Advanced women's healthcare
Prenatal Guide for a Healthy Pregnancy
Congratulations on your pregnancy! We are honored you have chosen us to
provide your prenatal care. We are dedicated to making your pregnancy a
positive and enjoyable experience. Although pregnancy is a very natural process
in life, it can sometimes be difficult and complications can occur. This guide is
provided as a resource to help you during those difficult times and an attempt to
avoid any complications.
The clinical staff and team are available during normal business hours. We are
available for emergencies only after normal business hours. You may reach us at
760-327-7900 for after hour emergencies. Business hours are Monday through
Thursday from 8:30 AM to 5:00 PM, and Friday from 8:30 AM to 1:30 PM. Our
office telephone numbers are:
Palm Springs: 760-327-7900
La Quinta: 760-564-7900
Our goal is healthy moms and healthy babies. We are dedicated to providing the
best prenatal care and delivery experience possible. This is one of the most
exciting and important times in your life and we want it to be special. Pregnancy
can be a time filled with many questions and concerns. We hope this guide will
help alleviate some of the more common ones. We will do our best to
accommodate your wishes, keeping in mind that the safety of you and your baby
is our utmost goal. Again, congratulations.
Dedicated to your care:
Dr. Lilia M. Pacini
Dr. Jolyn Fergon, DNP, CNM
Dr. Sunaina Sehwani
Barbara Welty, NP
Advanced Women's Healthcare Providers……………………………………3-4
Medications That Are Safe To Take During Pregnancy…….………….13
Precautions in Pregnancy…………………………………………………….14
Fetal Kick Counts……………………….…………………………………….16
Advanced Women's Healthcare Providers
Lilia Margarita Pacini, M.D. OB/Gyn is board certified in Obstetrics and
Gynecology, and co-owner of the practice. She is a compassionate physician
with a desire to provide the latest technology in medical care. She performs full
prenatal care and gynecology services, including laparoscopic surgery which is
performed through a small scope therefore leaving a minimal scar. Dr. Pacini is
also bilingual in English and Spanish. She finished her residency in Houston,
Texas in 2004 and is married and has three children. She is a fellow of the
American Board of Obstetrics and Gynecology. She loves the outdoors, hiking and
rock climbing, and spending time with family and friends.
Sunaina Sehwani, M.D. OB/Gyn is a board certified physician joining us in 2009
from Bethlehem, Pennsylvania where she completed her residency at St. Luke's
Hospital. Dr. Sehwani is originally from the Philippines where she completed her
medical studies and internship program. She provides full scope obstetric and
gynecologic care and has a lot of experience in minimally invasive gynecologic
surgery. She loves both obstetrics and gynecology. In her spare time you can find
her out shopping for the latest fashions, enjoying a book by the pool in the
beautiful sunshine we have or voting for the next American Idol. Dr Sehwani is
very compassionate, and this is apparent in her various interactions with friends,
family and patients.
Dr. Jolyn Fergon, NP, CNM is a Certified Women's Healthcare Nurse Practitioner
and Certified Nurse Midwife, and is also one of the practice owners. She
completed her doctorate of Nursing Practice at Duke University. She has been
providing healthcare to women in valley for 19 years. She grew up in the state of
Washington and moved to the desert during high school. After working as a
labor and delivery nurse for six years, she decided to become a Women's Health
Nurse Practitioner; inspired by the positive, close relationships that are built
between patients and providers. Her professional interests include all aspects of
women's healthcare with an emphasis and passion on infertility treatments. She is
able to provide infertility treatments including but not limited to Intrauterine
Insemination. She provides routine obstetrics and gynecology, and currently has
privileges to perform low risk deliveries at Desert Regional Medical Center. In
her free time, she is actively involved in volunteering in children's services at
Southwest Community Church. She enjoys reading, scrap-booking, and spending
time with her husband and two children. You might run into her hiking the local
bump & grind trail in Palm Desert.
Sandra Moran, NP, was born and raised in the Pacific Northwest. She completed
her undergraduate studies in nursing at Andrews University in Berrien Springs,
Michigan. After 10 years working as a registered nurse in women's health, she
went on to complete her Master of Science degree in Nursing from Gonzaga
University in Spokane, Washington. During her graduate studies, Sandy
completed clinical training under the expertise of Stanford University based
physicians and practitioners in Obstetrics and Gynecology, enhancing the varied
clinical experience she has in prenatal care, labor and delivery, and preventive
women's health care. Sandy is a member of the American Academy of Nurse
Practitioners and the National Association of Nurse Practitioners in Women's
Health. She has 4 sons and loves the rich life experiences that only they can
Barbara Welty, NP, has been a resident of the Coachella Valley for more than 30
years. She and her husband of 32 years raised their 2 children here. She
practiced as a RN for more than 18 years at JFK Hospital as a Labor and Delivery
Nurse, and was also the Perinatal Educator for the last 5 years. Barbara received
her BSN from the University of Phoenix, and then continued her education to
earn her MSN with a Family Nurse Practitioner degree from the University of
Phoenix in February 2010. After her graduation, she worked locally as a
Women's Nurse Practitioner. You can spot Barbara and her husband walking her
2 Great Danes and her Lhasa Apso in the desert.
Lower backache is the most frequent muscular-skeletal problem reported in
pregnancy. The progesterone-and relaxin-induced softening of joints,
particularly along the spinal column, as well as the changing center of gravity as
pregnancy progresses, contributes to the common complaint of backache. Upper
backache is associated with the increased weight of the breasts and postural
factors often associated with employment conditions. Lower backache is
associated with the lordosis created when the increasing weight of the uterus
pulls the spine out of alignment. Another type of pain, described by women as
occurring in the posterior part of the pelvis distal and lateral to the lumbosacral
junction, radiates to the posterior part of the thigh. This condition differs from
sciatica in that it is not specific to the nerve root distribution and does not extend
to the ankle or foot. Relaxation of the sacroiliac joints may contribute to this type
of pain. The prevalence of the low backache increases with parity and age. There
is no association between maternal, height, weight, pregnancy-induced weight
gain, or fetal weight and backache.
During the first trimester, the breasts undergo dramatic changes. Estrogen
stimulates the proliferation of the ductile system of the breasts. The glandular
system is stimulated by human placental lactogen, human chorionic
gonadotropin, and prolactin; progesterone stimulates growth of the lobules. The
hormones further stimulate the alveoli to increase in size and deepen in color.
The tenderness almost always diminishes at the end of the first trimester,
although some women may continue to experience tenderness throughout the
Progesterone-induced smooth muscle relaxation leading to decreased motility in
the bowel predisposes women to constipation in pregnancy. Delayed motility,
along with increased levels of aldosterone and angiotensin leads to increased
water absorption with resulting hard stools. Straining often becomes necessary
for evacuation. Changes in diet and activity, lack of adequate fluids, and use of
iron supplements also contribute to the development of this problem. In
addition, the increasing size of the gravid uterus may prevent the natural leaning
forward during evacuation, thereby decreasing the urge to evacuate.
Lightheadedness or actual fainting is most commonly caused by postural
hypotension in the latter half of pregnancy. Rapid changes in position, such as
standing quickly or bending over and then straightening up, as well as standing
in one position for prolonged periods of time, interfere with cerebral circulation.
Lightheadedness can also be caused by hypoglycemia throughout pregnancy.
Late in pregnancy women may experience faintness when lying in the supine
position (supine hypotensive syndrome). The weight of the gravid uterus
compresses the inferior vena cava and the aorta, resulting in decreased cardiac
output and decreased uteroplacental perfusion. In early pregnancy, nausea and
vomiting may contribute to lower blood glucose; later, fetal demand may affect
maternal glucose levels.
Fatigue during the first trimester is thought to be caused by increased basal
metabolism rate, increased demands on the cardiovascular and renal systems,
and loss of sleep caused by urinary frequency and emotional factors. Fatigue
lessens in the second trimester and increases late in pregnancy as a result of
increased maternal weight, difficulty finding a comfortable position, fetal factors,
and urinary frequency. Psychological factors that are associated with fatigue are
stress, anxiety, and depression.
FINGERS, NUMBNESS, OR TINGLING (CARPAL TUNNEL SYNDROME)
Carpal tunnel syndrome is the second most common muscular-skeletal discomfort
reported in pregnancy. During the second and third trimesters, fluid retention in
the wrists and hands may lead to compression of the median nerve. There can also
be swelling of the carpal tunnel. This pressure results in numbness, tingling, and
pain in the fingers and is usually bilateral. Signs and symptoms of carpal tunnel
syndrome may be unilateral for women with previous symptoms, usually as a result
of repetitive motion injury. In these cases the symptoms are exacerbated by the
usual changes in pregnancy. The symptoms are most common in older
primigravida who also are experiencing generalized edema. The symptoms are
usually more pronounced at night. When there has not been repetitive motion
injury before the pregnancy, the syndrome usually resolves spontaneously within
days of deliver, although there are reports of onset or continuation during lactation.
Another reason for pain in the hands is de Quervain tenosynovitis which results
from compression and inflammation of the tendons in the wrist. Fluid retention
puts pressure on the tendons, and women will describe pain in the wrist and radial
side of the hand. This type of tenosynovitis usually resolves after delivery but may
continue with lactation. Tingling of the fingers or numbness can also occur when
the woman does not have good posture and the exaggerated lordosis of the upper
back causes anterior flexion of the head. This position may compress the median
and ulnar nerves of the arms.
GAS, EXCESS (FLATULENCE)
Progesterone-induced relaxation of smooth muscles leads to decreased motility of
intestines, resulting in increased occurrence of pockets of gas. This can cause
bloating, gas pain, and flatulence.
GROIN PAIN/LOWER ABDOMINAL PAIN (ROUND LIGAMENT PAIN)
Rapid enlargement of the uterus in the early second trimester as the organ
changes from being a pelvic organ to an abdominal organ leads to tension or
stretching of the round ligaments. Women tend to notice the pain between 14 to
20 weeks' gestation, particularly with quick change of position. The round
ligaments can be affected unilaterally or bilaterally. The pain is usually noted
immediately above the level of the symphysis pubis in the right or left lower
quadrants. Some women experience a return of the ligament discomfort in the
third trimester secondary to the increasing weight of the uterus and its contents.
The diagnosis is one of exclusion after all other reasons for lower abdominal pain
have been ruled out.
Increased estrogen levels stimulate blood flow to the mouth and accelerate
turnover of gum epithelial cells. The gums become more vascular than in the
non-pregnant state. Increased numbers of small vessels, hyperplasia, edema, and
decreased thickness of the gingival epithelial surface result in bleeding that can
occur with chewing or brushing.
If you get a headache in the second or third trimester that is unrelieved with
Tylenol and rest, you MUST call our office and speak with a provider as it can be
a symptom of preeclampsia. The most common cause of common headaches in
pregnancy is muscle tension. The woman may describe the pain as persistent
and viselike, extending from the base of the head to the forehead. Headaches can
also be precipitated by stress, postural changes, eye strain, nasal or sinus
congestion, and fatigue. Migraine headaches typically are described as throbbing
and moderate to severe in intensity. They may be accompanied by nausea and
vomiting. Women with a history of migraine headaches tend to experience
remission or decreased frequency and severity during pregnancy, although some
studies have also found an increase in headaches in the third trimester.
HEARTBURN (GASTROESOPHAGEAL REFLUX)
Hormonal effects of estrogen and progesterone lead to relaxation of the cardiac
sphincter, delayed emptying of the stomach, and pressure from the enlarging
uterus that forces the acidic stomach contents into the lower esophagus late in
pregnancy. It is estimated that as many as 85% of women experience heartburn
Progesterone-induced relaxation of smooth muscle contributes to the weakening
of vessel walls. Pressure form the growing uterus on the veins around the rectum
and anus further contributes to dilation of the vessels. Constipation with
resultant straining with stools is also a factor in development of hemorrhoids.
Up to 50% of pregnant women experience leg cramps, usually in the latter half of
pregnancy. The cramps are usually defined as "sudden tonic or clonic
contractions of the gastrocnemius muscle, usually at night". The cause is
unknown, but they may be due to altered calcium/phosphorus ratio, magnesium
deficiency, or buildup of lactic acid in the muscles. What little research has been
done to explore this phenomenon has suggested that changes in calcium and
magnesium levels in pregnancy may be contributing factors, but results of
clinical trials are conflicting.
Estrogen-induced nasal mucosal edema may lead the woman to think that she
has a cold or allergies. Other factors, including allergy, infection, stress, and
rebound rhinitis, may also influence the sensation of "stuffiness". Nasal
congestion can lead to increase in frequency and severity of snoring and may
lead to sleep deprivation.
NAUSEA AND VOMITING
It is estimated that 50% to 80% of pregnant women experience nausea and
vomiting and approximately 5% of pregnant women require treatment for fluid
replacement and correction of electrolyte imbalance. Nausea and vomiting of
pregnancy typically occur during the first trimester and are most likely caused by
the elevated levels of human chorionic gonadotropin (hCG). Once the hCG levels
begin to fall, nausea is relieved. This hormonal association is further supported
by the fact that, in situations with higher than usual hCG levels (multiple
gestation, trophoblastic disease), nausea and vomiting are increased. Nausea is
also associated with the changes in smell and taste common in early pregnancy.
There is some evidence that nausea may be associated with B-vitamin
deficiencies, particularly B6. Although there is no relationship between the levels
of pyridoxine and degree of morning sickness, evidence suggests that vitamin B6
supplementation may relieve nausea and vomiting of pregnancy, particularly in
cases of sever vomiting.
Increased vascularity of the nasal mucosa occurs under the influence of
increased estrogen levels. Dry environment, such as that experienced in a
centrally heated home with poor humidification or in a home heated by a wood
stove, increases the friability of the vessels and the occurrence of bleeding.
Factors associated with nosebleeds include upper respiratory infections, sinusitis,
hypertension, vascular disease, ulcerative disease, trauma, and cocaine use.
Secretion from the apocrine glands, particularly in the axilla, decreases in
pregnancy, but the physiologic cause is unclear. Conversely, secretion from the
eccrine glands, located all over the skin surface, increases. This is possible
because of the increased thyroid activity during pregnancy. Increased dilation of
the blood vessels in the skin enhances the body's ability to eliminate waste
through this increase in perspiration and dissipate excess heat.
Picas has been described as "the ingestion of nonfood substances and/or food
staples in response to a craving" and as "an eating disorder that is manifested by
a craving for oral ingestion of a given substance that is unusual in kind or
quantity". It has been estimated that as many as 68% of pregnant women in
certain subgroups of the population of the United Sates experience pica. Some
women are at higher risk of unusual ingestion of substances; those who are
black, who live in rural or inner-city areas, and who have a family or childhood
history of pica are more likely to demonstrate this behavior. Pica has been
associated with anemia, bowel obstruction, toxicity from certain heavy metals,
poor nutrition, and parasites.
Whether ptyalism, or hypersalivation, actually occurs in pregnancy is
controversial. It is unclear whether there actually is increased production of
saliva or whether women do not swallow saliva because of nausea or changes in
taste. Regardless, the need to spit out excess saliva can be an inconvenient
problem. In addition, it can further contribute to nausea of pregnancy. In rare
cases the condition can lead to electrolyte loss and dehydration. There appears to
be a cultural component of this complaint, with some communities experiencing
RASH OF PREGNANCY
Women commonly present with the complaint of rash or itching in pregnancy.
Common rashes, including vermicelli and other childhood disease, insect bites,
eczema, and contact dermatitis should be readily identified by the clinician. Four
specific types of rashes are pregnancy related:
1. Papular dermatitis is characterized by discrete erythematous papules
approximately 3 to 5 mm in diameter that do not occur in groups. The
lesions may occur anywhere on the body and usually heal within 10 days.
Hyper pigmentation at the site of the lesion may occur. The condition may
recur in future pregnancies.
2. Prurigo gestationis is characterized by small excoriated pruritic papules on
the abdomen, trunk, or extensor surface of the extremities. The lesions
usually appear in the late second trimester and may persist for several
months following delivery.
3. Pruritic urticarial papules and plaques of pregnancy syndrome PUPPPS) is
characterized by discrete erythematous papules and urticarial plaques over
the abdomen, thighs, buttocks, legs, and arms. Excoriation is usually not
present. PUPPPS usually develops in the third trimester and may persist for
several weeks following delivery.
SHORTNESS OF BREATH (DYSPNEA)
Progesterone-induced respiratory changes and increased maternal metabolic rate
and fetal oxygen consumption contribute to women feeling like they can't "catch
their breath." This phenomenon often leads to the "sigh of pregnancy" a
purposeful deep breath to try to increase respiratory reserve. The pressure of the
enlarging uterus on the diaphragm further contributes to this problem.
Pigmentation changes can occur because increased estrogen levels stimulate
melanin. Stretch marks can occur anywhere on the body but most commonly are
found on the abdomen, breasts, and thighs. They may become deep pink in color
but usually fade to pale pink or silver following delivery.
SLEEP, DIFFICULTY WITH
Early in pregnancy sleep disturbances may be provoked by psychological
stressors, frequency of urination, and other first-trimester discomforts. Later in
pregnancy physical discomforts, difficulty finding a position of comfort, fetal
movements, and feelings of shortness of breath may also inhibit sleep.
Edema in the lower extremities is common in the latter half of pregnancy because
of increased venous pressure caused by pressure of the enlarging. Edema of the
hands is common in late pregnancy, particularly in the morning, and is most
likely postural. Generalized edema may be a sign of preeclampsia.
Increased vaginal discharge as the pregnancy progresses is caused by increased
cervical mucus and transudate and increased vascularity of the cervix and
vagina. Normal pregnancy-related discharge is clear to whitish clear, with no
associated symptoms of foul odor, itching, or burning. Microscopic examination
demonstrates epithelial cells and gram-positive bacilli.
The relaxation of smooth muscle of vessel walls caused by progesterone and the
anatomic pressure of the enlarging uterus leads to development or worsening of
existing varicose veins. Heredity, obesity, constrictive clothing, and standing for
long periods of time are all associated with varicosities. Pregnancy-related
varicose veins are most pronounced in the legs and vulva.
WARMTH/FEELING UNCOMFORTABLY HOT
Progesterone can cause a thermogenic effect that includes vasodilation that
increases skin temperature. In addition, maternal fatty stores may contribute to
the sensation of warmth. During the latter part of pregnancy the placenta may
contribute to the increased body temperature.
Oral health care is especially important for women during their childbearing
years. Ovarian hormones that are found in oral contraceptives and are present
during pregnancy increase a woman's chance of gingivitis, which includes gum
disease, redness, bleeding and enlargement of gum tissue. Pregnancy is a special
time to care for the teeth and gums. During pregnancy, women face special risks
and need to visit the dental office and have thorough dental care.
Gingivitis is an infection that causes swelling and redness in the gum tissue and is
quite common. When bacterial plaque remains in between the teeth or close to
the gum tissues, the bacteria infects the gum tissue and causes gingivitis. An
increase in estrogen and progesterone hormones in pregnant women, often
exaggerate the reaction of the gum tissue to bacterial plaque on the teeth.
Women who take oral contraceptives often have the same type of gingivitis. If
left untreated, this gingivitis can remain even after oral contraceptives have been
discontinued; therefore, these women may be more susceptible to severe
gingivitis when pregnant.
Periodontitis is a more severe form of gum infection that also involves the
destruction of the underlying bone and fibers that support the tooth. Untreated
periodontitis may be a risk factor in pre-term low birth weight as a consequence
of premature labor or premature rupture of membranes. Often associated with
gingivitis, periodontitis is an infection caused by certain specific, bacterial plaque
and involves loss of bone, fiber, and gum tissue attachment for the tooth.
Medications That Are Safe To Take During Pregnancy
Cold & Congestion
• Tylenol (aches, pains, headache – extra strength o.k. every 6 hours)
• Pseudoephedrine for sinus congestion (you must request this from the pharmacy
counter; it is no longer sold on the shelves, and not the same medication as "Sudafed"
brand). Do not take any products containing "phenylephrine" in pregnancy
• Mucinex for phlegm (generic name: guaifenesin)
• Benadryl • Cough drops/lozenges
• Chloraseptic spray • Claritin or Zyrtec( for seasonal allergies)
• Tylenol (acetaminophen) – extra strength o.k. every 6 hours
• *** Caution*** Motrin, Aspirin and Advil are not safe in pregnancy
• Tums (no Rolaids)
• Mylanta • Pepcid AC • Simethicone (for gas pain) • Zantac • Prilosec
• Metamucil • Senokot
• Colace • Citrucel
• Anusol (cream or suppository)
• Tucks pads • Do not use preparation H in pregnancy because it contains phenylephrine
Diarrhea lasting longer than 24 hours
• Imodium • Kaopectate • Clear liquids for 24 hours, no dairy, fruit or vegetables • Bland diet (bread, rice, noodles)
Nausea and Vomiting
• Lemon • Authentic Ginger Ale (must contain real ginger) such as Trader Joe's Ginger Ale • Vitamin B-6 take 25mg every 6 hours (must take for more than1 week to see results,
and continue using until approx. 15 weeks or nausea resolves whichever comes first).
• If no relief from B6 alone, add ½ Unisom tablet every 6 hours (with the B6)
Precautions in Pregnancy
If you experience any of the following symptoms, contact us immediately:
• Severe and/or lasting pain in any body part and no relief with bed rest
• Sudden onset of blurred vision with or without headache.
• Severe headache, unrelieved with Tylenol or rest in second or third
• Any large gush of fluid or continual vaginal leaking of fluid.
• Any bleeding from the vagina, spotting is not uncommon, only call for
vaginal bleeding similar to a period with or without pain or cramping.
• If the baby stops moving or has a significant decrease in movement of less
than 6-10 times in one hour after performing fetal kick counts.
(Refer to fetal kick counts sheet on the last page of this packet)
• A hot, reddened, painful area on your calf or behind your knee.
• Fever of 100.4° F or higher.
• Sudden swelling or puffiness in your face, or sudden swelling all over.
• Pain or burning with urination.
• More than 6 painful contractions in one hour before 35 weeks of
• Sudden weight gain (more than 5 pounds in one week).
• Any forceful injury to the abdomen, or if you trip or fall and hit your
• Persistent vomiting and unable to keep food or fluids down for greater
than 24 hours or persistent diarrhea for greater than 24 hours that are
unrelieved with the over the counter medications listed on medication list
1. If this is your first delivery and you have regular, painful contractions 3-4
minutes apart for one to two hours, please go to the hospital. Contractions are
timed from the beginning of one pain to the beginning of the next pain.
Occasionally, a woman may have contractions every 3-4 minutes but very
mild pain, and she does not need to go to the hospital yet.
2. If you have already had children, we recommend coming to the hospital based
on the level of pain (more than the frequency of contractions) although they
should be every 5 minutes or under.
3. If your water breaks, even if you are not contracting, you need to go to the
hospital. If you are unsure whether or not your water has broken, please call
our office and speak with someone. It is possible for the baby to move on your
bladder and expel urine without you knowing. Amniotic fluid typically has
no smell and is clear. Sometimes it can have an odor not like urine, or have a
green tinge to it, and it is very important to go to the hospital if it does.
4. During labor, it is normal to see blood tinged mucous that can be red, pink, or
brown in color, and is a good sign that your cervix may be opening with your
contractions. If you have heavy, red, vaginal bleeding that saturates a pad, or
flows like a period and is not mixed with mucous; you must go to the hospital.
It would be helpful to put your saturated pad or clothing into a Ziploc bag to
show the nurses how much bleeding you had. You may notice spotting after
intercourse and this is normal. If you pass your mucous plug, (a thick, large
"glob" of mucous" you do NOT need to go to the hospital).
5. Up until delivery, your baby should still be moving quite a bit in between
contractions. If you notice a decrease in fetal movement, please drink a large
glass of cold water and/or juice and lie down and count your baby's
movements. It is important that you are not watching TV or visiting as you
may not notice each movement. Once a day, your baby should move10 times
in one hour (not every hour, just once in a 24 hour period). Count each time
your baby moves: if the baby rolls around and then kicks twice that would
count as three movements. If you do not feel 10 movements in one hour, after
trying to wake the baby, please contact our office, even if it is after hours, or
go to the hospital.
6. If you experience fever greater than 100.4° F, uncontrolled vomiting, severe
abdominal pain with or without bleeding that is constant or any other
problem that does not seem normal to you, please contact us or go to the
hospital. If you are unsure of what to do, please contact our office first, even
if it is after hours, but please, only for emergencies.
Fetal Kick Counts
Knowing how often your baby moves or "kicks" is a good way to check on your
baby's health. Beginning at 28 weeks (your last trimester), you should pay
attention to your baby's movement's once a day. Prior to 28 weeks, we just
expect random movements.
• Count according to your baby's schedule – whenever he/she wakes up and
is moving, we want the baby to move 10 times in 2 hours. For many
women, this will take less than 15 minutes, but towards the end of the
pregnancy, it is normal to wait longer since the baby is larger and
crowded. You do not need to count every hour, only one time in a 24 hour
period. If you do not feel your baby move 10 times in two hours, try to
wake your baby by following the below suggestions, and count again for
another two hours.
• Any kick, wiggle, twist, turn, roll or stretch counts. Do not count the
baby's hiccups. If the baby rolls around and then kicks twice, that would
count as three movements. You can stop counting as soon as you feel the
• If you notice the baby hasn't been moving very much, and you are having
trouble getting your kick count, make sure you have eaten, drink 2 large
glasses of ice water or cold juice, and lay down on your side to count the
movements. You can try to wake the baby by talking to it, and gently
pressing or moving the baby with your hands. It is important that you are
not watching TV or visiting as you may not notice each movement.
• If you cannot count the 10 movements in two hours after trying to wake
the baby, please contact our office (even if after hours), or go to the
Irish Heart Foundation: Council for Stroke National Clinical Guidelines and Recommendations for the Care of People with Stroke and Transient Ischaemic Attack Revised Version March 2010 Foreword 18 months ago the Irish Heart Foundation published an audit of stroke services in the Republic of Ireland. The audit revealed what many had suspected. Adequate services and facilities to prevent, asses and treat the yearly toll of10,000 victims of stroke are not available to most of our population. Even when supposedly available they are often seriously deficient. Only one hospital had a stroke unit. The Rehabilitation services were often poorly organised and uncoordinated. The end result was that most patients with acute stroke received care which was less than optimal and were not accorded the timely rehabilitation which plays a major part in preventing long-term disability. The Stroke Council of the Irish Heart Foundation addressed the issues raised by the audit. It set up a working party to produce a comprehensive strategy for the development of a service in line with best international practice adapted to Irish conditions. The result, prepared over the last 18 months is this document. It sets out a strategy for the prevention, treatment and management of stroke. It shows that strokes may be prevented, that warning signs are often ignored and that simple population educational measures can be very effective in reducing numbers of victims. The establishment of proper assessment units for the prompt management of patients suffering transient ischaemic attacks is one of the key points of this preventive strategy. Prompt treatment reduces mortality from acute stroke and t disability levels amongst survivors. The key to this is rapid assessment of the stroke victim, the provision of thrombolytic therapy where appropriate and the organisation of Accident and Emergency departments to deal effectively with the victims and to direct them to designated stroke units. Such units provide immediate care, close monitoring of and appropriate intervention in the evolving stroke. The physical grouping of patients in such units ensures that rehabilitation can be provided in a timely fashion and the many disciplines involved can be organised in such a way as to ensure that this is done to provide optimal benefit. The patient can progress seamlessly from the acute event through early rehabilitation into properly organised appropriate rehabilitation programs and back to the community. Stroke at this stage has elements of a chronic illness, and ongoing nursing, medical and therapist support is required, both at home, and for an important minority of those affected, in nursing homes. The report deals with the role of allied and health professionals, nurses, doctors and primary care centres in this process. Central to this concept is the creation of stroke networks. Networks embrace all the hospitals, services and individuals providing care at every stage of the process. Care of the acute stroke victim begins in the ambulance, continues through thrombolysis, early recognition and assessment in the accident and emergency departments, stroke unit and the provision of internationally acceptable levels of ongoing care. Such a service could save up to 350 lives a year and substantially reduce the number of those suffering from major disability. As medical director of the Irish heart foundation I have watched with admiration the way in which so many people, far too numerous from me to acknowledge individually, have worked together to produce this report. They are drawn from all the disciplines associated with the care of the stroke patient and were joined by others
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