Dra. Leila Catherine Onbargi,

All patients are offered prenatal screening to assess whether or not their fetus is developing normally. There are various options available, including non-invasive laboratory testing as well as invasive testing such as amniocentesis and chorionic villus sampling. In addition, sonographic or ultrasound exams are performed at specific stages of pregnancy that can detect morphologic or genetic defects of the fetus. This testing, which is performed in our office, is done early enough to allow a decision to be made about whether to continue with the pregnancy.

In addition to prenatal screening, routine testing is performed throughout the pregnancy to monitor that the fetus is developing and growing normally. Pathologies and infections that can be dangerous to the fetus are ruled out. In this office we perform ultrasound scans, fetal monitoring and other tests of fetal well-being.

Professional careers and other personal reasons are making more and more women postpone the decision to start a family until later years. In these cases the patients' fertility is sometimes sub optimal, and the pregnancies themselves require specialized attention to help avoid problems that are more frequent in older mothers such as high blood pressure, diabetes and placental insufficiencies. We offer both preconceptual and obstetrical care that is specially geared to the needs of these patients so that the vast majority can have good pregnancies and give birth to healthy babies.

Many factors affect a couples' fertility; adequate ovulation, a healthy uterus and fallopian tubes, healthy sperm, and intercourse at the most fertile period in the menstrual cycle. Other factors that can affect fertility include alcohol consumption, smoking or drug abuse, as well as the general health of both partners. In up to 40% of cases, the infertility is secondary to a male factor. With specialized advice and care, a great majority of couples manage to conceive, often without resorting to techniques of assisted reproduction. When necessary, we offer specialized care by experts in reproductive medicine that are part of our team, and that offer comprehensive medical and surgical infertility treatment that is adapted to each couples' needs.

Pregnancy should be a joyful experience for most women, but some have uncomfortable symptoms. Nausea, vomiting, swollen hands and legs, insomnia, excessive weight gain, as well as limitation of normal activities are just some of the factors that can be issues that prevent the expectant mother from leading a normal life. We provide guidelines to keep these symptoms to a minimum using natural therapies whenever possible.

It is important to do some kind of regular exercise during pregnancy to keep muscles toned and keep weight gain in check. Walking, swimming, and a stationary bike are good options. Gentle gymnastic movements are also recommendable, as long as there are no high impact movements, and your lumbar and abdominal muscles are not strained. If you go to a class, let the monitor know you are pregnant so that the exercises are adapted to your needs.

High blood pressure is dangerous during pregnancy both for the mother and the fetus. Some women who have never had problems with their blood pressure develop this condition during pregnancy. It can also be associated with a more serious pathology specific to pregnancy known as pre-eclampsia. In this office, blood pressure is checked at each visit, and if found to be high, the correct treatment is immediately prescribed to safeguard both mother and child.

Blood loss can be very worrying for pregnant patients, although when only light it doesn't necessarily signify a problem. However all patients should be checked to rule out any serious complication such as a miscarriage, pre-term delivery or a problem with the placenta.

The amniotic sac or membranes sometimes rupture spontaneously ahead of schedule and the patient experiences loss of amniotic fluid through the vagina. From this moment on the patient requires hospitalisation and medical care. This is often associated with onset of labor. Even if it does not provoke early labor, this condition can lead to infection or improper growth of the fetus. Many of these cases resolve satisfactorily with strict medical care.

In spite of all the appropriate precautions and medical care during pregnancy some patients present symptoms of labor before term such as contractions, blood loss, and cervical dilatation and are often associated with other maternal conditions such as infection. Hospitalization is often necessary. In most cases the labor can be postponed with bed rest and medical treatment. Appropriate measures are taken to accelerate fetal maturity when necessary.

The changes that take place in the body during pregnancy affect the metabolism of some patients and they can develop gestational diabetes. It is important that this should be diagnosed and controlled by a specialist, who will recommend a diet, prescribe insulin if necessary and check on fetal wellbeing until birth. Most patients with a history of Insulin-dependant diabetes can become pregnant and undergo healthy pregnancies. They require specialized medical care and testing since these pregnancies can also be associated with fetal malformations and poor obstetrical outcomes.

Occasionally, for medical reasons, the safety of the baby or the mother requires that labor be induced or a cesarean performed before the estimated due date of the pregnancy. Sometimes the mother requests a programmed delivery to accommodate her personal schedule. If there is no maternal or fetal risk, and conditions are favourable (i.e. no higher risk for a caesarean), labour can be induced with medication from 39 weeks onward.

They mean double the joy, but these are pregnancies that require closer medical observation due to the specific complications that can arise with twins. They do not always go to full term (40 weeks gestation) and there is a higher risk of cesarean delivery unless both fetuses are in an optimal position. Most twin pregnancies have very good outcomes due to advances in neonatal care and modern incubators.

Misacarriage is the loss of a pregnancy before 20 weeks (usually less than 3 months) and occurs in 15-20% of all pregnancies. When a patient has 2 or more miscarriages in a row, the term repeat miscarriage is used. There are several conditions associated with repeat pregnancy loss that can be diagnosed and treated. Sometimes no cause is found. The use of aspirin and heparin is often useful in this condition.

Contrary to what is often believed, a woman may have a vaginal delivery after a previous cesarean section, although she must understand that there exists a small possibility of uterine rupture of the previous scar during labor. Among the patients who wish to try this option, the success rate is between 60% and 80%. The decisive factors include the type of incision performed, the condition of the placenta, the relative measurements of the fetus and the pelvis, and the fetal well being registered on the monitor. All this must be taken into account to decide on the best type of delivery. When vaginal birth is attempted it must be highly monitored, and fetal intolerance to labor may make another cesarean section necessary.

Smoking is a serious health risk for all women. If a woman smokes during pregnancy she is also putting the health of her future baby in danger. We help our patients to quit smoking by giving detailed information about the risks involved, as well as practical advice about effective therapies.