Microsoft word - advice for our obstetrical patients.doc
Taz E. Varkey, M.D.
Obstetrics, Gynecology and Infertility
6310 San Vicente Blvd Suite # 290
Los Angeles, Ca 90048
Phone: (323) 933-2930 Fax: (323) 933-2948
ADVICE FOR OUR OBSTETRICAL PATIENTS
Congratulations on your pregnancy! We are so excited that you have chosen
our practice to share this journey with you. After over ten years of
experience in this field, Dr. Varkey has compiled a list of answers to
commonly asked questions and concerns. We have also included some
medications that we feel are safe in pregnancy based on the current literature
and our many years of experience. Please always feel free to call us if your
questions are not answered in this short guide. It is only meant to be a guide
and not all inclusive. PAIN
You may take Tylenol Extra Strength – one tablet or one capsule as needed,
every three to four hours.
Do not take Aspirin, Ibuprofen, Naprosyn, Alleve or any other pain relievers
without consulting your doctor. Should you need a stronger medication for
pain, please call us. COLDS
Please keep in mind that most upper respiratory infections are caused by
viruses and not bacteria. Therefore, there is not usually a “cure” for your
cold, but only medications that provide symptomatic relief. The best “cure”
for your cold is to get plenty of rest/sleep and remain hydrated. Runny nose/Postnasal Drip:
Benadryl 25 mg: one to two tabs by mouth every six hours as needed. Chlor-Trimeton 4mg : one tablet every four to six hours as needed
Normal Saline nose sprays (ie: Ocean Mist Nasal Spray)
Robitussin D.M. – one teaspoonful every four to six hours.
Any throat lozenges for sore throat are fine: Ricolla, Halls, etc. Fevers:
Tylenol is ok for low grade fevers (under 100 degrees).
Please telephone your primary care doctor if:
1. Your cold lasts more than five days without improvement. 2. Your cough produces yellow or green sputum. 3. You have a temperature or 101 degrees or more. 4. Your upper respiratory symptoms are accompanied by
nausea/vomiting and body aches; this could be the flu and you may benefit from starting antiviral medications such as Tamiflu.
1. First make some dietary changes. For example, avoid spicy or
acidy foods. Very bland foods are better tolerated.
2. Eat something as soon as you BEGIN to feel hungry – the acid
build up associated with hunger can often trigger vomiting.
3. Small frequent meals are more tolerable than three bigger meals. 4. In the event of a gastroenteritis (stomach bug), soup for day or
two are particularly beneficial in quieting your stomach.
5. Seabands: acupuncture wrist bands. 6. Ginger 250mg capsules by mouth four times a day (or any other
ginger products: ginger ale, ginger popsicles, etc).
7. When dietary changes no longer produce desired effects, the
following medications may be safely taken:
-‐ Benadryl 25 mg. One tablet every six hours as needed. -‐ Vitamin B6 10-‐25mg. Orally every 8hrs as needed. -‐ Vitamin B6/Unisom. Vitamin B6 orally with Unisom
12.5mg every six hours as needed.
There are stronger prescription medications that are available so please telephone our office if you are unable to eat or drink for more than 24 hours.
First, it is important to understand that the hormone changes of pregnancy
alone are enough to cause constipation. In addition, too many supplements
(vitamins, calcium, etc) can cause constipation, so please discuss your
supplement intake with your doctor if you are constipated.
1. Avoid the “BRAT” diet (bananas, rice, applesauce and toast) 2. Increase your intake of water and foods high in fiber: prunes,
prune juice (easier to take if you dilute with water), pears, complex vegetables such as broccoli, green beans, asparagus.
If dietary changes do not help, the following over the counter
medications may help:
Milk of Magnesia: 30-‐60ml by mouth once a day.
Metamucil: one tablespoon in eight ounces of water/juice
Citrucel: one teaspoonful, one to three times a day
Colace: 100mg one capsule twice a day.
Please do not use any enemas unless approved by your doctor.
Hemorrrhoids can be caused by hormones changes to pregnancy and also by
constipation. If you are constipated, it is important to follow the guidelines
above to relieve your constipation and in this way, ease the hemorrhoids. It
is also important to remember that unless your hemorrhoids are causing you
any pain, itching, or bleeding they do not have to be treated.
Preparation H Ointment or suppositories: apply four times a day
Tucks Pads: apply as needed.
Sitz Baths: Take half a carton of sitz baths and add to a standard size bathtub
that is one third full. Dissolve the salts with hot water but make it a
lukewarm bath in the end. Then soak your bottom in the bath for
approximately 30 minutes a day. (You may repeat twice a day if you find
Turn off electronics – television, laptop, IPads. The light produced by these
devices is stimulatory and can contribute to insomnia. Do not consume any
caffeine containing products such as chocolate in the evenings. Try a
nighttime bath with lavender salts, which is believed to have sedative
properties. Lastly, try not to go to bed too early. If you go to bed at 9pm and
wake to use the restroom at 2 or 3 am, this may leave you wide awake for
the rest of the night.
An occasional Benadryl 25mg – 50mg at night is acceptable but if you take
it on a regular basis, it will no longer be as effective. HEARTBURN
Heartburn is common in pregnancy. It is usually limited to pregnancy but
will usually not resolve until after delivery.
It is important to first try lifestyle changes such as elevating the head of the
bead 45 degrees; eating small frequent meals; avoiding spicy or caffeinated
foods or beverages; and to avoid eating 3hours prior to bedtime.
If the above mentioned lifestyle changes do not help, the following
medications are safe. We prefer you try the Antacids prior to trying the H-2
Blockers (block acid production). Antacids
Carafate: 1g tablet dissolved in water, 4 times per day (the solution is safe too). TUMS: 200-500mg tablets, chewable, 4 times per day
Zantac: 75mg -150mg one tablet twice a day
Please notify us if these treatments do not work.
FOODS TO AVOID WHILE PREGNANT
Seafood: Certain types of seafood are high in mercury. Mercury can be
harmful to the developing fetus. Pregnant and breast feeding women should
avoid eating shark, swordfish, king mackerel or tilefish. Common types of
fish that are low in mercury are shrimp, catfish, salmon, canned light tuna
(not albacore), and pollock . You can safely eat up to 12 ounces (about two
to three meals) of these fish per week. Albacore (white tuna) and tuna steaks
have higher mercury levels than most fish, so you should eat only up to 6
ounces of these fish per week.
Unpasteurized Dairy Products: Milk or soft cheeses that are unpasteurized
can be contaminated by a bacteria called Listeria.
Listeria can infect the placenta and cause miscarriage or stillbirth. Most
dairy products in the United States are made with pasteurized dairy product
so check the labels. If it states that the product is made with pasteurized
dairy products then it is safe to eat.
Deli Meats, Hot Dogs: These prepared meats can also be contaminated with
Listeria, so do not eat unless cooked until steaming hot.
Raw or Undercooked Meat, Poultry, or Shellfish: These food items can be
contaminated with both Listeria (as mentioned above) and/or
Toxoplasmosis. The latter is a parasite that is found in certain types of
meat/fish but can be killed if the fish or meat is cooked properly.
Toxoplasmosis can cause birth defects in the developing fetus.
• Toxoplasmosis and Listeria can also be transmitted via fruits and
vegetables that are improperly washed.
Caffeine: Consuming less than 200mg of caffeine a day (two eight ounce cups of brewed coffee) has not been shown to increase the risk of miscarriage. It is advisable to keep your caffeine intake to less than one cup of coffee or other caffeinated beverage per day. Alcohol: Pregnant women should avoid consuming alcohol while pregnant. Alcohol has been proven to cause birth defects in the developing fetus.
The ideal time to travel during pregnancy is between 14-28 weeks because
that is when the risk of pregnancy related complications is lowest. After 28
weeks, it is best to stay within the continental United States. After 35 weeks,
we recommend that you stay in town to avoid the possibility of going in to
labor in another city.
When on long airplane flights (greater than 2 hours), we recommend that
you get an aisle seat so that you can get up and walk around once an hour if
possible. If on a long car ride, then please stop the car once an hour to get
out and walk around. This will reduce the risk of blood clots - a condition
for which pregnant women are at increased risk. HAIR TREATMENTS
Coal and tar products must be avoided during the first trimester of
pregnancy (that is, during the first twelve weeks). So, postpone any hair
coloring until after this time. Permanents, hair lightening or weaving are
permissible at any time during your pregnancy.
You may also use vegetable dyes or hennas.
Local anesthetics are acceptable but ask your dentist to avoid using
“epinephrine” if at all possible.
Antibiotics such as penicillins, ampicillins, or cephalosporins (eg: Keflex)
are all safe in pregnancy. Please ask your dentist to feel free to call us if
he/she is uncertain as to the safety of a medication he/she needs to prescribe.
Dental X-Rays are discouraged during pregnancy. If your dentist feels that
an X-Ray is absolutely necessary, please ask their office to contact us first.
It is strongly recommended that you try to exercise for 30minutes a day, 5
days a week. Regular exercise in pregnancy has many benefits including
increased endurance to help cope with labor; improved mood; decreased
back and joint pains; and improved energy. It can also decrease your risk of
gestational diabetes, constipation, bloating or swelling.
In general, we advise that you avoid any high impact exercises that jar the
body – such as brisk running. We also recommend that you avoid any
exercises that require a strong center of balance such as outdoor bicycling.
Please also avoid scuba diving or contact sports.
Examples of safe exercises would be swimming, brisk walking, prenatal
yoga or prenatal pilates. It is important to make sure that you are not laying
flat on your back for more than 5minutes. Low impact aerobic exercise of
any kind is encouraged but if you are new to excercising, it is important to
build up you stamina by starting 5-10 minutes a day, and adding 5 minutes
each week until you are comfortable.
If at anytime you experience dizziness, chest pain, uterine tightening,
vaginal bleeding or vaginal leaking of fluid, please stop and call our office
or go to the nearest emergency room.
Here are a few pregnancy guides that may be helpful to answer any further
questions that you may have:
Your Pregnancy and Childbirth: Month to Month. By the American College
of Ob/Gyn, May 2010
Expecting 411 by Michelle Hakakha and Ari Brown
What to Expect When You are Expecting by Heidi Murkoff and Sharon
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