Kull OB/GYN

Initial Prenatal Visit

Your first prenatal visit is typically 8 to 12 weeks after your last menstrual period.

What to Expect

• Medical history review with nurse / physician
• Lab work
• Pelvic exam
• Physical exam
• Extensive counseling and patient literature
• Brief ultrasound (depending on the length of pregnancy)

First Trimester Screenings

First trimester screenings are typically done during the 11th and 13th week of pregnancy.

What to Expect

• Ultrasound - confirms due date and multiple gestation
• Blood work screenings for:
  • Blood type
  • Rh factor
  • Anemia
  • Hepatitis B / Syphilis / HIV
  • Immunity to German measles (Rubella) and Chickenpox (Varicella)
  • Cystic fibrosis
  • Down syndrome (optional)

Second Trimester Screenings

During this trimester, we will be seeing you every four weeks. Once you have your glucose tolerance test – typically sometime between 24 and 28 weeks -- you will be seen every two weeks.

What to Expect

• Ultrasound - reveals gender and anatomical abnormalities
• Amniocentesis - (optional) detects neural tube defects and genetic disorders
• Glucose tolerance test (GTT) - screening for gestational diabetes
• Blood work screenings for:
  • Down syndrome
  • Open neural tube defects
  • Trisomy 18

Third Trimester Screenings

During the third trimester, you will continue to have visits every 2 weeks until week 36 when you will be seen every week. We will continue to monitor your blood pressure, weight, and require a urine sample at each visit.

Fetal malposition and preeclampsia will also be determined this trimester. Detection of a baby presenting in the wrong direction after 36 weeks allows for the possibility to turn the baby to the “head down” position.

What to Expect

• Ultrasound - evaluate fetal growth (optional)
• Non-stress test - measures the baby's heart rate as it moves
• Group B streptococcus (GBS)
• CBC/Blood count - checks for anemia
• Antibody screening - women with Rh negative blood type

When to Call Our Office

Your body will undergo many changes as a routine part of pregnancy; however, some symptoms may occur that warrant a call to our office.

Symptoms that Warrant a Call

• Heavy vaginal bleeding or clotting
• Light bleeding that lasts more than one day
• Passage of grayish or pinkish tissue (1st trimester)
• Bleeding accompanied by cramps, fever, chills or dizziness
• Severe abdominal pain or pain in your shoulder area
• Dehydration
• Fever higher than 101°F
• Painful urination
• Watery vaginal discharge
• Sudden swelling of the face, hands, or feet
• Significant decrease in fetal movement after the 24th week
• Signs of premature labor (2nd or 3rd trimester)
  • Regular uterine contractions
  • Lower back pain
  • Feeling of heaviness in the lower pelvis or abdomen
  • Diarrhea
  • Slight spotting or bleeding
  • Watery fluid or mucus discharge

If you are experiencing any of the above listed symptoms, please call our office as soon as possible.

Labor

One of the questions asked most often is, "How can I tell when I'm going to go into labor?" Your baby's due date is merely a point of reference, so it is difficult to know precisely when labor will begin. It is common for labor to begin as early as three weeks before the due date or as late as two weeks after it.

Your body will begin preparing for labor as much as one month before you give birth. You may notice some, if not all, of the early signs that labor is most likely imminent.

Early Signs of Labor

• Lightening - your baby's head drops down into the pelvis
• Bloody show - passage of a small amount of blood-tinged mucus
• Frequent diarrhea
• Ruptured membrane - your "water breaking"
• Intense contractions

Our physicians have compiled a list of questions to help determine if what you’re experiencing is true labor or false labor contractions (Braxton Hicks contractions).

	True Labor	False Labor
How often do contractions occur?	Regular intervals lasting 30-70 seconds and get closer as time passes	Irregular intervals and do not get closer together
Do contractions change with movement?	Continue even when you move or change positions	May stop when you walk, rest, or change positions
How strong are the contractions?	Generally increasing in strength as time passes	Usually weak and do not get stronger or start strong and gradually weaken
Where is the pain felt?	Usually starts in the lower back and moves to the front of the abdomen	Usually only felt in the front of the abdomen or pelvic area

Delivery

Vaginal Birth vs. Caesarean Section (C-Section)
There are significant factors to consider when choosing your birthing method. While many women labor with a vaginal birth, for some women, labor doesn’t progress as it should. In these instances, the baby may be in the wrong position, the contractions may not be strong enough to dilate the cervix, or her body may not go into labor on its own.

In these situations, medical intervention may be necessary, and depending on the circumstances, our physicians may recommend medication to help with labor or a caesarean delivery.

Symptoms that Warrant a Call

• Heavy vaginal bleeding with clots
• Fever and chills (temperature exceeding 100.4°F)
• Severe pain
• Foul smelling or purulent vaginal discharge
• Severe depression

If you are experiencing any of the above listed symptoms, please call our office as soon as possible.

Postpartum Exam Schedule

Healthy vaginal deliveries

An initial postpartum exam is scheduled at 4 to 6 weeks following your delivery.

Healthy caesarean deliveries

Postpartum visits are scheduled at 1 to 2 weeks following delivery and again at 4 to 6 weeks.

We generally plan a return visit to resume comprehensive wellness exams at 3 to 4 months following delivery. Should any concerns arise in the meantime, we will be happy to schedule as many visits as needed to assure your continued good health and comfort.