories. Both options are designed to control cycle duration and flow. Most commonly, birth control medications are used. Combined oral contraceptives are easy to use and provide cycle control. Other contraceptives that can be used are the vaginal ring, patch or the depo provera shot. The intrauterine device containing a contraceptive medication is a good alternative. It is placed by a doctor in an office setting and provides long-term cycle control. With this alternative, about 30% of users do not get a menstrual cycle. The other 70% usually have a light spotting type of period. The patient has no need to take a pill or place a patch. Surgical options can also be considered. Endometrial ablation is the use of various devices to destroy the endometrium. These include a balloon with circulating hot water, circulating hot water, cryotherapy and electrical current. I use the balloon device or the device employing electrical current as my devices of

Submitted by Salvatore Carfagno, DO, FACOOG

choice. Usually these types of procedures are performed in an outpatient surgery setting. The procedure itself lasts only several minutes. Post-op course is usually unremarkable and short. Return to activities is rapid, with very little down time. Post-op pain is usually restricted to menstrual-like cramps. The cramps can be controlled with non-steroidal medications such as Naproxen.

The response to treatment is varied and highly individualized. Most patients have no further periods. The amenorrhea rate (no periods) approaches 70%. Of those that have a return of their cycle, it most commonly light in flow and/or short in duration. The benefit of this type of surgical intervention is related to the lack of medication side effects. Birth control medications do have some undesirable side effects. The most notable are decreased libido (sex drive) and weight gain. These are real issues for most women.

Advanced Care Can Help!

This is a common problem in all ages. One does not have to tolerate this problem. As a Gynecologist, I have very good treatment options to help take care of women with heavy, benign vaginal bleeding.

If there are concerns about your periods and how heavy they are, feel free to contact my office for an evaluation.

SALVATORE A. CARFAGNO, DO, FACOOG Board Certified in Obstetrics and Gynecology Rachel Grencavich, CNM, MSN PICTURED: Salvatore A. Carfagno, DO, FACOOG, Board Certified in Obstetrics and Gynecology, with his beautiful family We’re With You All The Way We’re With You All The Way Old-Fashioned Care With State-Of-The-Art Technology Quality, Compassionate Healthcare for All Stages of a Woman’s Life Old-Fashioned Care With State-Of-The-Art Technology Quality, Compassionate Healthcare for All Stages of a Woman’s Life Courtyard Professional Offices 707 White Horse Pike, Suite D4 • Absecon, NJ 08201 Courtyard Professional Offices 609.272.0506 • Fax: 609.272.0607 707 White Horse Pike, Suite D4 • Absecon, NJ 08201 Linwood Commons 609.272.0506 • Fax: 609.272.0607 2106 New Road, Suite D10 • Linwood, NJ 08221 Linwood Commons 609.927.2244 • Fax: 609.927.2242 2106 New Road, Suite D10 • Linwood, NJ 08221 609.927.2244 • Fax: 609.927.2242 Affliated with: AtlantiCare Regional Medical Center and Shore Medical Center

Affliated with: AtlantiCare Regional Medical Center and Shore Medical Center