Prenatal Information
DELIVERING PHYSICIAN
Our call rotation is evenly split and you will be delivered by the physician on call. Our on call doctor is not scheduled to see patients in the office, allowing them to be more available to laboring patients.
PATIENT QUESTIONS
At your first visit the nurse will review our website which is an excellent resource for pregnancy related questions. If the information included in your packet fails to answer your questions, and you are unable to wait until your next appointment, please call our phone nurses. When you call the office our operator will pass the information to the nurses. Calls are returned between the hours of 9am and 4pm. Be sure to give a number where you can be reached all day. In addition, the patient portal is a great way to communicate non-urgent questions to our nurses. If you have not signed up for our portal, please ask your nurse at your first visit.
THINGS TO AVOID
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Cigarettes, alcohol, “street” drugs, caffeine, saccharin
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Vaginal douching
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Over the counter drugs, not listed on the “Common Problems & Medication” sheet
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Old prescription drugs, prescribed prior to being pregnant
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Hot tubs, Jacuzzis and whirlpools with water exceeding 100 degrees Fahrenheit
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Toxic substances, i.e. varnish, paint remover, etc. Use only with good ventilation for short periods of time.
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Avoid intercourse if threatening to miscarry, experiencing bleeding/cramping, if your bag of water has ruptured or if you feel you may be in premature labor.
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If you are a cat owner, refrain from emptying the cat litter box. Wear gloves while working in the yard or garden.
ISSUES OF CONCERN
If you experience any of the following please call our office, Monday – Friday, 8:00 a.m. to 4:30 p.m. If you experience the following after our regular clinic hours, please go to OB admitting at Sparrow Hospital, 3rd floor.
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Chills or fever over 101 degrees Fahrenheit
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Painful or burning urination
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Bloody discharge or bright red bleeding from the vagina
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Persistent abdominal pain that is not relieved by a bowel movement
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Severe nausea or vomiting/diarrhea that could lead to dehydration. (Severe meaning several times within an hour)
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Visual disturbances, i.e. blurring or doubling of vision
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Severe or persistent headache lasting more than 2-3 hours after taking regular or extra strength Tylenol as directed by package
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Before 36 weeks if you think you are in labor. Go to Sparrow early, as we may need to try to stop preterm labor conditions.
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After 36 weeks – as long as the baby is active and water is not broken, stay home as long as you are comfortable. When contractions are strong and regular, go to Sparrow.
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Gush or steady leaking of fluid from vagina, even if you are not having contractions.
It is not necessary to call us before you go to Sparrow, they will notify us of your arrival.
NUTRITION, HYDRATION AND WEIGHT GAIN
We DO NOT want you to diet while you are pregnant. We encourage you to read the information in your packet regarding what you can and cannot eat. This will provide you with good information on healthy eating while pregnant. We encourage a minimum of six to eight glasses of water daily. A weight gain of 20-40 pounds during your pregnancy is recommended, depending on your build.
EXERCISE GUIDELINES
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Do not become over fatigued while exercising
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Do not put yourself at risk for injury, or risk of falling and possible injury to the baby
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Keep heart rate under 140
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Any other questions regarding exercise or other activities, please ask your doctor.
GENERAL PLAN OF CARE
An average pregnancy lasts 40 weeks and the following is a general plan of care. Below is a generalized appointment list. There may be changes to the schedule below due to individual needs and as directed by your physician
At each visit you can anticipate: Weight, Blood Pressure, Urine dip (to check for protein & sugar), Measurement of uterus and Baby’s heartbeat (after 10 weeks) via Doppler.
TRADITIONAL CARE
Your visits will be organized to reflect our “modified group practice”. One of our physicians will be your primary obstetrician. This means you will see him/her for the majority of your visits, especially in the first 20 weeks and last 4 weeks where decisions are to be made and complications occur more frequently. The middle months are usually uneventful, and are used to visit each one of the other physician’s so you can get to know all of us. You also have the option of scheduling all of your appointments with your primary physician. If you choose to only schedule with your primary there are a couple things we need to bring to your attention; one of the other physicians may be on call when you deliver and when you reach 36-40 weeks and are seen on a weekly basis, your physician may be out of the office and you would be required to see another physician.
CENTERING PREGNANCY CARE
This is a new way to get prenatal care in a group setting facilitated by a Nurse Practitioner or Nurse Midwife. Each group consists of 8-12 women with similar due dates and meets for 10 2-hour sessions during your pregnancy. These group schedules are set in advance for your entire pregnancy allowing you to plan ahead and have little risk of changing. Groups include discussion, activities and time for sharing in a relaxed and fun setting. In this model you will also have a few traditional visits with your primary physician.
COMPARISON CENTERING VS. TRADITIONAL
Here is a comparison of what your appointment schedule would be like in the CenteringPregnancy model vs. Traditional model. This may be helpful for you to determine which option works best for you.
CenteringPregnancy
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Traditional
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7-9 weeks – RN Visit
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History review
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Education
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Lab work
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7-9 weeks – RN Visit
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History review
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Education
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Lab work
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10-12 weeks – Exam with Usual Provider
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Physical Exam
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History review
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Listen to baby’s heartbeat (using Doppler) 10 weeks or more
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10-12 weeks – Exam with Usual Provider
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Physical Exam
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History review
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Listen to baby’s heartbeat (using Doppler) 10 weeks or more
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12-16 weeks – Session 1 Group
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14-16 weeks – Visit with Nurse Practitioner
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18-20 weeks – Ultrasound & Usual Provider Visit
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An ultrasound of the baby’s anatomy
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18-20 weeks – Ultrasound & Usual Provider Visit
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An ultrasound of the baby’s anatomy
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16-20 weeks – Session 2 Group
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24 week – Visit with Physician
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20-24 weeks – Session 3 Group
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28 week – Visit with Physician
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24-28 weeks – Session 4 Group
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32 week – Visit with Nurse Practitioner
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Discuss labor, baby care and postpartum planning
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26-30 weeks – Session 5 Group
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34 week – Visit with Physician
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28-32 weeks – Session 6 Group
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36 week – Visit with Usual Provider
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30-34 weeks – Session 7 Group
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37 week – Visit with Physician
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32-36 weeks – Session 8 Group
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38 week – Visit with Physician
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34-38 weeks – Session 9 Group
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39 week - Visit with Physician
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37-39 weeks – Visit with physician**
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40 weeks 1 day – Visit with physician
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Non-stress Test with MA
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Ultrasound – with Ultrasound Tech
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36-40 weeks – Session 10 Group
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40 weeks 1 day – Visit with physician
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Non-stress Test with MA
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Ultrasound – with Ultrasound Tech
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Labor & Delivery Class – 2 sessions*
Natural Child Birth Class – 4 sessions*
Held at Expectant Parent Organization*
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*This is an optional service with an additional cost and is not provided at Alliance.
**Group session and traditional visits to equal once a week between 36 weeks and 40 weeks gestational age.
Should I have Prenatal Testing done?
Although most babies are born in great condition, worrying that your baby may have a problem is common in pregnancy. A variety of tests are available to help detect some of these problems. This worksheet will help you decide if you want any testing done, and if so, what type is right for you. Please review this information and answer the questions at the end BEFORE your first visit with the nurse, and bring it with you so we can help make a plan for your pregnancy.
Prenatal tests are used to screen for problems such as chromosome abnormalities (for example Down or Edwards Syndrome), or open neural tube defects (for example spina bifida or anencephaly). Test types fall into two categories: screening tests and diagnostic tests. They can be performed in the first trimester at 10-13 weeks, the second trimester at 15-20 weeks, or in both trimesters. Different types of testing are recommended based on each mother’s individual risk.
Screening tests do not tell you if your baby has a problem, they only tell you if you are above or below the average risk for them. The advantage of screening tests is that they pose little to no risk to you or your baby. The disadvantage is that they don’t give you a definitive answer, and they have “false positives” (abnormal test, normal baby) and “false negatives” (normal test, abnormal baby). The chance that an affected baby will have an abnormal screening test (abnormal test, abnormal baby) is called the “detection rate”.
Diagnostic tests are very accurate and will almost always give you definitive yes or no answer. Diagnostic tests are nice because you usually know for sure what’s happening, but they carry small risks, sometimes causing miscarriage of a normal baby. So the result of a diagnostic test is more definite than one you get with a screening test, but the risk is slightly higher too. These types of tests are generally recommended if you have an abnormal screening test.
Fetal Anatomy Ultrasound
As a part of your routine prenatal care, your doctor will order a fetal anatomy ultrasound between 18-20 weeks. This ultrasound will be ordered regardless of your decision to have prenatal genetic screening or diagnostic testing.
What is it?
This ultrasound is one of the best ways to see how your baby is developing and offer some reassurance that at this point in pregnancy the baby is developing normally. This is a screening ultrasound, not a diagnostic test. An anatomic Ultrasound will evaluate your baby’s growth and major organs, to be sure they have formed properly. It is a special test that gives you a specific glimpse of your growing baby. This test does not check your baby’s chromosomes. A prenatal anatomic ultrasound does not detect all physical abnormalities of a baby. During your ultrasound, the baby will be measured from side to side on his/her head, around the head, around the abdomen, and from hip to knee (femur bone). And that's just for starters. The four chambers and blood vessels of the heart will be evaluated, as well as the stomach, kidneys, and bladder of your baby. The internal structures of the baby's brain will be evaluated along with the spine, arms, legs, face and profile. A survey of the baby's anatomy, as well as the placenta location, amniotic fluid levels, and umbilical cord, will help to ensure that the pregnancy is overall developing normally. But if not, it may identify potential problems and thus lead to creating the best possible care plan for you and your baby. The ultrasound will give your doctor a picture of the overall health of your baby and your pregnancy. If you would like to find out the gender of your baby, that too is possible at this time.
What does the mother expect during the ultrasound?
You will lie back on an exam table with your belly exposed, and a sonographer will apply a special gel and move the transducer over your abdomen. As sound waves are emitted from the transducer, they will bounce off "structures" inside your belly and images are formed on the screen. To get the most information from the anatomy of your baby, the sonographer will be obtaining many different views from a lot of different angles. When the sonographer obtains a clear picture, she will freeze-frame the picture for the doctor. The ultrasound can take anywhere from 20 to 50 minutes, depending upon how cooperative your little one wants to be. All electronic devices (including cell phones) must be turned off during the appointment. We don’t allow any pictures or recording of the exam, but you can expect to go home with a couple of pictures as well as a CD. The doctor will review the results of the exam following your ultrasound once the sonographer has obtained all of the images and measurements needed.
Screening Blood Tests
Full Integrated Test
This test combines results from two sets of tests, a blood test and ultrasound done at 11-13 weeks, and another blood test done at 15-18 weeks. The results of the ultrasound and both blood tests are analyzed together after the second blood draw. This test screens for Down Syndrome (Trisomy 21), Trisomy 18, and open neural tube defects such (spina bifida for example). This test detects 94% of fetal Down Syndrome, and has a low false positive rate (5%). Results are available by about 16-19 weeks (after your second blood draw). The results will provide you a personalized risk number for each tested condition. For example: Down Syndrome risk is 1 in 1100. Because of its low false positive rate, this test is recommended for patients who are low risk but wish to have more information than that which is provided at the 20 week ultrasound.
Noninvasive prenatal test
A noninvasive prenatal test (NIPT) is a single blood test performed any time at or after 10 weeks. During pregnancy, 3-13% of the DNA in your blood stream is circulating cell free fetal DNA that comes from the placental cells. A NIPT works by evaluating the amount of cell free DNA in your blood. NIPTs screen for Down Syndrome (Trisomy 21), Trisomy 18, and Trisomy 13. This screening test is recommended for patients who are considered to be high risk for fetal chromosome abnormalities. Detection rate for Down Syndrome is reported at 99% in high risk women (those who are age 35+, who have a history of a previous child with a chromosomal abnormality, or those with Robertsonian translocation). Cell free DNA screen does not evaluate the risk of open neural tube defects or any other abnormalities that may be present. This testing is not recommended for low risk patients due to an increased likelihood of false positive results.
Alpha-Fetoprotein test
This test is a single blood test done around 15-22 weeks and assesses only the risk for fetal open neural tube defects. This test may be recommended for high-risk patients who are also having a non-invasive prenatal test.
Look over this table for more information about the pros and cons of each of the above screening tests.
Test
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What it tests for
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Detection rate
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False positive rate
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Results available
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Full Integrated test
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Down Syndrome, Trisomy 18, open neural tube defects
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94%
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5%
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16-20 weeks
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Non-invasive prenatal test
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Down Syndrome, Trisomy 13, Trisomy 18
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99%
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0.5% (high risk)
Up to 50% (low risk)
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10 or more weeks
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AFP test
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Open neural tube defects
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80%
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5%
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16-22 weeks
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Diagnostic Tests
Diagnostic testing options include Chorionic Villus Sampling and Amniocentesis. Please let your physician know if you are interested in either of these testing options.
Facts to consider
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Diagnostic tests are more invasive and therefore less safe, but are more accurate
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Screening tests are safer but don’t give you a “yes or no” answer
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The genetic conditions being tested for cannot be “fixed”, even if we know about them in advance. Having information regarding your baby’s genetics allows your provider to optimize your care and your baby’s care during pregnancy.
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Prenatal testing is done to gather information, not to find abnormal babies for pregnancy termination. Many parents who would not terminate an abnormal pregnancy have prenatal testing done in order to be prepared for their newborn’s special needs.
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Many mental and physical handicaps are not due to chromosome abnormalities or anatomic abnormalities, and are therefore not detectable by blood tests, ultrasounds, or amnio/CVS.
Find your age-based risk
Age at delivery
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Down Syndrome risk (Trisomy 21)
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Total risk for Trisomy 21, Trisomy 18, and Trisomy 13
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33
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1/625
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1/345
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34
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1/500
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1/277
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35
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1/385
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1/204
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36
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1/303
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1/167
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37
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1/227
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1/130
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38
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1/175
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1/103
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39
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1/137
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1/81
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40
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1/106
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1/63
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41
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1/81
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1/50
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42
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1/64
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1/39
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43
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1/50
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1/30
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44
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1/38
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1/24
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45
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1/30
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1/19
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Adapted from Schreinmachers, DM, Cross, PK, Hook, EB. Rates of trisomies 21,18,13 and other chromosome abnormalities in about 20,000 prenatal studies compared with estimated rates in live births. Hum Genet 1982; 61:318. In UpToDate.
Cystic Fibrosis Carrier Screening
What is Cystic Fibrosis?
Cystic fibrosis is a genetic disorder in which an abnormal gene is passed from parents to their children. It is an illness that does not have a cure, though treatment options are available. CF affects all of the organs in the body, but it most commonly causes problems with the gastrointestinal and respiratory systems. It does not affect a person’s physical appearance or mental abilities. The chances of being a carrier is 1 in 20.
What is Cystic Fibrosis carrier screening?
Cystic Fibrosis is a recessive trait, which means that people can carry the gene that causes cystic fibrosis without actually having the illness. These people are called “carriers”. If two carriers have a baby, there is 25% chance that their child will have cystic fibrosis. Carrier screening is a blood test that can be performed before or during pregnancy to determine whether or not a mother carries this gene.
Is testing covered by my insurance?
Although this simple test is highly recommended, insurance coverage varies greatly. For this reason, it is recommended that patients check with their insurance company to see if this test is covered. To check coverage, call the customer service number on the back of your card and give the representative the following information:
Diagnosis Code:
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If you are not pregnant: Z14.1 (Cystic Fibrosis Screening)
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If you are pregnant: Z14.1 (Cystic Fibrosis Screening)
Test Code: 81220
What if my test is negative?
A negative test indicates that your risk of being a CF carrier is extremely small. No additional testing is recommended for you or the baby’s father.
What if my test is positive?
A positive result indicates that you are a carrier of the abnormal gene that causes Cystic Fibrosis. If your test is positive, your doctor will recommend that the baby’s father undergo the same testing.
What if I’ve been tested in the past?
If you have had a cystic fibrosis carrier screen in the past, please tell us! Your result will not change, so repeating the test is not necessary. We will simply add your result into your medical record.
Insurance Codes for Prenatal Labs
Test
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Code(s)
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Cystic fibrosis
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81220
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Combined Test
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84163; 84702
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Serum Integrated Test
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84163; 82105; 82677; 84702; 86336
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Full Integrated Test
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84163; 82105; 82677; 84702; 86336; 76813
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Quad Test
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82105; 82677; 84702; 86336
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Alpha-Fetoprotein
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82105
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Non-Invasive Prenatal test**
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81420
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Nuchal Translucency Ultrasound
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76813
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Fragile X Syndrome
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81243
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Sickle Cell
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85660 and 83021
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Spinal Muscular Atrophy (SMA)
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81401 ** Sent to Mayo Lab**
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Tay Sachs
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81255
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Ashkenazi Jewish mutation panel
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81200, 81209, 81242, 81251, 81412 ** Please note that this panel DOES NOT include testing for Cystic Fibrosis, but ordering concurrently is recommended.
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Diagnosis code for Labs (use the code that applies to you)
Z34.01 Normal first pregnancy in first trimester
Z34.81 Normal pregnancy (other than the very first) in first trimester
Z36.82 Encounter for Nuchal Translucency ultrasound
*Pricing for the above tests is determined by the performing lab and is subject to change. Please call the labs listed below for pricing if your chosen testing is not covered by insurance.
Sparrow Hospital: 517-364-6000
**Pricing for Non-Invasive Prenatal Tests is determined by the performing lab and may differ from insurance quotes. Ariosa Diagnostics, the lab that performs and bills for the Harmony Prenatal test located in California may be “out-of-network” for your insurance carrier. We therefore encourage you to call Harmony Client Services (1-855-927-4672 option 1) PRIOR to having your blood drawn for the test. A Billing Specialist will be able to review your unique insurance plan to provide you with more specific information regarding your cost for the Harmony Test.