Janet Davis, M.D., P.C. | 1348 Walton Way, Suite 4300 | Augusta, GA 30901 | Tel: (706) 722-4300
Janet Davis, M.D., P.C.
Maternal Fetal Medicine

Frequently Asked Questions

Frequently Asked Questions

What is a Maternal-Fetal Medicine Specialist?
A Maternal-Fetal Medicine Specialist is an obstetrician/gynecologist who has received 2-3 years of additional education and practical experience to gain special competence in various obstetrical, medical and surgical complications of pregnancy. By virtue of this training and technical proficiency, he/she provides care or consultation for both mother and fetus in a complicated pregnancy. In addition, he/she provides education and research concerning the most recent approaches to the diagnosis and treatment of obstetrical problems. He/she thus promotes awareness of the diagnostic and therapeutic techniques for optimal management of these complicated pregnancies.

It is recognized that many obstetricians are also qualified by training and experience to manage complicated pregnancies. Maternal-Fetal Medicine Specialists are complementary to obstetricians in providing consultations, comanagement or direct care for complicated patients both before (preconceptual counseling) and during pregnancy. The relationship between the obstetrician and the Maternal-Fetal Medicine Specialist will depend on the acuity of the condition and the local circumstances.
Who needs a Maternal-Fetal Medicine Specialist?
The discipline of Maternal-Fetal Medicine involves four major subgroups of patients:
  1. Patients undergoing diagnostic or therapeutic procedures, such as:
    1. Abdominal cerclage
    2. Chorionic villus sampling
    3. Comprehensive ultrasound
    4. Fetal gene therapy
    5. Fetal blood sampling
    6. Fetal transfusion
    7. Fetal muscle/organ biopsy
    8. Fetal reduction
    9. Fetal skin sampling
    10. Fetoscopy/embryoscopy
    11. Genetic amniocentesis
    12. Other diagnostic/therapeutic modalities
  2. Patients with medical and surgical disorders, such as:
    1. Antiphospholipid Antibodies
    2. Cardiac disease (Clark's Group II, III, any valve replacement)
    3. Chronic renal disease
    4. Chronic Hypertension
    5. CNS Disease:
      • seizure disorders
      • multiple sclerosis
      • AV malformation
      • berry aneurysm
      • prolactinoma
      • pseudotumor cerebri
    6. SLE/Other collagen vascular disease
    7. Congenital disorders with potential untoward outcomes
      • cystic fibrosis
      • Marfan's syndrome
      • Protein S, C, AT-III deficiency
    8. Endocrinologic disorders
      • Addison's Disease
      • Diabetes, insulin-requiring/dependent
      • Thyroid disease
      • Parathyroid disease
      • Pheochromocytoma
    9. Gastrointestinal Disease
      • Hepatitis
      • Acute fatty liver of pregnancy
      • Portal hypertension
      • Hyperemesis, unresponsive to conservative therapy
      • Ulcerative colitis
      • Crohn's disease
      • Cholecystitis/cholelithiasis
      • Pancreatitis
    10. Sickle cell disease/other hemoglobinopathies
    11. Thromboembolic disease, past or current
    12. Allo- and autoimmune thrombocytopenia
    13. Infectious diseases
      • HIV
      • CMV
      • Toxoplasmosis
      • Rubella
      • Parvovirus
      • Varicella
      • Herpes (primary)
      • Septicemia
      • Coccidiomycosis
      • Any life-threatening infection
    14. Maternal malignant disease
    15. Myasthenia gravis
    16. Paraplegia/quadriplegia
    17. Pulmonary hypertension
    18. Eating disorders
    19. Restrictive lung disease
    20. Severe preeclampsia/eclampsia HELLP syndrome
    21. Asthma requiring frequent medications
    22. Substance abuse
    23. Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome
    24. Transplants
  3. Healthy gravidas with fetuses at markedly increased risk of adverse outcome, such as:
    1. Abdominal pregnancy
    2. Abnormal maternal serum testing
    3. Fetal hydrops; immune, nonimmune
    4. Fetal anomaly or cytogenetic abnormality
    5. Fetal supraventricular tachycardia or congenital heart block
    6. Incompetent cervix
    7. Isoimmunization
    8. Mullerian abnormalities
    9. Multifetal pregnancies (twins or greater)
    10. Recurrent prior to preterm deliveries
    11. Nonobstetric abdominal surgery in the current pregnancy
    12. Oligohydramnios at <37 weeks gestation
    13. Placenta accreta, increta, percreta
    14. Polyhydramnios
    15. Premature rupture of membranes <34 weeks gestation
    16. Preterm labor <34 weeks gestation
    17. Prior second trimester fetal loss
    18. Prior intrauterine fetal demise
    19. Recurrent pregnancy loss
    20. Significant 2nd or 3rd trimester bleeding
    21. Suspected IUGR
    22. Twin-to-twin transfusion syndrome
  4. Any antepartum patient admitted for "other than delivery" and patients with postpartum complications such as severe hemorrhage, refractory infections, complicated preeclampsia, eclampsia and difficult post cesarean complications.
Approved by the Committee on Obstetric Practice: February 7. 1997
I am an OB; how can I refer patients to your practice?
Thank you for trusting us with your high risk pregnancies. Please fill out our referral form and fax to: 706-722-7337, or e-mail to jdavis@janetdavismd.com
When is the office open?
Monday through Thursday, 8:00 AM-5:00 PM; Friday 8:00 AM-12 Noon.
We are closed on the following holidays:
  • New Year's Day
  • Memorial Day
  • The Fourth of July
  • Labor Day
  • Thanksgiving Day and Black Friday
  • Christmas Eve and Christmas Day
How do I make an appointment?
In order to make an appointment, there are several steps you can follow:
  1. For established patients, simply call the main office number, (706) 722-4300, and speak to the receptionist or leave a message indicating the time and date that you would like to have your appointment.
  2. For those who are new to our practice, your obstetrician must refer you for consultation. Please use this referral form.
Are your new patient forms available online?

Yes, we have made our patient forms available online for your convenience. Feel free to print and fill these out before your appointment, or keep for your records. You will need Adobe Reader to view these files.

Where is the office?

Our main office is located in the W.G. Watson Women's Center of University Hospital, 1348 Walton Way, Suite 4300 (on the 4th floor), Augusta, Georgia, 30901. To see it on a map, click here. You can also use this site to get driving directions to the office.

We also see patients in Aiken, SC. Click here for a map, or click here for driving directions. You can also call our office at 706-722-4300 for more details.

Post Partum (After Delivery) Instructions

Please follow these instructions carefully upon discharge:

ACTIVITY: Restrict unnecessary activity for five days. Do not lift objects weighing more than 10-15 pounds. Climbing stairs should be kept to a minimum. Avoid full household duties and strenuous activity (lifting, stooping, and bending) for 2-3 weeks. Take morning and afternoon rest periods daily.

DIET: Eat balanced meals high in protein. Keep your bowel movements fairly soft. If necessary, use one or two Peri-Colace capsules at night before retiring with several glasses of liquid. If you are breast feeding, drink at least three additional glasses of liquid a day; preferably milk.

MEDICATION: Continue your prenatal vitamins/iron tablets as before delivery. If you are bottle feeding, start your birth control pills on the second Sunday after delivery. If you are breast feeding, we will discuss contraception at your post partum check-up visit. Take your other medication (if any) as prescribed.

BATHING: No tub bathing for at least 4-6 weeks. Take only showers or sponge baths. You may wash your hair at any time.

VAGINAL BLEEDING: Normally, postpartum bleeding will continue for 3-4 weeks. After a few days, it will turn into a brownish discharge, but at times you may have bright red blood again and occasionally blood clots. Should your postpartum bleeding become heavier than a normal menstrual period or should you continue to pass blood clots, contact the office.

MENSTRUATION: If you bottle feed, you will probably start menstruating in five to ten weeks. If you are breast feeding, you will probably not menstruate until at least three months after delivery.

SEXUAL INTERCOURSE: Intercourse, tampons, and douches must be avoided until after your post partum examination.

EPISIOTOMY CARE: Continue sitz baths and heat lamp treatments. Heat lamp treatments can be accomplished with a table lamp (shade on) with a 40-60 watt bulb. Use warm tap water for sitz bath. Check your temperature daily, and call if greater than 100. Also call if you notice bad odor or purulent vaginal discharge.

POST PARTUM CHECKUP: Call the office during your first week at home and make an appointment at six weeks.

BREAST FEEDING: Follow the breastfeeding nursing instructions. If you are not breastfeeding, follow the protocol provided by the hospital. If nursing, cleanse nipples with water and dry before and after nursing. Nursing bras should be worn for support. If not nursing, wear a bra 24 hours a day for at least 7 to 10 days. Supporting bra should be continued for pendulous breasts.

FOR CESAREAN SECTION: You may be going home with the staples still in place. Call the office in 1-2 days to have them removed. You also need to make an appointment to be seen in the office in 10-14 days for an incision check.
Continue to check your temperature 2-3 times a day, and call the office if it is greater than 100°.
You should call the office if you notice redness or tenderness about the incision or see drainage from the incision.
Restrict unnecessary activity for two weeks. Do not lift objects weighing more than 10-15 lbs. Climbing stairs should be kept to a minimum. Avoid full household duties and strenuous activity for four weeks. Avoid driving for 3-4 weeks.
Avoid tub baths for 4-6 weeks. You should take showers, but try to cover the incision in the first two weeks.

Please do not hesitate to call the office at (706) 722-4300 at any time if you should have any questions or problems.

Frequently Asked Questions: Amniocentesis
Amniocentesis is a procedure which allows a pregnancy to be tested for certain kinds of birth defects. Since you are going to have amniocentesis (or are thinking about having it), this may help answer some of your questions about the procedure and the tests that can be done.
  • What is Amniocentesis?
    Amniocentesis is the withdrawal of a small amount of amniotic fluid (the water surrounding a developing baby) from the uterus. The procedure is done in a doctor's office or hospital clinic, usually between the 15th and 18th week of pregnancy. Amniocentesis can sometimes be scheduled as early as about 12 weeks, although the risk may be a little higher. Before the procedure, the doctor performs an ultrasound scan (sonogram) which shows a picture of the uterus, the placenta, the amniotic fluid, and the fetus on a screen. Then the doctor inserts a very thin needle through the woman's abdominal skin into the uterus. About an ounce or less of amniotic fluid is removed. This fluid contains cells which have been shed from the fetus and which can be tested for certain serious genetic diseases. The fluid also contains various proteins which can be tested to look for other diseases. Some women say amniocentesis doesn't hurt at all; others say they feel a pressure or cramping. After the sample is taken, another ultrasound check is done. Then the procedure is finished and the woman can go about her usual daily activities.
  • What Tests Can Be Done On Amniotic Fluid?
    Different tests are done on a sample of amniotic fluid, depending on what the particular pregnancy is at risk for.
    • Testing for chromosome abnormalities:
      Most people who decide to have amniocentesis have the procedure in order to test for chromosome abnormalities. Chromosomes are tiny microscopic packages, each one containing several thousand genes. Genes are the stored bits of chemical information needed to make a single fertilized egg cell turn into a human being. A missing or extra chromosome causes many changes in the way an unborn baby develops; almost always the changes lead to serious physical birth defects or mental retardation, or both. The most common chromosome abnormality is Down syndrome, which is caused by an extra chromosome. This causes physical problems (such as heart defects) and mental retardation. Every cell of the body has a set of the chromosomes. Therefore, amniotic fluid cells, which have come from the developing baby, can be tested for chromosome abnormalities. The results of the testing are usually ready one week after the amniocentesis.
    • Testing for inherited genetic diseases
      Some couples have amniocentesis if they have a known risk for one of the inherited genetic diseases that can be tested for prenatally. Examples are Tay-Sachs disease, most frequent in the Jewish population; cystic fibrosis, most common in Caucasians of Northern European ancestry; and sickle cell disease, most frequent in the Black population. A sample of amniotic fluid can be tested for the specific gene known to cause the disease, or in some cases, for particular proteins. Test results are usually ready in 1-5 weeks, depending on the number and type of tests performed.
    • Testing for other diseases
      Amniotic fluid can also be tested for a few other serious birth defects, such as neural tube defects (spina bifida is one), in which the brain and spinal cord have not developed properly. The standard test for this condition measures the concentration of a protein called alphafetoprotein (AFP). The results are ready in one week or less.
  • Who Should Have Amniocentesis?
    Every pregnancy has a small risk, about 3%, for the kinds of birth defects that do not have a known cause. Some examples are cleft lip, hernia, nonspecific mental retardation, and most heart defects. There are no prenatal tests yet for these kinds of problems. Some pregnancies have an additional risk for chromosome abnormalities, inherited genetic diseases, neural tube defects, or other conditions for which tests are available. People with these risks should consider amniocentesis. If a woman thinks she should have amniocentesis but isn't sure, she should talk to her doctor and maybe also to a specialist in genetics, such as a genetic counselor.
    • Advanced maternal age
      Older women have a greater risk than younger women for having a baby with Down syndrome or other chromosome abnormality. The risk gradually increases with age, as shown in the chart below.
      Age of Mother 
      (in years)
      Risk of Chromosome 
      Problems in Pregnancy
      15-29 1 in 700
      30 1 in 450
      31 1 in 400
      32 1 in 350
      33 1 in 300
      34 1 in 250
      35 1 in 200
      36 1 in 160
      37 1 in 130
      38 1 in 100
      39 1 in 80
      40 1 in 65
      41 1 in 52
      42 1 in 42
      43 1 in 33
      44 1 in 26
      45 1 in 20
      46 1 in 16
      47 1 in 13
      48 1 in 10
      49 1 in 8
      It is routine in the United States to offer amniocentesis to all women who will be 35 years or older at the time the baby is born.  Some younger women may also decide to have this prenatal procedure.
    • Family history of chromosome abnormality
      If someone in the family, especially a close relative, is known to have a chromosome abnormality, there may be increased risk for another child to be born with the same problem. This risk is independent of the age of the mother. Amniocentesis for chromosome testing can provide the answer.
    • Family history of inherited genetic disease
      If someone in the family is known to have (or has had) an inherited disease, or if the parents have been found to be carriers of an inherited disease, the pregnancy is at increased risk for that problem. Many inherited diseases today can be diagnosed with tests done from amniocentesis.
    • Family history of neural tube defects
      These birth defects, such as spina bifida, tend to run in families. If a close relative has been born with such a problem, there may be an increased risk to other pregnancies in the family. Testing of amniotic fluid is the most accurate method of diagnosis of neural tube defects.
    • Positive maternal serum screening test
      Screening tests to identify pregnancies at risk for Down syndrome or neural tube defects have recently been developed. These tests are done on a small sample of blood from a pregnant woman, usually between the 15th and 18th week of pregnancy. The testing is for women of any age. When the results show a high risk that the pregnancy has one of these problems, then amniocentesis should be considered.
  • How Safe Is Amniocentesis?
    Since it was developed in the late 1960's, genetic amniocentesis has been performed on hundreds of thousands of pregnancies. Though it is now a routine procedure, it does have some risks:
    • Miscarriage
      Though uncommon, this is the most serious risk of amniocentesis. Some miscarriages would happen anyway, but a few are caused by the procedure. The average risk for miscarriage is about 1 in 200. Early amniocentesis (before 16 weeks) has a somewhat higher risk, up to about 1 in 100.
    • Bleeding, cramping, leaking fluid from the vagina
      These symptoms, which happen to about 1% of women having amniocentesis, do not usually result in a miscarriage. But a woman having these symptoms should call her doctor for advice about what activities she should or shouldn't do.
    • Infection
      This is very rare.
    • Harm to the fetus
      Since the ultrasound picture gives the doctor exact information about the location of the fetus inside the uterus, the risk that the needle will touch the fetus is extremely low.
    • Rh problems
      If a woman having amniocentesis has Rh negative blood type, and the baby's father has Rh positive, the woman should have an injection of Rh immune globulin following the procedure. This helps prevent Rh disease in the baby.
    • Repeat testing
      Very rarely, the doctor cannot obtain enough amniotic fluid, or the laboratory test for some reason cannot be done. Neither of these means that something is necessarily wrong with the pregnancy, but the amniocentesis will have to be repeated in order to get results.
    • Waiting and worrying
      Many people find that the 5 to 10 day period of waiting for the results is the hardest part of amniocentesis. Anticipating this helps a little.
  • Options
    Most people having amniocentesis have normal test results. These parents can then stop worrying about whatever special risk their pregnancy had. For some people, however, the testing shows abnormal results. These parents will need to talk with their doctors, and maybe with geneticists or genetic counselors, about what the test results mean, and what to do. Deciding whether or not to have amniocentesis usually depends on your special risks and concerns, your family situation and your feelings. Some people opt for prenatal testing and some don't. Your doctor can help answer any further questions you may have about the procedure or about the tests that can be done.
Frequently Asked Questions: Maternal Serum Screening
  • What is the Maternal Serum Screening Test?
    Maternal serum screening is a blood test available to all pregnant women. It is best to have it done between 15-18 weeks of pregnancy (counting from the first day of the last menstrual period). The purpose of this test is to identify pregnant women who may be at increased risk for having a baby with certain birth defects, such as an open neural tube defect, Down syndrome, or trisomy 18. Babies with these disorders are usually born into families in which no one else has had the same disorder.
  • How is the Screening Test done?
    A small amount of blood is drawn from a vein in the pregnant woman's arm and several substances in the blood are measured. The results are affected by many factors, including:
    • The number of weeks pregnant the woman is on the day the blood sample is taken.
    • Her weight, race, and whether she is an insulin-dependent diabetic.
    • Whether she has a single or multiple pregnancy.
    These factors, as well as the woman's age and any significant family history, are taken into account in calculating the individual patient's specific risks.
  • What is an Open Neural Tube Defect?
    The neural tube is a structure that forms in the developing embryo very early in pregnancy. This tube eventually develops into both the baby's brain and the spinal cord. If the tube does not close completely, an opening may remain along a part of the baby's back or head. An open neural tube defect occurs in 1 or 2 out of every 1000 births. It occurs in two forms: anencephaly and spina bifida. In anencephaly the brain and back of the skull are incomplete. These babies are often stillborn or die shortly after birth. In spina bifida there is an opening in the baby's spine. Depending on which part of the spine is affected, different problems result for the baby. Usually there is some weakness or paralysis of the legs. There may also be problems with bowel and bladder control, as well as other medical problems such as hydrocephaly (water on the brain) and delayed development. Children with spina bifida require surgery and may also need ongoing special medical care.
  • What is Down Syndrome?
    Down syndrome is a condition that results from having an extra chromosome in the fertilized egg. Normally there are 46 chromosomes in each human cell. Individuals with Down syndrome have a total of 47 chromosomes in their cells; they have an extra #21 chromosome. This condition is also called trisomy 21. People with Down syndrome have a distinct physical appearance and varying degrees of mental retardation. They are also at increased risk for certain birth defects, such as congenital heart disease. Overall, approximately 1 in 800 babies is born with Down syndrome. Older women have a greater risk than younger women for having a baby with Down syndrome or another chromosome abnormality. The risk gradually increases with age.
  • What is Trisomy 18?
    Trisomy 18 is also a chromosome abnormality, this one resulting from having an extra #18 chromosome in every cell. Babies with trisomy 18 have many serious mental and physical disabilities including mental retardation, heart defects, and feeding and growth disorders. Only 1 out of 10 affected babies lives past the first year. About 1 in 8000 babies is born with trisomy 18. As with Down syndrome, the risk increases with the age of the mother.
  • Why is the Test called a Screening Test?
    A screening test DOES NOT provide a diagnosis; rather, it predicts the likelihood of a problem to occur. For example, cholesterol screening determines a person's risk for heart disease based on the amount of cholesterol in the blood, but it does not necessarily mean the person has heart disease. Maternal serum screening determines if a woman is at a higher or lower risk of carrying a baby with an open neural tube defect, Down syndrome, or trisomy 18. This means that some women with normal babies will have abnormal screening results (and will be offered the appropriate follow-up testing). Also, some women whose babies have these defects will not be detected through screening, as it cannot detect all the high-risk pregnancies.
  • What does an Abnormal Screening Result mean?
    If a woman's maternal serum screening result is abnormal, it DOES NOT necessarily mean that the baby HAS a birth defect, but rather that the risk is higher than average. The results can vary from a slightly increased risk to a more significant one. The laboratory report states a woman's specific risk, and also shows it pictured on a graph. False positive screening results happen in less than 10% of women under 35 years of age (20-25% of women age 35 or older). Most often the reason is:
    • The pregnancy is not as far along (or is further along) than thought when the blood was drawn. The substances measured in the screening test very week by week. If the pregnancy dating was incorrect, the screening results could also be incorrect.
    • The woman is carrying twins but did not know it when the blood was drawn. Twins usually produce twice the amount of the substances measured in the screening test, causing misinterpretation of the results.
    • In either of these situations, the laboratory will use the corrected information to recalculate the risks and send a new report.

  • What Follow-Up Testing may be recommended if the Screening Test is Abnormal?
    Your health care provider may suggest several options, depending on your individual circumstances:
    • A basic ultrasound (sonogram) to date the pregnancy. If the ultrasound shows a different gestational age, the screening test results may be recalculated, and may lead to a different interpretation.
    • A more detailed ultrasound examination which allows the doctor to look at the baby's brain and spinal cord, as well as other parts of the body. This ultrasound can often identify an open neural tube defect or other malformation associated with an abnormal screening test.
    • An amniocentesis. Amniocentesis is the withdrawal of a small amount of amniotic fluid (the water surrounding the baby) from the uterus. The fluid contains proteins and cells which can be tested with great accuracy for open neural tube defects, Down syndrome and trisomy 18. Click Here to see our Amniocentesis FAQ Page.
    Unlike the screening test, which is done on a blood sample from the pregnant woman, amniocentesis has some risk of causing a miscarriage. For this reason, amniocentesis is not offered to everyone. It is offered to women over 35 years old and those with abnormal screening results.
  • What else should you know about Maternal Serum Screening?
    • A normal pregnancy outcome is still most likely, even after an abnormal screening result.
    • Serum screening will not detect all high risk pregnancies.
    • There are two similar screening tests currently available, AFP3 and AFP4.
    The AFP3 test has been in use for many years. In the Genzyme Genetics laboratory, the AFP3 test leads to the detection of approximately:
    • 75% or open neural tube defects;
    • 70% of Down syndrome cases in women under 35 years;
    • 85-90% of Down syndrome cases in women age 35 years or older;
    • 60-80% of trisomy 18 cases.
    The AFP4 test is new, and some insurance companies do not yet cover it. In the Genzyme Genetics laboratory, the AFP4 test leads to the detection of approximately:
    • 75% of open neural tube defects;
    • 75-80% of Down syndrome cases in women under age 35 years;
    • 85-90% of Down syndrome cases in women age 35 years or older;
    • 60-80% of trisomy 18 cases.
  • Statistics Out of 1000 pregnant woman who had maternal serum screening, approximately 25 will have results that show increased risk for having a baby with an open neural tube defect. Of those, only 1 or 2 will actually have a baby with a neural tube defect. Approximately 70 women will have results that show increased risk for having a baby with Down syndrome. Of those, only 1 or 2 will actually have a baby with Down syndrome. Some women who carry fetuses with an open neural tube defect or Down syndrome will not be identified as being in the high-risk groups. This is because no screening test can detect all the high-risk pregnancies.
What is a Cell Free Fetal DNA Testing?
It is now possible to avoid an amniocentesis when the question of trisomy 13, 18, or 21 arises, thanks to cell free fetal DNA testing. Cell free fetal DNA is a test that measures the level of fetal chromosome 13, 18, and 21 DNA present in maternal blood. This test provides patients with valuable information without the risk of miscarriage associated with other tests.
What is Expanded Carrier Screening?
ACOG and ACMG now recommend that all patients be offered Cystic Fibrosis, Fragile X, and Spinal Muscular Atrophy carrier screening. For patients with an Ashkenazi Jewish background, there are additional tests that are recommended. These tests include Canavan, familial dysautomonia, Tay Sachs, Fanconi anemia type C, Niemman-Pick type A, Bloom, Mucolipidosis IV, and Gaucher disease. We now offer an expanded carrier screen for 107 diseases including all of those mentioned above. This testing is done for approximately the cost of the Cystic Fibrosis test alone.
Preterm Birth
The Problem of Preterm Birth
Preterm birth is a significant problem affecting newborns today. Babies born prior to 37 weeks of pregnancy may have various problems due to incomplete growth and development. They may experience different problems of varying severity depending on the timing of their birth. Because the birth of a premature baby can affect you and your child for many years to come, we feel that it is important that you have the tools to identify preterm labor early. Early identification may help prolong your pregnancy.

Who is at Risk for Preterm Birth?
The following conditions may be associated with an increased likelihood of preterm birth.
  • Previous preterm labor or delivery
  • Abnormally shaped uterus, DES Daughter, uterine surgery
  • Two or more second trimester abortions or miscarriages
  • Incompetent cervix, cone biopsy, large fibroids
  • Current pregnancy with twins, triplets, etc.
  • Sever kidney and urinary tract infections
  • Cervical dilation or effacement before 36 weeks
  • Bleeding, placenta previa, too much or too little amniotic fluid
  • Age less than 18 or greater than 35, unusual physical or mental stress.
If you have any of these conditions, you can discuss them with your physician.

What is Preterm?
The duration of pregnancy is calculated from the first day of your last menstrual period. Your due date is calculated as being 40 weeks from your last period, but every delivery occurring beyond the 37th week is considered full term. In order to understand what preterm is, it is necessary to divide the pregnancy into three stages. First stage, from the first day of the last menstrual period to the 19th week; second stage, from the 20th to the 36th week; and third stage, from the 37th to the 40th week of pregnancy.

If pregnancy ends prior to 20 weeks of gestation, it is considered a miscarriage or an abortion (spontaneous or therapeutic). If pregnancy ends after the 20th week, it is considered a delivery. If the delivery occurs during the period from 20 to 36 weeks, it is a preterm birth. If delivery occurs after 37 weeks of pregnancy, it is a term birth.
What is Labor?
Labor is the process by which the uterus (womb) contracts or tightens in a regular pattern and causes the cervix (the mouth of the womb) to open and prepare for delivery. Labor is diagnosed when both uterine contractions and cervical change occur. The changes in the cervix can be evaluated during a pelvic examination by your practitioner. The cervical changes that would occur during labor include:
  1. Softening or change in the consistency of the cervix
  2. Effacement or thinning and shortening of the cervix
  3. Dilation or opening of the cervix
  4. Change of the baby from a posterior position to a more anterior position (moves forward)
  5. Descent or lowering of the presenting part (either the head or the buttocks of the baby enters the birth canal).
These changes may be difficult to detect even for an experienced examiner. Your role in the early identification of labor is to monitor for uterine contractions and report signs of preterm labor. See the information about Preterm Labor below.
Preterm Labor
What is the Cause of Preterm Labor?
The cause of preterm labor is not completely understood. It is known that certain situations are associated with preterm labor and may increase your risk for early delivery. Very common factors would include carrying more than one baby (twins or triplets) or having had a preterm delivery in the past. Your practitioner may discuss these factors with you. At this time, preterm labor can't be prevented. We can only do the next best thing -- identify it early and treat it effectively to help the pregnancy continue.

Warning Signs of Preterm Labor
Early recognition of the signs of preterm labor may result in better management of your pregnancy. We feel that because you are the only person who stays "close" to your uterus 24 hours a day, you should be the one who can identify these signs early. You probably have a better sense of the changes occurring within your body than anyone else. The following are signs that occur during preterm labor. However, they can also be a very normal part of a healthy pregnancy. What you need to keep in mind as you go over these signs is what may represent a change from your normal pattern or experience.
  1. Uterine contractions. The uterus (womb) is composed of muscle fibers. A uterine contraction is the tightening of the muscle within the uterus. Using your fingertips to feel the uterus, you should be able to indent your uterus when it is relaxed. During a contraction you can feel your uterus tighten and become hard.
    Contractions occur normally throughout pregnancy. They are usually painless and they can occur at any time. Certain activities such as changing your position or having a full bladder may cause you to have a contraction. The type of contraction you will have with preterm labor may also be painless, but there is often a pattern to the tightenings. Your uterus will feel hard over the entire surface and this tightening may occur every 15 minutes or closer. Each contraction may last from 40 seconds up to 1 1/2 to 2 minutes.

    Remember: Preterm labor contractions are often painless -- occurring every 15 minutes or closer. The following signs may also occur normally in your pregnancy, but if you feel these signs, you should monitor for uterine contractions.
  2. Menstrual-like cramps. These are felt low in the abdomen, just above the pubic bone. The cramping may be rhythmic, feeling like waves or fluttering. You may also feel constant cramping.
  3. Lower, dull backache. This backache is located mainly in the lower back and may radiate to the sides or front. It may be rhythmic or constant, and often is not relieved by change of position.
  4. Pelvic pressure. You may feel pressure or a fullness in the pelvic area, in your back or your thighs. It may feel as though the baby is going to "fall out."
  5. Intestinal cramps. These may occur in the presence or absence of diarrhea. You may have the feeling of "gas pains."
  6. Increase or change in vaginal discharge. The amount may be more than that which is normal to you. The consistency may change to mucousy or watery. The color may become pink or brown-tinged.
  7. A general feeling that something is not right, even without a specific cause.

Again, in the presence of any of the above signs, or if you feel something is different, lie down and monitor for uterine contractions.

What to do if you think you have Preterm Labor
  1. Go to the bathroom and empty your bladder.
  2. Check to make sure you have not missed a dose of any medication you might be taking.
  3. Maintain adequate fluid intake as instructed by your physicians.
  4. Rest on your LEFT side, lying down.
  5. Record uterine contractions.
  6. Call your health care provider.
Emergency Situations
Sometimes, a problem can occur that needs attention right away. If you notice any of the signs below, CALL YOUR PHYSICIAN IMMEDIATELY.
  • Bleeding. If you experience vaginal bleeding, a large gush or steady stream of bright red blood is an emergency. Get help immediately, lie on your side and put your feet higher than your head. Save pads or cloths used to catch the blood.
  • Rupture of the Bag of Water (Amniotic Sac). Sometimes the bag of water around the baby will rupture prematurely. If you notice a gush of fluid or a steady trickle of fluid, you should call your physician. Be sure to note any color or odor that might be present in the fluid. Save pads or cloths and bring them with you to the hospital.
  • Severe Stomach Pain. If you have constant, severe pain that doesn't go away when you change position, with or without contractions, notify your physician.
Warning: Any of the above situations may indicate an emergency. Contact your physician immediately.