CONGRATULATIONS!! You are pregnant.

An expecting mother needs utmost, gentle and

continuous care through all stages of her pregnancy .At VAATSALYA CLINIC; We provide
comprehensive ante/pre natal care and a healthy delivery for your baby. Pregnancy is a time of
anticipation, excitement, preparation, and even uncertainty among new parents-to –be.

OBSTETRICAL CARE

Dr. MAULIK JOSHI specializes in obstetrical care; he knows there is nothing like welcoming a
child into this world. He only wants only the best for you and your baby. We deliver the highest
quality prenatal care and are on the forefront of providing great medical care. Dr. JOSHI is well
supported by his compassionate staff members and together, we work as a team to encourage
and assist you throughout this special experience.

ANTE NATAL CARE

Antenatal care is the care you receive from healthcare professionals during your pregnancy.
INITIAL PRENATAL VISIT

What to Expect?

This first visit will take approximately 30 minutes. You will meet with Dr. JOSHI, who will
review your past history and provide comprehensive educational counselling.
Along with Prenatal education and counselling during this visit, necessary laboratory testing
with be conducted such as a urine pregnancy test may be done. Also an ultrasound might be
needed at this time. Also routine inspections of weight, blood pressure, urine, and foetal heart
tones depending on the gestational age will be checked on this day and on all future visits.

Dr. JOSHI will see you at every prenatal visit and he delivers all of his patients babies unless on
vacation. He also provides you with his personal cell phone number, which you can call 24/7 for
any questions or concerns.

YOUR FIRST VISIT

Your first visit with your doctor is the appointment when you tell them that you’re pregnant. At
this first visit, you will be given information about:

folic acid and vitamin D supplements

nutrition, diet and food hygiene

lifestyle factors that may affect your health or the health of your baby, such as smoking,
recreational drug use and drinking alcohol

antenatal screening tests

They will give you information on keeping healthy, and ask whether you have had any previous
health or pregnancy issues, such as complications in pregnancy. It’s important to tell your doctor
if:

 You’ve had any complications or infections in a previous pregnancy or delivery, such

as pre-eclampsia or premature birth.
 You’re being treated for a chronic disease, such as diabetes or high blood pressure.
 You or anyone in your family have previously had a baby with an abnormality, such
as spina bifida.
 There’s a family history of an inherited disease, such as sickle cell or cystic fibrosis.
 An important part of antenatal care is getting information that will help you to make
informed choices about your pregnancy.

VISIT SCHEDULE

Your future visits with be scheduled as follows:

From 8-24 weeks = 3 weekly/monthly visits
At 24 to 36 weeks = every two week visits
At 36 weeks to delivery = weekly visits or more.
This may vary depending on the health needs of each individual.

LATER ANTENATAL VISITS

Later visits are usually quite short. Your doctor will:

 check your urine and blood pressure

 feel your abdomen (tummy) to check the baby’s position
 measure your uterus (womb) to check your baby’s growth
 listen to your baby’s heartbeat
  You can also ask questions or talk about anything that’s worrying you. Talking about your
feelings is as important as all the antenatal tests and examinations.

CHECKING YOUR BABY’S DEVELOPMENT AND WELLBEING

At each antenatal appointment from 24 weeks of pregnancy, your doctor will check your baby’s
growth. To do this, he’ll measure the distance from the top of your womb to your pubic bone. In
the last weeks of pregnancy, you may also be asked to keep track of your baby’s movements. If
your baby’s movements become less frequent, slow down or stop, contact your doctor
immediately. You’ll be offered an ultrasound scan if they have any concerns about how your baby
is growing and developing.

Cervical checks will be done toward the very end of pregnancy, (38 or 39 weeks) unless you may
be having a potential problem. i.e. (premature onset of labour or amniotic fluid leak).

ROUTINE ANTENATAL TESTS

During your pregnancy, you’ll be offered a range of tests, including blood tests and ultrasound
scans. These tests are designed to check for anything that may cause a problem during your
pregnancy or after the birth, check and assess your wellbeing and your baby’s development and
wellbeing, as well as screen for particular conditions.

At 18 to22 weeks you will be advised an elaborate ANOMALY SCAN-a type of ultrasound.

Weight and height

Your height and weight are used to calculate your BMI (body mass index). Women who are
overweight for their height are at increased risk of problems during pregnancy.

Most women put on 10-12.5kg in pregnancy, most of it after they are 20 weeks pregnant. Much
of the extra weight is due to the baby growing, but your body also stores fat for making breast
milk after the birth. During your pregnancy, it’s important to eat the right foods and do
regular exercise.

Urine
You’ll be asked to give a urine sample at your antenatal appointments. Your urine is checked
for several things, including protein or albumin. If this is found in your urine, it may mean that
you have an infection that needs to be treated. It may also be a sign of pre-eclampsia.
Blood pressure
Your blood pressure will be taken at every antenatal visit. A rise in blood pressure later in
pregnancy could be a sign of pregnancy-induced hypertension. It’s very common for your blood
pressure to be lower in the middle of your pregnancy than at other times.

ANTE NATAL BLOOD TESTS

As part of your antenatal care you’ll be offered several blood tests. Some are offered to all
women, and some are only offered if you might be at risk of a particular infection or inherited
condition. All the tests are done to check for anything that may cause a problem during your
pregnancy or after the birth, or to check that your baby is healthy. Below is an outline of all
the tests that can be offered.

Full Blood Count

Blood group
It is useful to know your blood group in case you need to be given blood, for example if you have
heavy bleeding (haemorrhage) during pregnancy or birth. The test tells you whether you are
blood group rhesus negative or rhesus positive. Women who are rhesus negative may need extra
care to reduce the risk of rhesus disease (see below).

Rhesus (Rh) factor

Most people have a substance in their blood called the Rh factor. Their blood is called Rh
positive. On average 17 people out of a 100 people don’t have the Rh factor – so their blood is
called Rh negative. If your blood is Rh negative, it isn’t usually a problem, unless your baby
happens to be Rh positive. If it is, there’s a risk that your body will produce antibodies against
your baby’s blood.

People who are rhesus positive have a substance known as D antigen on the surface of their red
blood cells. Rhesus negative people do not. A rhesus negative woman can carry a baby who is
rhesus positive if the baby’s father is rhesus positive. If a small amount of the baby’s blood enters
the mother’s bloodstream during pregnancy or birth, the mother can produce antibodies against
the rhesus positive cells (known as ‘anti-D antibodies’).

This usually doesn’t affect the current pregnancy, but if the woman has another pregnancy with a
rhesus positive baby, her immune response will be greater and she may produce a lot more
antibodies. These antibodies can cross the placenta and destroy the baby’s blood cells, leading to
a condition called rhesus disease, or haemolytic disease of the new-born. This can lead to
anaemia and jaundice in the baby.

Anti-D injections can prevent rhesus negative women from producing antibodies against the
baby. Rhesus negative mothers who haven’t developed antibodies are therefore offered anti-D
injections at 28 and 34 weeks of pregnancy, as well as after the birth of their baby. This is quite
safe for both the mother and the baby.

Anaemia
It is very common for women to develop
iron deficiency during pregnancy. This is
because your body needs extra iron so your
baby has a sufficient blood supply and
receives necessary oxygen and nutrients.
Increasing the amount of iron-rich food
you consume during your pregnancy can
help avoid iron deficiency anaemia. Some
pregnant women require an iron
supplement, particularly from the 20th
week of pregnancy. Anaemia makes you
tired and less able to cope with any blood
loss during labour and birth.

Your doctor can tell you if you need iron tablets to prevent or treat anaemia. Your iron levels will
be checked throughout your pregnancy.

Infections

You’ll be offered tests for:

Susceptibility to rubella (German measles) – if you get rubella in early pregnancy, it can
seriously damage your unborn baby. Your midwife or doctor will talk to you about what happens
if your test results show low or no immunity.

Syphilis – you’ll be tested for this sexually transmitted infection as it can lead to miscarriage and
stillbirth if left untreated.

Hepatitis B – this virus can cause serious liver disease, and it may infect your baby if you’re a
carrier or you’re infected during pregnancy. Your baby won’t usually be ill but has a high chance
of developing long-term infection and serious liver disease later in life. Your baby can be
immunised at birth to prevent infection. If you have hepatitis B, you’ll be referred to a specialist.
Hepatitis C – this virus can cause serious liver disease and there is a small risk it will pass to your
baby if you are infected. It can’t be prevented at present. If you’re infected, you’ll be referred to a
specialist and your baby can be tested after it’s born

HIV (human immunodeficiency virus) – this is the virus that causes AIDS. HIV infection can be
passed to a baby during pregnancy, at delivery or after birth by breastfeeding. As part of your
routine antenatal care, you’ll be offered a confidential test for HIV infection. If you’re HIV
positive, both you and your baby can have treatment and care that reduces the risk of your baby
becoming infected.

Be aware that you can still catch all these infections during pregnancy after you’ve had a negative
test result. This includes sexually transmitted infections such as syphilis, HIV and hepatitis B if
you or your sexual partner takes risks, such as having unprotected sex. You can also get HIV and
hepatitis if you inject drugs and share needles.

More about HIV

If you think that you’re at risk of getting HIV or you know that you’re HIV positive, talk to your
doctor about HIV testing and counselling.

If you’re HIV positive, your doctor will need to discuss the management of your pregnancy and
delivery with you.

There is a one-in-four chance of your baby being infected if you and your baby don’t have
treatment. Treatment can significantly reduce the risk of transmitting HIV from you to your
baby. One in five HIV-infected babies develop AIDS or die within the first year of life, so it’s
important to reduce the risk of transmission.

Your labour will be managed in order to reduce the risk of infection to your baby. This may
include an elective caesarean delivery.

Your baby will be tested for HIV at birth and at intervals for up to two years. If your baby is
found to be infected with HIV, paediatricians can anticipate certain illnesses that occur in
infected babies and treat them early. All babies born to HIV positive mothers will appear to be
HIV positive at birth, because they have antibodies from their mother’s infection. If the baby is
not HIV positive, the test will later become negative because the antibodies will disappear.
You’ll be advised not to breastfeed as HIV can be transmitted to your baby in this way.

Gestational diabetes
Gestational diabetes (GDM) is a type of diabetes that affects some women during pregnancy.
Diabetes is a condition where there is too much glucose (sugar) in the blood.

Normally, the amount of glucose in the blood is controlled by a hormone called insulin.
However, during pregnancy, some women have higher than normal levels of glucose in their
blood and their body does not produce enough insulin to transport it all into the cells. This
means that the level of glucose in the blood rises. Between 2 and 10 per cent of pregnant women
will develop GDM.

In most cases, gestational diabetes develops in the third trimester (after 28 weeks) and usually
disappears after the baby is born. However, women who
develop gestational diabetes are more likely to develop type
2 diabetes later in life.

Group B streptococcus
Group B streptococcus (GBS, or group B strep) is a bacteria
carried by up to 30% of people but it rarely causes harm or
symptoms. In women it’s found in the intestine and vagina
and causes no problem in most pregnancies. In a small
number of pregnancies, it infects the baby, usually just
before or during labour, leading to serious illness.

If you’ve already had a baby who had a GBS infection, you

should be offered antibiotics during labour to reduce the
chances of your new baby getting the infection. If you have
had a group B streptococcal urinary tract infection with
GBS (cystitis) during the pregnancy, you should also be
offered antibiotics in labour.

GBS infection of the baby is more likely to occur if:

 your labour is premature (before 37 weeks of pregnancy)

 your waters break early
 you have a fever during labour
 you currently carry GBS.

Your doctor will assess whether you need antibiotics during labour to protect your baby from
being infected.
It’s possible to be tested for GBS late in pregnancy, if you have concerns talk to your doctor.

Its okay to ask questions

It’s good to ask questions. Asking questions helps you understand more about your care.
Remember that it’s your right to be fully informed about any tests or treatment you’re asked to
have.

Write your questions down and take to your next appointment.