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Getting Ready to Get Pregnant The Preconceptional Visit

Sometimes you can schedule this visit during a routine gynecological appointment When you go in for your annual PAP test, mention that you're thinking about having a baby, and your practitioner will take you through the preliminaries. If you aren't due for your annual exam for several more months and you're ready to begin trying to get pregnant now, go ahead and schedule a preconceptional visit with your practitioner, and bring along the father-to-be, if at all possible, so both of you can provide health histories and know what to expect from this adventure.

Considering the physical exam

At your first prenatal visit, your practitioner examines your head, neck, breasts, heart, lungs, abdomen, and extremities. She also performs an internal exam (see Figure 5-3). During this exam, your practitioner evaluates your uterus, cervix, and ovaries, and performs, if due, a PAP test (cervix cancer and pre-cancer screening). If you feel you also should be tested for the possibility of sexually transmitted diseases, inform your physician because the PAP test doesn't screen for all of them.

Checking your progress The first postpartum doctor visit

During a postpartum checkup, your practitioner performs a complete exam (including a breast and vaginal exam) and obtains a PAP smear. In most cases, the six-week checkup suffices for your annual gynecological exam. Your practitioner probably also talks with you about your birth control options. Discuss the spacing of future children (see Chapter 15) and other precautions before conceiving again such as taking folic acid a few months beforehand and, if this pregnancy had complications, getting whatever special blood tests your practitioner may advise.

4127 Vein therapeutics and other local therapeutics

Genital or veneral warts are condylomata acuminata caused by the human papilloma virus (HPV) of several types, especially 6 and 11. Treatment is usually by electrocautery, laser, cryotherapy, or surgical excision. Chemical abalation can be used, and involves the use of topical antimitotics such as podophyllotoxin, podophyllin, or 5-fluorouracil, or caustics such as trichloroacetic acid. Interferon-inducers such as imiquimode are also used, and again require multiple applications. Information about these chemicals while breastfeeding is not available, but both the area treated and the dosage are small. Interferon is known to be a large molecule that does not pass into milk even during systemic treatment. The development of the HPV vaccine has shown a decrease in the incidence of these lesions, and will perhaps decrease the need for these medications.

21713 5Fluorouracil

Dermal treatment with 5-fluorouracil is contraindicated in pregnancy, apart from for the treatment of an individual wart. Treatment of vaginal warts should be postponed until after the birth, or other treatments (such as cryotherapy) used instead. Local use of the cytostatic is, however, not an indication for interruption of pregnancy or for invasive diagnostic procedures.

Chlamydia

Chlamydia is one of the more common sexually transmitted diseases. It often comes with no symptoms. Some practitioners routinely perform a culture from the cervix to check for chlamydia at the same time they do a PAP smear. If you have a positive culture, your doctor will prescribe a medication to treat the infection. Chlamydia can be passed to your newborn during vaginal delivery, increasing the chance of the baby developing conjunctivitis (an eye infection) or, less likely, pneumonia. Most hospitals routinely place an ointment in a newborn's eyes shortly after delivery to prevent conjunctivitis, regardless of whether the mother is infected with chlamydia.