Obstetrics Services

1. ANTENATAL PLAN OF VISITS

Pregnancy is a physiological condition which usually lasts 40 weeks and results in the birth of the baby.

This is a suggested schedule for your antenatal and postnatal appointment plan; however, it may not be strictly adhered to, and you should not be worried if it differs slightly.

Doctors, Rumbidzai Majangara, Tsitsi Magure and Nangisai Mutare are active consultants of obstetrics and gynecology at MIG Alexandra Park. You will be seen by one of them during the course of your antenatal/ postnatal care to meet all team members in the eventual case of an emergency when Dr D is not available.

Please be aware that although you will likely have a scan at each visit with, scans themselves are not a compulsory component of your antenatal consultation unless there is a perceived risk factor for the baby.  If you do not have a scan at an appointment or do not wish to have one, this is perfectly fine. Dr D scans to check on baby’s well-being and reassure you on the steady progress and development of your baby. 

When you phone to make an appointment, the Administrator Kathlyn Kambarami will advise you accordingly.  However, below is an outline of what you can expect and the links that the Doctor expects you and your partner to read and make yourselves ready for the next appointments (web portal).  There are only two visits with scans that are covered by medical aid throughout the pregnancy. Those are second and third trimester anomaly scans and Dr D refers to imaging fetal maternal specialists Dr Verenga –0784814611/ 0242708259.

Please note that visits are paid per appointment. 

2. ANTENATAL VISITS FOR LOW-RISK PREGNANCIES
   (HIGH RISK PREGNANCIES WILL BE SEEN AS PER DOCTOR’S ADVISE

6-8 weeks: at your initial consultation is ideally when you will meet/ greet the Dr and the MIG team and get an invitation to the Dr’s web portal (scan QR code at the reception) for additional information.  At this appointment, you can expect vitals to be taken, several forms will be given to you to fill in (preferably you can download them from this web site and fill in at home) the scan will be done to confirm pregnancy and you will be sent for Initial blood tests (see attached referral form and links to read). The social component of this appointment is very important, the team is very friendly, relaxed yet vibrant. Use the opportunity to “make yourself at home “and introduce yourself, to the team, explain how you feel about the new condition, your social circumstances and your quality of life.

 8-10 weeks  : this is ideally when you will meet/ greet the Dr and the team and get an invitation to the Dr’s web portal ( scan QR code at the reception )for additional information have your initial consultation.  At this appointment, you can expect a scan to confirm pregnancy and you will be sent for blood tests. Initial blood tests (see attached referral form and links to read). You will be also advised on chromosomal anomaly tests that are performed after ten weeks (NIPT test). Counseling will also be done during this period. It is perfectly acceptable to decline Chromosomal testing, a disclaimer form will be given to the couple to sign during the appointment. Please note that blood is taken for the NIPT test at Medicity laboratories (optional Lancet) and is transported to Bio Next laboratory in Johannesburg; results are expected in 10-14 days later. Should everything be okay with the results, the doctor will sign them, and you will get a soft copy via WhatsApp or email. If there is an issue with results suspected, the Doctor will call you for an appointment to explain the results and suggest further management.

Also note that after the first appointment in between 8 and 12 weeks you will have an initial “meet and greet/ social appointment” with the doctor’s assistant Tariro Sakala for a an introduction to MIG services in the duration of 15 to 20 minutes.

11-13 weeks: Doctor will discuss with you first trimester blood test results , enquire about your quality of life and You will have a scan at this appointment..

14-15 weeks: 12-weeks results discussion.  You will be given a 20-week scan referral form for your next appointment with Dr Verenga, fetal specialist. If you haven’t done a 12-week Chromosomal anomaly test or NIPT, you will be given a form for Medicity or Lancet 2^nd Trimester Chromosomal anomaly test, should you wish to have one.

20 weeks: You will have “ANOMALY SCAN” done by a specialist of fetal medicine.  We routinely refer to Dr Verenga.

N.B* DELIVERY DEPOSIT TO BE PAID IN FULL BY NOW IN ORDER TO BE ISSUED WITH A HOSPITAL BOOKING FORM

22-24 weeks: debriefing from the 20-week anomaly scan with fetal maternal specialist Dr Verenga and further follow-up of development of the baby. GTT test recommendation which is done at Medicity/ Lancet laboratories (optional). There will be discussions about the expectations and care during the second trimester. You will be referred to the second trimester antenatal class with the affiliated midwife Urma Hodgson and further follow-up on the baby’s progress. A referral for a glucometer test at Medicity laboratories will be given. 

26-28 weeks: there will be assessment of the development and growth of the baby.  You will be given a referral for placental growth factor (PLGF) second trimester test. A prescription for anti D antibodies will be issued for Rhesus Negative mothers (you will be given a prescription and bring them for or after the appointment for administration). There will be debriefing after the midwife’s appointment and referral for further 3^rd trimester consecutive classes with the midwife will be issued.

32 weeks:  Antenatal consultation. This is a follow up visit with scan for fetal growth and well-being. You will be issued a referral for a 35-week scan with Dr Verenga.

35 weeks: 3^rd trimester 35 weeks anomaly scan with Dr Verenga. He will check on overall fetal wellbeing in particular cerebral median artery, Doppler, and pulmonary artery velocity index (technical terms).

36-37 weeks: Standard consultation. At this appointment, there will be discussion about expectations and care during labour, (Birth plan) will be discussed. Vaginal examination and genital swab for Streptococcus B screening will be done.  3^rd trimester blood test referral will be issued.

40 weeks:  Antenatal consultation, with scan to assess fetal growth and wellbeing.

Please note that if your baby has not come by 10 days after 40 pregnancy weeks, you will be scheduled for an induction of labour/ c-section depending on the situation.

Post-natal day 7visit.  There will be a debriefing on the labour / hospital stay/ breastfeeding/ assessment of the wound (if any). There will be an ultrasound scan to check on the condition of the uterus. There will be a breast check and overall psychological assessment check (Edinburgh postnatal depression questionnaire). It is strongly recommended to see a lactation specialist straight after delivery (should there be an issues).  Please have contact numbers in a visible place. Three additional follow-up visits will be done up to 6 weeks postnatally. Pelvic floor exercises are highly recommended.

6 weeks post-delivery: is your final post-natal visit with your Obstetrician/Gynecologist. A postnatal depression questionnaire will be given to the patient to fill in. A Pap smear should be taken if no Pap smear was not done in the past one year.  Pelvic floor exercises will be gain be reinforced and a pelvic floor physiotherapist will be recommended ( Jane Du Toit/ Gyrid Chitombo are available on the premises).

3. PSYCHOLOGIST

Please note that psychologist Amy Garden is available on the premises she will meet with the couple at 16 weeks, usually on Wednesdays. Amy provides women with psychoeducation on how to actively improve their own wellbeing and happiness as they go through life and throughout their pregnancy. A positive mental wellbeing helps to promote a healthy relationship with mother and child and the family as whole.

4. MIDWIVES AND ANTENATAL CLASSES (INDEPENDENT)

Irma Hodgson +263 772 275 533

As part of Dr Djordjevic’s model of shared maternity care, it is expected that you will have 4-6 prenatal classes with independent midwives for primi-parous (first time mum-to be) and two classes for multi-parous mums (Labour & Birth) and /or (Baby and Breastfeeding).

1. The first class is The Early Pregnancy Introduction Class – which ideally takes place between 10-14 weeks. However, this can be undertaken any time shortly after booking.
2. From 20 weeks – prenatal preparatory classes, either:
3. As a set of 4 group classes that prepare you and your birth partner for the final stages of pregnancy, the normal labour and birth, the assisted or complicated labour and birth as well as breastfeeding and the care for the newborn baby.

Or:

1. b) A choice of 1 or 2 private classes covering 1) Labour and Birth

Below is a list of useful contacts you might need during pregnancy, at birth and in the postpartum period please always keep them on your phone. Thank you.

This is to confirm I fully read and understood the information above

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Your first prenatal visit may be one of the longest you will have during your pregnancy — and the most comprehensive. Not only will there be tests and information-gathering, but there will also be lots of time spent on questions and answers. There will also be plenty of advice given, from what to eat (or not), what prenatal vitamins to take, and how much to exercise.

As soon as you have a positive result on a home pregnancy test, call your practitioner to schedule an appointment. Good prenatal care is one of the most important steps in having a healthy pregnancy and baby.

Here’s what to expect:

• A prenatal ultrasound scan is done during the first visit, which is the most accurate way of dating a pregnancy.
• You will get a check-up. This may include a general health exam (checking your heart, lungs, breasts and abdomen); measuring your blood pressure to serve as a baseline reading for future appointments; noting your height and weight; a look for varicose veins and swelling as a baseline for future visits; a pelvic exam; and an assessment of the size of your uterus and the size and shape of your pelvis.
• You will get a confirmation of your pregnancy. Even if you got a positive result on a home pregnancy test, your practitioner will repeat a urine test and do a blood test to check your hCG levels.
• You will undergo a battery of other tests.Some tests are routine for every pregnant woman, some are routine in some areas of the country, and some are performed only when necessary. The most common tests at your first prenatal visit include:
• Urine test. Your urine is checked for protein, glucose (sugar), white blood cells, blood, and bacteria.
• Bloodwork. A sample of your blood will be used to determine blood type and Rh status and check for anemia. Your blood will also be screened for antibody titers (levels) and immunity to certain diseases (like rubella and chicken pox) and possibly for vitamin D deficiency.
• Non invasive prenatal test. To screen for chromosomal anomalies in the baby. This should be done before 15 weeks.
• Genetic carrier screening.If you were not screened before conception, a blood draw also tests for whether you are a carrier for the more common genetic conditions, including cystic fibrosis, sickle cell anemia, thalassemia, Tay-Sachs disease and others.
• STD tests.Your doctor may screen for sexually transmitted infections like hepatitis B, syphilis, gonorrhea, chlamydia and HIV.
• A blood sugar test. You may get this test if you had gestational diabetes in a previous pregnancy or if you are at higher risk for gestational diabetes(for example, if you have a family history).

• Just as you have had regular visits to your healthcare provider in your first trimester, you will continue to do so in your second trimester. These check-ups help monitor the development and health of your baby — and your health as well.
• Most pregnant people see their doctors every month for a prenatal check-up. You may see your doctor more often if you have a pre-existing health condition or high-risk pregnancy.
• During the second trimester, you will likely have an exciting 20-week ultrasound with fetal specialist Dr Verenga. With this scan, you will get a good look at your developing baby — even their cute little fingers and toes!
• You will likely have blood work, urine tests, and a glucose tolerance test, too (maybe not the most fun test, but certainly important to screen you for gestational diabetes).

Third trimester prenatal visits

In your third trimester (28 weeks through the end of your pregnancy), you will most likely have a check-up every two weeks from 28 to 36 weeks, then switch to once-a-week visits until you deliver. As your due date draws near, you can expect a mix of regular physical exams, late-pregnancy tests, and discussions about the coming birth. Here are some of the things your caregiver will do at these appointments.

Your practitioner will check your baby’s heartbeat and feel your belly to estimate your baby’s size. She’ll also measure the distance between your pubic bone and the top of your uterus (this is called your fundal height) and compare it to your baby’s gestational age – as well as to the measurement from your previous visit – to make sure your baby’s growth rate seems normal. An ultrasound scan is done to evaluate his growth and to check your amniotic fluid levels.

If you’re Rh-negative, an injection of Rh immune globulin is given at 28 weeks which will prevent your body from producing these antibodies for the last part of your pregnancy.

Between 36 and 37 weeks, your practitioner will swab your vagina to check for a common infection called group B strep. If your test is positive, you will be given antibiotics during labor to help keep you from passing it on to your baby.

Your blood may be checked again for anemia, particularly if you were anemic earlier in your pregnancy.

If you’re at risk for sexually transmitted infections, you’ll be tested again for syphilis, chlamydia, gonorrhea, and HIV.

If you were found to have placenta previa or a low-lying placenta during an earlier ultrasound, you’ll have another ultrasound early in this trimester to check the location of your placenta.

If your pregnancy is normal but you go past your due date, your practitioner will induce labor if you don’t have your baby by 41 or 42 weeks

Pregnancy symptoms you should never ignore

• Your baby is moving or kicking less than usual. You’ll start to feel your baby move when you’re about 16 weeks pregnant, and if the frequency of his movements slows down, it could signal a problem. Tell your provider right away if your baby seems quieter than normal.
• Vaginal bleeding or spotting. Keep in mind that it’s normal to have a little spotting after sex or a vaginal exam.
• A change in vaginal discharge from milky white to watery, mucousy, or bloody – even if it’s only pink or blood-tinged. If you’re in your third trimester, know that after 37 weeks an increase in mucous discharge is normal and may indicate your body is preparing for labor.
• Pelvic pressure (a feeling that your baby is pushing down), lower back pain (especially if it’s a new problem for you), menstrual-like cramping or stomach pain, or six or more contractions in an hour before 37 weeks (even if they don’t hurt). If you start feeling these symptoms, drink some water and rest to see if they ease up or go away within an hour. If they don’t, or if symptoms increase in intensity and last longer than an hour, call your provider.
• Painful or burning urination, feeling the urge to go again minutes after peeing, having little or no urination, and having urine that’s cloudy, blood-tinged, or has a strong odor can be signs of a bladder infection.
• Chills or fever of 100.4 degrees Fahrenheit or higher
• Vomiting along with pain or fever
• Sudden vision changes or visual problems, such as double vision, blurring, dimming, flashing lights, auras, or “floaters” (spots in your field of vision). These can be signs of preeclampsia.
• Persistent or severe headache that doesn’t go away when you rest or take acetaminophen, or any headache with blurred vision, slurred speech, or numbness
• Persistent swelling in your face or puffiness around your eyes, anything more than a little swelling in your hands, or severe and sudden swelling of your feet or ankles, particularly in the morning. (Swelling is a concern when you press your thumb into your skin, and an indentation remains for a few seconds.)
• Rapid weight gain
• Abdominal injury, such as from a fall or a car accident
• Persistent intense itching of your torso, arms, legs, palms, or soles, or a feeling of itchiness all over your body
• Persistent pain in your upper belly or shoulder, especially under the ribs on your right side
• COVID-19 exposure or symptoms. These may include fever, cough, and shortness of breath, chills, muscle pain, sore throat, and the loss of taste or smell.
• Flu exposure or symptoms. These may include fever, sore throat, cough, runny or stuffy nose, exhaustion, and body aches and chills. You may also have vomiting or diarrhea. To minimize your risk of the flu, get the flu shot as soon as it’s available in the fall. The flu is very risky for pregnant women.
• Possible exposure to Zika virus. If you or your partner live in or have traveled to an area where Zika virus has been reported, tell your healthcare provider right away. It’s important to be tested, even if you don’t notice any signs of the disease. Most people don’t have any symptoms of Zika, but when they do develop can include fever, rash, painful joints, pink eye (conjunctivitis), muscle pain, and headache.
• Exposure to a communicable disease, like chicken pox or rubella, if you’re not immune or show signs of infection. Call your provider to discuss your symptoms before going to the office.
• Depression or severe anxiety. If you feel profoundly sad or hopeless, have panic attacks, feel unable to handle your daily responsibilities, or have thoughts of harming yourself, seek help immediately.
• Any other health problem that you’d ordinarily call your provider about, even if it isn’t related to your pregnancy (like worsening asthma or a cold that gets worse rather than better). If you’re near your due date, check out the signs of labor so you’ll know what to look for and when to call.

Signs of labor

You may notice the following signs or symptoms in the final days, weeks, or month before your due date:

• Your baby “drops.” If this is your first pregnancy, you may feel what’s known as “lightening” a few weeks before labor starts. Lightening means the baby now rests lower in your pelvis.

You might feel less pressure just below your ribcage, so it will be easier to catch your breath, and if you experienced heartburn during pregnancy, it might now improve. If this isn’t your first baby, however, lightening may not happen until labor begins.

• You have more Braxton Hicks contractions. More frequent and intense Braxton Hicks contractions can signal pre-labor, which is when your cervix starts to thin and widen, setting the stage for true labor. (See “What are the signs that labor is about to begin?” below.) Some women experience menstrual-like cramps during this time.
• Your cervix starts to change. In the days and weeks before delivery, changes in the connective tissue of your cervix make it soften and eventually thin and open. The thinning of the cervix is called effacement. The opening is called dilation.

If you’ve given birth before, your cervix is more likely to dilate a centimeter or two before labor starts, but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor is imminent.

When you’re at or near your due date, your doctor or midwife may do a vaginal exam during your prenatal visit to see whether your cervix has started the process of effacement and dilation.

• You pass your mucus plug. If your cervix begins to efface or dilate significantly as you get close to labor, you may pass your mucus plug – the small amount of thickened mucus that has sealed off your cervical canal during your pregnancy. The mucus plug may come out in a lump all at once or as an increased amount of vaginal discharge over the course of several days.
• You have some “bloody show.” When your cervix starts to soften or dilate, you may notice a pink discharge or bright-red blood. If this happens at the same time you lose your mucus plug, the mucus may be tinged with blood, but it can also happen independently. (Having sex or a vaginal exam can also disturb your mucus plug and result in some blood-tinged discharge, even when labor isn’t necessarily starting any time soon.)

POST NATAL EXAMINATION

This is what to expect on a post natal visit with Doctor:

• Vital Signs: BP, Pulse, Temperature, Weight
• Urine output and color, stool frequency and consistency
• To fill in Post Natal Edinburgh Depression Questionnaire
• Checking for Anaemia on mucous membranes
• Checking for breast engorgement, lumps, whether secreting colostrum or milk
• Abdomen – Assess for tenderness, swelling
• Uterus- Check whether contracting well or not
• Suture line- Check for inflammatory signs such as redness, swelling. Any presence of haematomas, wound gapping
• Perineum – Check for inflammatory signs if episiotomy, check for wound gapping.
• PV loss – Comment on colour of lochia, smell, and amount
• Legs – Check for calf pain, DVT or any muscle pains
• Educate on importance of breastfeeding and general hygiene and wound care.
• Advise on pelvic floor muscle exercises, Kegel Exercises ( Pelvic Floor)
• Educate on good dietary intake e.g high protein, high fibre diet
• Discuss any family issues.
• Breastfeeding / Any Breastfeeding Issues: Revert to breastfeeding specialist advice as we all follow American O&G College Protocol
• You can donwload more breastfeeding related material from here or follow this link

The visit with Doctor will be at 6 weeks, Pap smear is done and scan to assess for healing.

Exercises can resume as normal as from 6 weeks.

Please kindly read the consent and fill in only those consents that are applicable to your medical condition / treatment