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A pap smear is a screening test for abnormal changes in the cervix including cervical cancer. The primary cause of cervical cancer is the Human Papillomavirus (HPV). It is a very common sexually transmitted virus. Most patients with HPV have no symptoms or warnings although it may present with warts. Males with HPV have no signs or symptoms. Thankfully the HPV vaccine can be given to young women (age 9-26). This will help to reduce the risk of cervical cancer.

Cervical cancer screening should start at age 21 years. We generally advise to Pap smear every 3 years. While previously it was done yearly new information suggests a 3 year interval is preferred to reduce unnecessary treatment.
In most cases, women can stop cervical cancer screening after age 65 once they have multiple documented normal pap smears.

Colposcopy is performed if you have an abnormal pap smear result which is concerning for possible pre-cancerous cells.  It is performed in the office using a microscope to directly examine your cervix under magnification and obtain biopsies. The procedure takes less than 15 minutes and anesthesia is not required.  

After a cervical biopsy you can expect to have some light bleeding for 1-2 days with some mild cramping.  Please avoid sexual intercourse for 2 weeks after, otherwise you may resume normal activity.  We will generally review the biopsy results with you in the office 2-3 weeks after the specimen is sent to the pathology lab.  

The past couple of years have seen the improvement of birth control options. There are new, lower dose pills with fewer side effects than those used years ago. There is the birth control injection (Depo-Provera) which is given in the office every 3 months. The NuvaRing is a vaginal ring changed monthly. This has similar effect to the pill and is not felt by either you or your partner.

The Intrauterine device is a great option for long acting reversible contraception (LARC). This option comes in a hormonal and a non-hormonal option. We can further discuss which option is right for you in the office.

A laparoscopic tubal ligation is a permanent procedure done in the hospital as a same day procedure.

A “bloody show” is a small amount of red/ brown mucous which is often seen in the last month of pregnancy. While this may mean that your cervix is softening and preparing for dilation it does not mean you are in labor. You do not need to be evaluated; however, if you are concerned you should contact our office for further instructions.

Heavy period like bleeding is never normal during pregnancy and it must be evaluated immediately.

Braxton-Hicks contractions are mild, irregular contractions that may feel like menstrual cramps or abdominal tightening. They can be normal during the 2nd and 3rd trimester and do not require evaluation.

Swelling during pregnancy is common and normal in most circumstances. It does not occur in all pregnancies. It will go away in 1 – 2 weeks after delivery. Swelling is abnormal when accompanied with high blood pressure. That is what we call Preeclampsia or gestational hypertension.

Pre-eclampsia is high blood pressure during pregnancy with protein the urine. It most often occurs in the last trimester although it can occur earlier in some cases. Pre-eclampsia can be very dangerous and lead to dangerous seizures (eclampsia). The cure for this disease is delivery. You may receive medication to prevent seizures and also to lower your blood pressure. Most patients have no symptoms but some may experience severe headache, upper abdominal pain, blurry vision or spots in the vision.

Always consult with us before you take any medication you are not sure of. For a simple cold you may take Sudafed for stuffiness/ congestion, Tylenol for headache/ fever, Robitussin for cough.  You should rest and drink plenty of water for hydration.  You may take Immodium for diarrhea.

All of the above medication are over the counter and are safe in pregnancy. Follow the label for dosing.  Please call if you feel worse or the symptoms are not improving.  Please contact us for a temperature above 100.

Yes, you should exercise during pregnancy, unless you have been specifically directed by your physician not to such as due to a high-risk pregnancy.  The general guideline is to maintain your usual exercise intensity from prior to pregnancy.  Do not suddenly increase your intensity level now that you are pregnant.  Be sure to drink plenty of water for hydration.  Walking, swimming, and yoga are good options.  

Yes, unless you have been instructed not to (abnormal bleeding or at high risk for premature delivery). Sex should be gentle and you should stop if you notice any blood.

You may not feel regular movements until 28 weeks after which point you should feel good movements every day.  Many times if you are busy you may not notice that there is movement occurring. If you are unsure or feel no movements, stop what you are doing, drink some water or eat a snack, and lay on your side in a quiet room.  You should feel 10 kicks or 10 good fetal movements within 1½ hours.  This is called Kick Counts.  Please contact the office if you do not feel 10 kicks or good movements.

You should be evaluated anytime you are concerned that something is wrong with you or your baby. Here are some examples of situations which require evaluation.

Your water breaks – This would usually feel like a large “gush” of water. Once the water breaks you will continue to have leaking of fluid. The fluid is usually clear however it can have a yellow or green color.

You have heavy bleeding – A small amount of red or brown mucus may be the “bloody show” which can be normal and it does not mean you have to go to the hospital. Heavier bleeding like a period is not usual and should be evaluated.

You do not feel the baby move – You should feel regular movements every day after 28 weeks. Check for “kick counts” if you feel less movements or no movements by finding a quiet place to lay down on your side and place a hand on your belly. You should be able to count 10 kicks or movements within an hour and a half otherwise the baby needs to be evaluated.

You have strong contractions – Contractions generally feel like your belly gets very tight and the baby feels like a ball. Occasional contractions are normal after 36 weeks however if you notice these contractions getting stronger and more regular take note. If you notice the contractions are every 5-7 minutes apart for 1 hour you should be evaluated. If you notice the contractions go back to 10 minutes or even 15 minutes apart this may be “false labor”.

Once you arrive at labor and delivery you will be placed on a fetal monitor. The labor nurse will evaluate you and then call the doctor.

An episiotomy is a controlled “cut” the doctor makes at the time of delivery at the vagina in order to facilitate delivery and/or avoid a large tear. It is not mandatory and is a last minute decision if you need one or not. It is the philosophy of this office to avoid an episiotomy if possible.

No. A circumcision is the removal of the foreskin of penis. It is a cosmetic (or religious) procedure desired by some parents. If the child is taught proper hygiene and how to retract his foreskin he should have no problems in the future.
If you desire a circumcision for your son please inform us after the delivery. We will obtain consent in the hospital prior to discharge home. Generally, the circumcision is done the day of or day before discharge.

If colposcopy shows cervical dysplasia (pre-cancer) on your cervix, then a LEEP procedure may be recommended to remove the abnormal cells and surrounding tissue. We will generally do this procedure in the hospital to control pain of the procedure. You will usually experience some discharge, bleeding, and cramping for 1 -3 days after the procedure. Please avoid sexual intercourse or tampon use for at least 2 weeks after the procedure.

This is a very common procedure done in the office to evaluate abnormal bleeding. During this procedure a very thin plastic straw is used to sample tissue from the inside of the uterus (endometrium). It is very quick but you may feel brief cramping. You may continue to have some mild cramping and spotting for 24 hours after the procedure.

Alternatively we can plan for a hysteroscopy in the hospital to evaluate the uterine lining.

A hysteroscopy is a minor surgical procedure used to evaluate the cause of abnormal bleeding or possible abnormalities in your uterus. After filling the uterus with fluid a very thin camera can be used to examine the endometrial cavity and possibly take biopsies. This procedure can be used to remove fibroids or polyps if seen.

A Saline Sonogram or Sonohysterogram is an office procedure in which fluid is introduced into the uterus using a very thin catheter to better view the uterine cavity and also to confirm if the fallopian tubes are open. This procedure is often done prior to using fertility treatment to stimulate ovulation.

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