Obstetrics Services in Manchester, NH

You will receive obstetrical care from Board Certified physicians, nurse practitioners and registered nurses. Our practice has made a personal and professional commitment to serve the health needs of women in our community, and we offer a variety of services and choices in women s health care

Here are two Obstetrical services we Provide:


Amniocentesis
 
 
Amniocentesis is a procedure done during pregnancy to obtain amniotic fluid from around your baby. The procedure is done in our office with the use of an ultrasound. A pocket of fluid is identified that can be sampled without hurting the baby. After preparing the belly a very thin needle is passed while watching with ultrasound and a small amount of fluid is obtained and sent off for testing as indicated. Amniotic fluid samples can be used in early pregnancy to detect genetic, structural and chemical abnormalities of the fetus. Later in the pregnancy it can be used to test for fetal lung maturity and for amniotic infections. Amniocentesis is a very safe procedure and usually causes only mild discomfort and cramping. Infrequently there can be vaginal bleeding or leakage of amniotic fluid. In this case additional treatment may be necessary. Rarely, less than 1 in 300, amniocentesis can lead to the loss of the pregnancy.
 
Amniocenteses - Obstetrical care in Manchester, NH
 
Non Stress test
 
A non-stress test, or NST, is one of the simplest ways to assess a baby's well-being during the third trimester of pregnancy. Some of the most common reasons a NST may be done are for monitoring of high-risk pregnancies, monitoring a baby who has gone past his or her due date, or for checking the baby's heart rate when he or she has not been moving well.

During a NST, you will be asked to sit in a recliner while monitors for fetal heart rate and contractions are placed on your abdomen. These are the same type of monitors that will be used when you are in labor. We will then watch the baby's heart rate for 20-30 minutes.

What your doctor is looking for on the NST is for your baby's heart rate to increase (accelerate) above the resting heart rate (baseline). When the heart rate has two or more accelerations in a 20 minute window, your NST is reactive, or reassuring, and the test is done. Sometimes we will use an acoustic stimulator (buzzer) on your abdomen to send a sound vibration to wake up a baby who is sleeping
 

Obstetrical Conditions


Choriod Plexus
 

Choroid Plexus Cysts


The choroid plexus is the part of the brain that makes cerebrospinal fluid. In approximately 2% of normal babies, a tiny bubble of fluid is formed as the choroid plexus develops and this looks like a cyst on ultrasound. In the majority of cases, the cyst will resolve on its own during the course of pregnancy. Choroid plexus cysts have no impact on the brain development or intelligence of the child.

On rare occasion, choroid plexus cysts (CPC) are associated with a devastating chromosomal abnormality called Trisomy 18 or Edwards Syndrome, in which the baby has an extra copy of chromosome 18. Individuals with Edwards Syndrome have multiple birth defects, mental retardation, and do not survive for an extended period of time. Neither the number of cysts nor the size of the cysts has a significant impact on the risk of a fetus having Trisomy 18. These cysts tend to go away whether a baby is normal or has trisomy 18 and therefore, the resolution of the cyst is not helpful in the diagnosis of Trisomy 18.

During the course of your ultrasound, we will evaluate your fetus in meticulous detail in order to identify any other possible markers for trisomy 18. This evaluation includes a detailed structural survey of your baby including the face, heart, and extremities (especially hands) and is optimally performed between 18-20 weeks gestation. If no other abnormalities are detected, and you are at low risk for Trisomy 18 based on age and maternal serum screening (sequential or AFP4), the risk that your fetus has Trisomy 18 is very low.

The only way to actually know for certain if a fetus has Trisomy 18 is by performing an amniocentesis and examining the chromosomes directly. This procedure carries a risk of 1:200-1:300 for pregnancy loss. In general, if choroid plexus cysts are the only abnormality seen on ultrasound, and your serum screening was normal, the risk of your baby having Trisomy 18 is much lower than the risk of amniocentesis.
Fifths Disease
 

Fifths disease - Parvovirus B19


Fifth's disease is a very common viral illness in childhood which is characterized by a rash and achy joints, most often it is very mild in nature and many times there are no symptoms at all. It is transmitted by respiratory secretions and hand to mouth contact. An infected person is infectious 5 to 10 days after exposure and is no longer infectious with the onset of the rash. Many pregnant women are already immune to fifth's disease due to infection earlier in life.

When a pregnant woman is exposed to the parvovirus the first step is to get serum antibodies (a blood test) to see if there is past immunity or acute infection. If there is no immunity or infection a repeat test is done in 2 to 3 weeks to look for acute infection. Unless acute infection is found there is no follow up necessary and no harm to the baby.

If parvovirus infection is documented in pregnancy management is based on how many weeks along the patient is. In most cased the risk to the mother and baby is extremely low. In rare instances miscarriage and stillbirth can occur. Congenital anomalies and long term fetal abnormalities have not been observed unless there has been severe fetal infection.

With exposure and infection in pregnancy the initial testing will be ultrasound exams with further testing and evaluation done if the ultrasound becomes abnormal.
Gest Diabetes
 

Gestational Diabetes Mellitus


Gestational diabetes mellitus (GDM) is simply diabetes that develops during pregnancy. The placenta releases a substance that makes your body resistant to insulin, the hormone that regulates blood sugar levels. Although most women overcome this resistance, in some cases a woman's blood sugar becomes higher than is normal, and this is when GDM is diagnosed.

Some women have risk factors for GDM. These risk factors include older age, a history of GDM in a prior pregnancy, a history of a large baby, a strong family history of diabetes, or a twin pregnancy. However, many women who develop GDM have no risk factors. Therefore, every pregnant woman is screened for GDM at the start of the third trimester.

If you are diagnosed with GDM, you will have a visit with one of the doctors to discuss treatment. This will include changes to your diet and medication may be needed. We may also monitor your baby more frequently toward the end of your pregnancy.
Group B Strep
 

Group B Strep


Group B Strep, also known as Beta Strep or GBS, is a bacteria that can live in your vagina or rectum. About 20% of women carry this bacteria and do not know it – it does not cause discharge, pain, or any other symptoms of infection and will not make you sick. It is not sexually transmitted and will not affect your husband or partner. However, it can make your baby sick at the time of your labor and delivery.

The Center for Disease Control recommends that all women be cultured for GBS in the third trimester of pregnancy. The test is done with a simple vaginal/peri-rectal culture swab at 35-37 weeks. You will be tested even if you plan to be delivered by Cesarean section.

If you test negative, no further treatment is needed. If your test is positive, we will treat you with IV antibiotics when you break your water or go into labor. We do not need to treat you before labor as GBS does not harm you.

If you are GBS positive and receive antibiotics, there is a 98-99% chance your baby will NOT become infected. To maximize your chances of receiving antibiotics in a timely fashion, you will be given special instructions at your 36 week prenatal visit. We ask that you follow the instructions as provided.
PP Depression
 

Pregnancy and Postpartum Mental Health


Pregnancy and the months following the birth of a baby are both exciting and very stressful! Fluctuations in hormone levels, which are connected to one's brain chemistry, can result in significant mood changes. Women may develop depression or anxiety because of changes in relationships, feelings, or stress about work, housing, or money. The challenges of a high risk pregnancy, difficult birth, newborn care, and breastfeeding can also affect a woman's coping mechanisms during this time. If you are experiencing anxiety or depression during pregnancy or postpartum, we want you to know that it is very common. and treatable.

POSTPARTUM “BLUES”

DEPRESSION AND ANXIETY DURING PREGNANCY AND POSTPARTUM

POSTPARTUM PSYCHOSIS

How common is it?

NORMAL.
50-80% of women experience the blues.

15% - 23% of women, more often in teens.
10% of men.

1-2 per 1000 women.
More often if someone has a history of mental illness.

When does it start and how long does
it last?

Can occur any time in the first week.
Usually gone by 2-3 weeks after birth.

Can occur any time in pregnancy or first year after birth.
It can start gradually or suddenly.
Unless treated, it may not go away.

Usually occurs within the first 4 weeks after birth.
Needs treatment immediately.

Are you experiencing?

•Frequent crying

•Sleep disturbances (insomnia/excessive sleeping)

•Appetite disturbances (eating too much or too little)

•Anxiety/panic attacks

•Feelings of anger/irritability

•Over-concern or lack of concern for baby

•Scary thoughts or mental pictures

•Reliving past trauma

•Feelings of guilt and worthlessness

•Feeling overwhelmed/unable to cope

•Loss of interest in things you previously enjoyed

•Fear of harming baby or yourself

•Seeing or hearing things that others do not.

•Agitation, restlessness, irritability

•Mania: feeling speeded up, distracted, excitable, having a decreased need to sleep, or exhibiting fast, pressured speech

•Confusion

•Paranoia (extreme fears)

•Extreme mood swings

•Inability to reason, delusions

•Thoughts or plan of hurting yourself or baby

What can I do?

Treatment
Options

• See your healthcare provider to address any other medical issues that could be causing anxiety or depression

• Talk therapy to discuss these feelings

• Medication – talk to your provider about safe options that are available during pregnancy and breastfeeding

• Good self-care including 4-5 consecutive hours of sleep, small, healthy, frequent meals, exercise, limiting caffeine

• Social support or a pregnancy/postpartum depression support group to connect with other new moms experiencing similar issues

THIS IS AN EMERGENCY.

Needs to be treated by a doctor right away. Another family member or friend may notice something is wrong before you do.

Who do I call for support and information?

Elliot Hospital Postpartum Emotional Support Program: 663-8927
Postpartum Support International Warmline: 1-800-944-4PPD www.postpartum.net

Suicide Prevention Hotline: 1-800-273-TALK

Go to the nearest Emergency Department