Common OB-GYN Questions & Answers

When you schedule an appointment, you should be clear about why you are coming in to see your doctor. Do you need an annual examination? Do you have a problem you would like to discuss with your doctor? Is this follow up for an established problem?

What should I bring with me to my appointment?
Please bring along a list of your current medications. Make sure you write down the dose, when you take it and for what reason you take it. Also bring along your current insurance card.

How should I prepare for my appointment?
To maximize your visit, make a list of questions you have for your doctor so that you don’t forget anything. If you are coming to discuss a new problem, write down what you can about it – when did it start, what it feels like, what makes it better or worse.

Your doctor will likely review your history, so be prepared to discuss:

• Past medical history including any major illnesses or
  hospitalizations
• Surgeries you have had and when they were performed
•  Medications and allergies
•  Family history including your parents, grandparents,
  siblings and children
•  Social history including smoking, alcohol or drug use

If possible to obtain records from previous doctors, this can also be helpful. We can help you request this information as well so have your previous doctor’s information available.

What will happen at my visit?
The nurse will take your vital signs and put you in a patient room. At this time, the nurse may review your medications, allergies and history. Depending on why you are coming in, you may need a physical examination. Please let your provider know about any cultural or religious concerns so that we may be respectful of these concerns. You will be provided a gown to change into if an examination is needed.

After your visit, you will be given instructions on any new medications or treatments planned. If you have questions after your visit, feel free to contact our office by phone or through MyChart.

A hysterectomy is the surgical removal of the uterus. There are several types of hysterectomy:

• Total hysterectomy: The entire uterus, including the cervix, is removed.
• Supracervical (also called subtotal or partial) hysterectomy: The upper part of the uterus is removed but the cervix is left in place.
• Hysterectomy with removal of the fallopian tubes and ovaries

Source: The American College of Obstetricians and Gynecologists

A hysterectomy may be done to treat conditions that affect the uterus:

• Uterine fibroids
• Endometriosis
• Pelvic support problems (such as uterine prolapse)
• Abnormal uterine bleeding
• Cancer
• Chronic pelvic pain

Source: The American College of Obstetricians and Gynecologists

There are three ways that hysterectomy can be performed:

• Vaginal Hysterectomy. In a vaginal hysterectomy, the uterus is removed through the vagina. Because the incision is inside the vagina, the healing time may be shorter than with abdominal surgery. There may be less pain during recovery. Vaginal hysterectomy causes fewer complications than the other types of hysterectomy and is a very safe way to remove the uterus. It also is associated with a shorter hospital stay and a faster return to normal activities than abdominal hysterectomy.
• Abdominal Hysterectomy. In an abdominal hysterectomy, the surgeon makes an incision through the skin and tissue in the lower abdomen to reach the uterus. This type of hysterectomy gives the surgeon a good view of the uterus and other organs during the operation. This procedure may be chosen if you have large tumors or if cancer may be present. Abdominal hysterectomy may require a longer healing time than vaginal or laparoscopic surgery, and it usually requires a longer hospital stay.
• Laparoscopic Hysterectomy. In a laparoscopic hysterectomy, a laparoscope is used to guide the surgery. A laparoscope is a thin, lighted tube that is inserted into the abdomen through a small incision in or around the navel. It allows the surgeon to see the pelvic organs on a screen. Additional small incisions are made in the abdomen for other instruments used in the surgery. In a total laparoscopic hysterectomy, the uterus is detached from inside the body and then removed in small pieces through the incisions or through the vagina. In a laparoscopic assisted vaginal hysterectomy, the uterus is removed through the vagina, and the laparoscope is used to guide the procedure. In a robot-assisted laparoscopic hysterectomy, the surgeon uses a robot attached to the instruments to assist in the surgery.

Source: The American College of Obstetricians and Gynecologists

Endometrial ablation destroys a thin layer of the lining of the uterus and stops the menstrual flow in many women. In some women, menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be required.

Source: The American College of Obstetricians and Gynecologists

If you have an abnormal cervical cancer screening result, your health care provider may suggest that you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment.

LEEP is one way to remove abnormal cells from the cervix by using a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the cervix.

For more information please click here.

Source: The American College of Obstetricians and Gynecologists

Women

- Sterilization procedures for women are called tubal sterilization. Tubal sterilization involves closing off the fallopian tubes. Tubal sterilization prevents the egg from moving down the fallopian tube to the uterus and keeps the sperm from reaching the egg. It does not affect a woman’s menstrual cycle or sexual function.

Men

- The sterilization procedure for men is called a vasectomy. In a vasectomy, each vas deferens is tied, cut, clipped, or sealed to prevent the release of sperm. A vasectomy is not effective right away. It takes about 1–3 months for the semen to become totally free of sperm. A vasectomy needs to be medically confirmed before it is considered effective. After a vasectomy, a man’s sexual function does not change. He can have an erection and ejaculate normally.

Source: The American College of Obstetricians and Gynecologists

Hysteroscopy is used to diagnose or treat problems of the uterus. A hysteroscope is a thin, lighted telescope-like device. It is inserted through your vagina into your uterus. The hysteroscope transmits the image of your uterus onto a screen. Other instruments are used along with the hysteroscope for treatment.  Click for more information on hysteroscopy.

Source: The American College of Obstetricians and Gynecologists

Some of the skin disorders that affect the vulva include:

Folliculitis. Folliculitis appears as small, red, and sometimes painful bumps caused by bacteria that infect a hair follicle. It can occur on the labia majora. This can happen because of shaving, waxing, or even friction. Folliculitis often goes away by itself. Attention to hygiene, wearing loose clothing, and warm compresses applied to the area can help speed up the healing process. If the bumps do not go away or they get bigger, see your health care provider. You may need additional treatment.

Contact Dermatitis. Contact dermatitis is caused by irritation of the skin by things such as soaps, fabrics, or perfumes. Signs and symptoms can include extreme itching, rawness, stinging, burning, and pain. Treatment involves avoidance of the source of irritation and stopping the itching so that the skin can heal. Ice packs or cold compresses can reduce irritation. A thin layer of plain petroleum jelly can be applied to protect the skin. Medication may be needed for severe cases.

Bartholin Gland Cysts. The Bartholin glands are located under the skin on either side of the opening of the vagina. They release a fluid that helps with lubrication during sexual intercourse. If the Bartholin glands become blocked, a cyst can form, causing a swollen bump near the opening of the vagina. Bartholin gland cysts usually are not painful unless they become infected. If this occurs, an abscess can form.If your cyst is not causing pain, it can be treated at home by sitting in a warm, shallow bath or by applying a warm compress. If an abscess has formed, treatment involves draining the cyst using a needle or other instrument in a health care provider’s office.

Lichen Simplex Chronicus. Lichen simplex chronicus may be a result of contact dermatitis or other skin disorder that has been present for a long time. Thickened, scaly areas called “plaques” appear on the vulvar skin. These plaques cause intense itching that may interfere with sleep. Treatment involves stopping the “itch-scratch” cycle so that the skin can heal. Steroid creams often are used for this purpose. The underlying condition should be treated as well.

Lichen Sclerosus. Lichen sclerosus is a skin disorder that can cause itching, burning, pain during sex, and tears in the skin. The vulvar skin may appear thin, white, and crinkled. White bumps may be present with dark purple coloring. A steroid cream is used to treat lichen sclerosus.

Lichen Planus. Lichen planus is a skin disorder that most commonly occurs on the mucous membranes of the mouth. Occasionally, it also affects the skin of the genitals. Itching, soreness, burning, and abnormal discharge may occur. The appearance of lichen planus is varied. There may be white streaks on the vulvar skin, or the entire surface may be white. There may be bumps that are dark pink in color.

Treatment of lichen planus may include medicated creams or ointments, vaginal tablets, prescription pills, or injections. This condition is difficult to treat and usually involves long-term treatment and follow-up.

Source: The American College of Obstetricians and Gynecologists

Any bleeding after menopause is abnormal and should be reported to your health care provider. Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. Postmenopausal is defined as no period for 12 months. A good rule to follow is to tell your health care provider if you notice any of the following changes in your monthly cycle:

- Very heavy bleeding

- Bleeding that lasts longer than normal

- Bleeding that occurs more often than every 3 weeks

- Bleeding that occurs after sex or between periods

Source: The American College of Obstetricians and Gynecologists

Bleeding in any of the following situations is abnormal:

- Bleeding between periods
- Bleeding after sex
- Spotting anytime in the menstrual cycle
- Bleeding heavier or for more days than normal
- Bleeding after menopause

Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of periods for 3–6 months (amenorrhea) also is abnormal.

Source: The American College of Obstetricians and Gynecologists

The following situations are some of the reasons why a cesarean birth is performed:

- Multiple pregnancy—If a woman is pregnant with twins, a cesarean birth may be necessary if the babies are being born too early, are not in good positions in the uterus, or if there are other problems. The liklihood of having a cesarean birth increases with the number of babies a woman is carrying.

- Failure of labor to progress—Contractions may not open the cervix enough for the baby to move into the vagina.
- Concern for the baby—For instance, the umbilical cord may become pinched or compressed or fetal monitoring may
detect an abnormal heart rate.
- Problems with the placenta
- A large baby
- Breech presentation
- Maternal infections, such as human immunodeficiency virus or herpes

Source: The American College of Obstetricians and Gynecologists

Pregnancy should be a pleasant time for you, but some body changes may appear. If you know about them, they are less likely to worry you.

These are some body changes you may feel while pregnant:

• Your breasts will get larger and firmer. The areolae or dark areas around your nipples will get darker and may develop bumps in them. Veins in the breast may become more noticeable. At the 4th or 5th month your nipples may start giving off a clear or cloudy liquid.
• You may have to urinate (empty your bladder or pass water) more often. However, this may lessen during the middle months of pregnancy and then become more frequent toward the end of pregnancy.
• You may feel sick to your stomach during the first half of your pregnancy. Sometimes this is worse in the morning. Also, you may feel heartburn (a burning sensation in your chest). These discomforts can be helped by eating smaller meals and eating more often. For example, rather than eating three regular meals a day, try six small meals each day. Also try to snack on plain crackers (without butter) especially early in the morning before getting out of bed. Try getting more rest and drinking very hot or very cold liquids. For heartburn, try not to lie down for at least one hour after eating.
• Your moods may change. It is not unusual for a pregnant woman to feel happy one minute then sad soon after without an apparent reason.
• You may get tired more easily.
• You may notice pulling pains in your lower belly and hip areas. These are usually caused by the growth of your uterus.
• Your belly will get larger as your baby grows inside.
• You may notice skin changes such as stretch marks or striae (pinkish lines on your breasts or belly) later in the pregnancy and some brown blotches on your face. Creams, lotions or oils do not prevent these changes. However, after pregnancy the marks tend to fade and are less noticeable.
• You may get constipated and have to strain to have a bowel movement. Hemorrhoids (large blood-vessels near the opening in your rectum) may develop. Constipation is best prevented or relieved by including more fiber in your diet. Foods such as fresh fruits, fresh vegetables and bran cereal are often helpful. Do not take laxatives unless this is first discussed with your OB-GYN doctor.
• You may experience changes in your legs such as cramps and possibly develop enlarged blood vessels (varicose veins).
• You may get acne and body hair increase. These are usually normal results of changes in the body’s hormones during pregnancy.

If these changes are bothering or worrying you, don’t hesitate to let us know at your next visit. If you need it taken care of sooner, call the office.

Cystic Fibrosis is a serious disease that affects many parts of the body. It causes the glands that help us digest food, make sweat, and moisten the linings of airways in our lungs to not work right. It can cause a man to be sterile. It can also show up as problems with digestion, breathing, or sweating. It most commonly causes repeated lung infections and bronchitis.

Find additional answers about Cystic Fibrosis by clicking here.

The First Trimester Screen test is a combination of a blood test (Nuchal) on the mother and a specialized (Nuchal)
ultrasound on baby. These both need to be done between 11 weeks 6 days & 13 weeks 6 days of the pregnancy.
Results of this test give an estimated risk for three abnormalities:
• Trisomy 21-Down Syndrome is the most commonly occurring chromosomal abnormality which results in
physical, developmental and intellectual problems. May range from mild to severe. About 96% of cases are
detected with this test. False positive results occur in about 5% of tests.
• Trisomy 18-Edwards Syndrome is the second most common chromosomal abnormality which results in
developmental problems along with deformities of the organs. About 95% of cases are detected with this test.
• Trisomy 13-Patau Syndrome is associated with severe mental and physical problems. About 95% of cases
are detected with this test.

This test is optional therefore you will need to check with your insurance for coverage
information and cost to you if you choose to have this done. You will need to know,
PRIOR to your first office visit with the MD, what your financial responsibility will be before having the test. Below are codes that will help determine your insurance
coverage.
Nuchal blood test: CPT codes are 84704, 84163, 36415
Diagnosis Codes are Z34.9 pregnancy, O09.5 pregnancy age 35 or over, O09.291
pregnancy with a history of prior pregnancy with Trisomy defect.
Nuchal Ultrasound: CPT code is 76813.
Diagnosis codes are the same as listed above for the blood test.

Moreland OB-GYN utilizes the Perinatal Assessment Center (PAC) at Waukesha
Memorial Hospital for this testing. 

Find additional answers about First Trimester Screening by clicking here.

This test is used to identify pregnancies that may be at higher risk for Down syndrome, spina bifida and Trisomy 18. The spine problem (spina bifida) occurs when the fetus (baby in your womb) doesn’t form a complete covering around the major parts of the nervous system (brain and spinal cord). It may lead to various physical problems ranging from needing braces to walk, to severe handicaps including not being able to walk, as well as mental problems and even death. Down syndrome means the baby has an extra chromosome 21. Down syndrome causes mental retardation, heart abnormalities and other birth defects. Trisomy 18 is due to an extra 18 chromosome and causes mental retardation and other abnormalities more severe than Down syndrome.

Find additional answers about Maternal Serum Screening by clicking here.

Studies of pregnant women in car accidents have shown that you and your baby are much less likely to have injuries if you are wearing a seat belt.

Find additional answers about seat belts during pregnancy by clicking here.

Yes. Your ligaments become easier to stretch. That is why you may feel a little wobbly when walking. Because of this it is easier to sprain something (an ankle), or pull a muscle. As your baby grows, your weight distribution is different; your center of gravity changes, which may make it easier for you to lose your balance. Your ability to catch your breath (get enough oxygen) is decreased during exercise. Because of these changes in your breathing and circulation systems, you may occasionally experience dizziness or weakness. Now when you exercise, you will notice you don’t have the aerobic capacity (the same energy) you did before. With some adjustments you can continue to enjoy exercising and return slowly to your desired program after your baby is born and your body is ready.

Find additional answers about exercise during pregnancy by clicking here.

Muscle cramping, particularly in the legs, is common during pregnancy. There are 2 things that cause cramping: muscle fatigue and less oxygen getting to the muscles.

Yes, as long as it is not causing you to have pain or bleeding. For certain problems, you may be told to avoid sex. Some women find that sex is more comfortable during pregnancy if they are on top or lying side to side. Feel free to ask us any questions about sexual relations during any of your prenatal visits.

Find additional answers about general health during pregnancy by clicking here.

Yes. There are generally no problems with riding in a plane or taking auto trips unless you have certain medical problems or are in the last month of pregnancy. It’s best to ask your OB-GYN doctor if it’s OK for you to go on a trip. If you are a frequent flyer or a crewmember, please let your obstetrician know. As you get toward the last few months of pregnancy, check with airlines about any restrictions. In case you will be away for more than a week or away from home near your due date, it is a good idea to get the name of a medical provider in the area where you will be. We can help you with this. If an overseas travel destination requires certain vaccinations not recommended for pregnant women, you may be advised not to go there.

Find additional answers about general health during pregnancy by clicking here.

There is a possibility that using a douche while pregnant may cause premature (preterm) labor – which means going into labor too early. It is recommended for you to not use any vaginal douche.

Find additional answers about general health during pregnancy by clicking here.

Keep getting your regular dental check ups. Take good care of your teeth. Gum disease has been connected to premature (preterm) deliveries. Let your dentist know that you are pregnant before any x-rays are taken or any medicines are given to you. Tell your dentist to add lead shielding to your abdomen (lower tummy) and to your neck area when taking x-rays.

Find additional answers about general health during pregnancy by clicking here.

In non High Risk pregnancies short stays (several days) at high altitude are generally not felt to be a significant problem. Women who are at low risk during pregnancy living at low altitudes should avoid vigorous exercise if they visit high altitudes for short periods of time. In High Risk pregnancies high altitude exposes the mother and developing fetus to less oxygen and should be avoided whenever possible. Your obstetrician will be happy to discuss your special problem with you.

Find additional answers about general health during pregnancy by clicking here.

You can take acetaminophen (Tylenol) for mild aches and pains.

Viewing Moreland OB-GYN’s Medication Guide During Pregnancy can help you understand safe and effective over-the-counter medications you can take during pregnancy to keep you feeling your best and keep your baby growing strong.

This easy-to-read guide offers information on:

• Common illnesses and ailments
• Over-the-counter medications to relieve symptoms
• Possible side effects
• Advice on when to call your doctor

Open safe medication guide here. 

- Breast-feeding or nursing is unquestionably an excellent way to feed your baby. It can give you much pleasure to have your child in close contact with you during feedings, and, of course, this contact gives much pleasure to your little one.

- Breast milk is the most easily digestible food that a baby can consume. In other words, it is very agreeable and is unlikely to cause spitting-up or any stomach problems.
No special preparation is needed such as measuring and sterilizing and it’s definitely cheaper than formulas.

- If asthma or allergies run in the family, it seems that breast-feeding can cut down the chances of these happening in the baby. Nursing babies have a lower risk of crib death (Sudden Infant Death Syndrome – SIDS).

- Breast milk contains antibodies that protect young babies against infections. They are made in your body and passed to your child in the breast milk.

- Breast-feeding helps your body get back to its normal size and shape. The baby’s sucking stimulates the muscles of your uterus (which got stretched out during pregnancy) to return to normal.

- Breast-feeding can help prevent overfeeding. Breast-fed infants usually get just what they need during each feeding.

Some women are not able to breast feed and some may choose not to nurse their baby and, instead, desire to give them formula. Formula is safe and healthy.

It is easy to buy. Most supermarkets and drugstores sell it.

Formulas are easy to prepare. In fact, some are already premixed so no preparation is needed.
If you choose to bottle-feed, it is important to remember a few things:

Keep bottles and nipples clean so germs don’t get into the baby’s milk.

Try to hold the baby close to you while giving the formula. This can help you and the baby build a closer relationship. Propping a bottle on a blanket, so the baby lies alone and drinks is not a good habit and can be dangerous. Babies need and like close contact.

Always use formula for the entire 1st year of your baby’s life. Using regular or low fat homogenized milk before your baby is a year old is not recommended and can lead to anemia or a low blood count in the baby.

Later during your pregnancy, more information will be given to you regarding the feeding of your baby.

Often when a person becomes pregnant, she begins experiencing different moods and concentrates on these feelings and on how her body is changing. These changes can make the partner feel neglected. Participation in the pregnancy may be important to the partner. Concerns about the new baby and growing a family can put some strain on your relationship. It is often helpful to talk about the feelings both of you are having about the new baby.

Several other helpful things you can do are:

- Bring your partner to some/all of your prenatal visits. Let your partner feel the baby as it kicks and moves.

- Involve your partner in childbirth classes.

If you have more questions, ask one of the staff here.

Sometimes the partner does not seem interested in the upcoming baby or even worse, may seem angry. If this is a problem for you, please let us know so we can help you better deal with it.

Sometime during the month before your due date you might want to pack a suitcase of things, to take with you to the hospital.

Some of the things you may want to bring are:

- Bathrobe, slippers
- 2 or 3 nightgowns
- Toothbrush, toothpaste
- Hair brush
- Loose fitting outfit to wear home
- Cosmetics
- Nursing bras (if you plan to breast feed or otherwise just 2 good support bras)

Be sure to read our blog What to Pack In Your Hospital Bag for more ideas.

It is very important that you have an approved infant car seat in your vehicle to transport your baby. Some hospitals may loan you one to take your baby home if you do not already have one. Also, if you belong to an HMO, they may provide a car seat. A phone call to them to find out is worthwhile. For more information on car seats, call the Auto Safety Hotline at 1-800-424-9393 (service of the National Highway Safety Administration).

About all you’ll need for the baby is a baby blanket, a sleeper or nightshirt. If you are expecting cold weather, then make sure these items are heavy enough to keep the baby warm on the way home.

Usually, no specific preparation is needed however, occasionally a full bladder is required.  Please check with a Patient Service Representative at check in if you are able to use the restroom prior to your ultrasound exam.

Ultrasound exams range in length from 30 to 60 minutes depending on the exam being performed. The 18-20 week anatomy scan in pregnancy typically takes 1 hour to perform.

A typical gynecology ultrasound usually lasts 30 minutes.

We use Tricefy™ Medical Imaging Technology at Moreland OB-GYN. An innovative web-based management platform that instantly sends information from medical imaging equipment to any mobile device including phones and tablets. This new technology allows sonographers to text or email expectant mothers and fathers a secure link to their baby’s 3D ultrasound images or 4D videos. The images can then be instantly shared with family members or on social media.  For more information read our blog.

The U.S. Food and Drug Administration (FDA) has cleared the da Vinci Surgical System for use in a wide range of procedures.

For additional information, please see Indications for Use.

da Vinci surgical procedures are routinely performed in the specialties of: general, urologic, gynecologic, transoral, cardiac, thoracic, and pediatric surgery. da Vinci® Single-Site™ technology enables surgeons to remove the gallbladder and uterus through one small incision in the belly button.

Over the last decade, the da Vinci System has brought minimally invasive surgery to over 2 million patients worldwide.

Since 1998, more than 7,000 peer-reviewed publications have appeared in various clinical journals on da Vinci Surgery.

The amount of clinical evidence on the da Vinci System is increasing at a rate of 100 publications per month.

Robotic surgical devices are designed to perform entirely independent movements after being programmed by a surgeon. The da Vinci Surgical System is a computer-enhanced system that introduces a computer interface and 3DHD vision system between the surgeon’s eyes, hands and the tips of micro-instruments. The system mimics the surgeon’s hand movements in real time. It cannot be programmed, nor can it make decisions on its own to move or perform any type of surgical maneuver.

So, while the general term “robotic surgery” is often used to refer to our technology, it is not robotic surgery in the strictest sense of the term.

The average price of a da Vinci Robotic Surgical Hysterectomy varies.

Please call 262-544-4411 and ask to speak to a representative from our Surgery Scheduling department for more information.

Serious complications may occur in any surgery, including da Vinci® Surgery, up to and including death. Examples of serious or life-threatening complications, which may require prolonged and/or unexpected hospitalization and/or reoperation, include but are not limited to, one or more of the following: injury to tissues/organs, bleeding, infection and internal scarring that can cause long-lasting dysfunction/pain. Risks of surgery also include the potential for equipment failure and/or human error. Individual surgical results may vary.

Risks specific to minimally invasive surgery, including da Vinci Surgery, include but are not limited to, one or more of the following: temporary pain/nerve injury associated with positioning; temporary pain/discomfort from the use of air or gas in the procedure; a longer operation and time under anesthesia and conversion to another surgical technique. If your OB-GYN doctor needs to convert the surgery to another surgical technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications.

Patients who are not candidates for non-robotic minimally invasive surgery are also not candidates for da Vinci® Surgery. Patients should talk to their gynecologists to decide if da Vinci Surgery is right for them. Patients and gynecologists should review all available information on non-surgical and surgical options in order to make an informed decision.

For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to http://www.intuitivesurgical.com/safety. Unless otherwise noted, all people depicted are models.