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
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.
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.

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.     NAUSEA/VOMITTING:

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.   3. 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
this helpful.)

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 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).
Carafate: 1g tablet dissolved in water, 4 times per day (the solution is safe too). TUMS: 200-500mg tablets, chewable, 4 times per day H-2 Blockers

Zantac: 75mg -150mg one tablet twice a day Please notify us if these treatments do not work.

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. TRAVEL
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.
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.

Additional Resources
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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