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Our passion is to partner with women through the continuum of life
by providing premier medical and surgical care that is patientcentered, high quality and comprehensive in an academic setting.
WELCOME TO COLLEGE HEIGHTS OBGYN ASSOCIATES
and
Congratulations on Your Pregnancy!
We are looking forward to getting to know you and caring for you and your baby these next several months.
Please take the time to review all enclosures. They provide valuable information and explain the blood work
you will require. There are also several forms that should be completed prior to your first visit.
Your first visit is an important one and we encourage you to bring your spouse or partner. First, you will meet
with the nurse who will review your medical history and provide you with further information regarding all
aspects of your pregnancy care. At your first visit with a medical provider you will have an ultrasound and
physical exam. The providers will be able to review and discuss all of your concerns during that visit.
Please arrive 15 minutes prior to your appointment and be certain to bring your insurance card and copayment, a photo ID, a list of your current medications including strength and dosage, and any required
referral forms.
In an effort to better serve our patients, our office has implemented an electronic medical record (EMR). This
new system will make it easy for us to share information with you and members of your care team. Most
importantly, this system will allow us to provide a safer, more efficient healthcare experience for you.
Additionally, our office can accommodate those patients who utilize email for scheduling appointments,
prescription refills, or non-urgent medical questions.
Please visit our website at www.chobgyn.com for additional information regarding our practice and providers.
Sincerely,
The Patient Care Team of College Heights OBGYN Associates
1245 S Cedar Crest Blvd STE 201
Allentown, PA 18103-6267
610-437-1931
1665 Valley Center Pkwy STE 130
Bethlehem, PA 18017
610-317-0208
2101 Emrick Blvd STE 201
Bethlehem, PA 18020
484-895-3230
333 Normal Avenue STE 202
Kutztown, PA 19530
610-683-5522
Health Center at Trexlertown
6900 Hamilton Blvd
Trexlertown, PA 18087
484-664-2970
Revised: 12-05-2012
LVPG-COLLEGE HEIGHTS OBSTETRICAL & GYNECOLOGICAL ASSOCIATES
WHAT TO EXPECT DURING YOUR FIRST VISIT AND OUTLINE OF YOUR PRENATAL CARE
At your initial obstetrical visit, you will meet with one of our obstetrical nurses who will take your medical history and
review pertinent pregnancy information. This will take approximately one hour.
You also will be given a laboratory slip for initial prenatal blood work. These tests include:

Complete Blood Count – to check for low iron or anemia.

RPR – to screen for syphilis.

Rubella – to check for immunity to German measles.

Hepatitis – to screen for hepatitis B.

HIV test – The American College of OBGYN recommends HIV screening for all pregnant women.

Blood type and Rh screen – to determine the mother’s blood type. If a woman is Rh negative, she will need RhoGAM
(an injection) during the pregnancy to prevent Rh incompatibility.

Antibody Screen – to screen for other blood incompatibilities.

Other tests may be ordered depending on medical and family history. (I.e. blood glucose screening, thyroid function
testing, EKG, etc).
At the following visit, you will meet with one of our providers who will review your history, answer any questions, and
do a complete physical exam including a Pap smear and cervical cultures.
WHAT YOU CAN EXPECT DURING YOUR PRENATAL CARE COURSE
Initially, you will be seen every four weeks. At 32 weeks, your visits will be every two weeks until 36 weeks, at which
time you will come every week.
Other highlights include the following:
 Initial visit – outlined above.
 9-10 week visit –ultrasound to confirm your due date
 11-13 weeks—First part of “sequential screen” to be performed at Maternal Fetal Medicine
 16 week visit – Second part of “sequential screen” to be performed at Maternal Fetal Medicine
 18-20 week visit – Level II ultrasound.
 28 week visit – lab work to evaluate blood count and screen for gestational diabetes, delivery consents and hospital
registration.
 36 week visit – vaginal culture to check for a bacteria called Group B Streptococcus (GBS).
Of course, your visit frequency, lab work and followup will depend on any problems that may be encountered in the
pregnancy.
Revised: 03-05-2012
LVPG-COLLEGE HEIGHTS OBSTETRICAL & GYNECOLOGICAL ASSOCIATES
FAMILY AND MEDICAL HISTORY QUESTIONNAIRE
Name: ________________________________________________
Appt. Date _____/_____/_____
DOB: _____/_____/_____
Appt. Time: _______________
MR# __________________________
Please bring this form with you to your appointment.
Yes
___
No
___
1. Are you 34 years or older?
Comments:
_____________________________
___
___
2. Is the father of your baby 55 years or older?
_____________________________
___
___
3. Are you and the father of your baby blood relatives?
______________________________
___
___
4. Have you had a stillborn or more than one miscarriage? ______________________________
___
___
5. Do you have diabetes? Are you insulin dependent?
______________________________
___
___
6. Do you have seizures or epilepsy?
______________________________
___
___
7. Do you have any other medical conditions for which
you receive treatment?
______________________________
8. What countries are your ancestors from originally?
(Be specific, i.e., England, Africa, Vietnam) Myself:
Father of baby:
______________________________
______________________________
______________________________
___
___
___
___
9. Are either of you Jewish, French Canadian or Cajun?
___
___
10. Have you had the Expanded AFP Blood test? If so, when? ___________________________
Do you or the father of your baby:
___
___
___
___
___
___
___
___
___
___
___
___
___
___
11. Have any birth defects, handicapping condition or
disorder that might be hereditary?
______________________________
12. Have any previous children with birth defects,
handicaps, or genetic disease?
______________________________
13. Have any children who died (other than accidental?)
______________________________
14. Have a brother, sister or parent with a handicap,
birth defect or genetic disease?
______________________________
15. Have any uncles, aunts, cousins, grandparents, nephews
or nieces with birth defects or genetic diseases?
______________________________
16. Know of any family member with mental retardation
(even mild) or learning disabilities?
______________________________
17. Have any family members who have had multiple
miscarriages or a stillbirth?
______________________________
Family and Medical History Questionnaire - Page 1 of 2
LVPG-COLLEGE HEIGHTS OBSTETRICAL & GYNECOLOGICAL ASSOCIATES
FAMILY AND MEDICAL HISTORY QUESTIONNAIRE
Please check any of the following that might be in either of your families and indicate who in the family is affected.
___ Anencephaly (open skull)
___ Kidney disease (i.e., polycystic kidney)
___ Anemia
___ Limb defects
___ Blindness
___ Mental illness
___ Cancer
___ Mental Retardation
___ Chromosome abnormality
___ Muscular dystrophy/Myotonic Dystrophy
___ Cleft lip/palate
___ Neurofibromatosis
___ Cystic fibrosis
___ Neurologic or degenerative disorder
___ Deafness
___ Phenylketonuria (PKU)
___ Down Syndrome
___ Sickle cell anemia
___ Epilepsy or seizures
___ Skeletal problems (like easily broken bones, dwarfism)
___ Heart defect
___ Skin diseases (including dark or light patches of skin)
___ Hemophilia (bleeding tendency)
___ Spina bifida (open spine)
___ Huntington’s Chorea
___ Thalassemia (Mediterranean anemia)
___ Hydrocephalus (water on the brain)
___ Urinary tract disease
___ Birth defects or inherited disorders not listed above:______________________________________________________________
___ None of the above:
Environmental Exposure History
Yes
No
Have you…
___
___
Taken any prescription drugs or over the counter medications since becoming pregnant?
Circle any that apply: Accutane, Epilepsy medication, Lithium, Blood thinner (anti-clotting)
Other: ___________________________________________________________________
___
___
Had an illness or infection during pregnancy?
___
___
Had a fever over 101 degrees or taken saunas or whirlpool baths during pregnancy?
___
___
Had x-rays or surgery since becoming pregnant?
___
___
Had alcohol during your pregnancy?
___
___
Smoked during your pregnancy?
___
___
Used any other drugs during your pregnancy?
Anything else not mentioned above or any comments you would like to make about your answers to any of the questions on this form?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
3/01
Adapted From:
Table 2-1
Maternal Fetal Medical Saunders 4th Edition—1999
University of California, San Diego, Department of Medical Genetics, Center for Fetal
Diagnosis and Treatment
Revised: 08-22-2007
Family and Medical History Questionnaire - Page 2 of 2
LVPG-COLLEGE HEIGHTS OBSTETRICAL & GYNECOLOGICAL ASSOCIATES
PRENATAL GENETIC TESTING
The chance of having a baby with a birth defect or chromosomal abnormality can be related to one’s family history,
environmental exposures and the mother’s age. Often, however, a specific underlying factor cannot be found.
During pregnancy, there are a few tests available to screen and diagnose some of these abnormalities. There are many
abnormalities, however, which cannot be diagnosed prenatally. It is important to understand the difference between a
screening test and a diagnostic test.
 A screening test is done to look for the presence or absence of a given condition in apparently normal individuals. The
results of a screening test, however, may or may not mean that the individual or baby is affected. In other words, a
screening test may be “falsely positive” – meaning it comes back “abnormal” when the individual is actually
“normal” or, it may be “falsely negative” – meaning the test result is “normal” when the individual is actually
“abnormal.”
 A diagnostic test, on the other hand, produces direct data that is virtually 100% accurate.
Described below are the most common conditions for which testing (both diagnostic and screening) is available during
pregnancy:
1. Neural Tube Defect. Malformation that affects the spinal column or brain of the baby. Approximately 1 or 2 out of
1,000 babies are born with this defect. The two main types of neural tube defects are anencephaly and spina bifida.
Screening for this is done via maternal blood sampling for alpha fetoprotein, or AFP in the second trimester.
2. Down Syndrome (Trisomy 21). A condition in which the baby has extra genetic material (that is, one extra copy of
chromosome number 21). Babies born with Down syndrome have a distinctive physical appearance, mental
retardation, poor muscle tone and a higher frequency of heart defects. On average, 1 out of 800 babies are born with
Down syndrome. The risk of having a baby with Down syndrome increases as the mother’s age increases. Diagnostic
studies for this include the CVS or amniocentesis. Screening studies for this include all those described below.
3. Trisomy 18. Another condition in which the baby has extra genetic material (one extra copy of chromosome number
18). Like Down syndrome, the risk is greater in women age 35 or older and it is a condition with similar outcomes as
in Down syndrome. Trisomy 18 occurs in only 1 out of 8,000 births and approximately 80% of these infants die
within the first year of life. Diagnostic studies for this include CVS or amniocentesis. Screening studies include those
described below.
On the next pages is a summary of the prenatal/genetic options which are currently available for our patients.
These will be discussed and reviewed with you at your first prenatal visit. It is also important to understand that
certain tests may be offered to you because of your family history or your age. If there is a specific disorder for which
there is genetic testing or if your age is 35 years or more, a “diagnostic” test will be offered because of the increased
likelihood of finding an abnormality.
Page 1 of 3
Prenatal Genetic Testing
Page 2 of 3
DIAGNOSTIC TESTS
 FIRST TRIMESTER

CVS: This diagnostic test stands for chronic villus sampling. It is a procedure that is done between 10-12 weeks
of pregnancy. A sample of placental tissue is removed through the abdomen or vagina. The retrieved tissue is
then grown up in the laboratory and specific genetic and chromosomal abnormalities are looked for. The
pregnancy loss rate or miscarriage rate is about 1:100 procedures. Other possible complications include rupture of
membranes, bleeding and infection. The results of this test take about 12-14 days
 SECOND TRIMESTER

Amniocentesis: This diagnostic procedure is performed between 16-18 weeks of pregnancy. It involves
withdrawing some of the amniotic fluid from around the baby within the maternal abdomen. Sloughed off fetal
cells within the fluid are then grown up in the laboratory and specific genetic and chromosomal abnormalities are
looked for. The pregnancy loss rate, or miscarriage rate is about 1:200 procedures. Other possible complications
include rupture of membranes, bleeding, infection, needle marks on the baby’s skin. The results of this test take
about 12-14 days.
SCREENING TESTS
 FIRST TRIMESTER and SECOND TRIMESTER

Sequential Test: This is a two part test.

Part One: Between weeks 11 and 13, a small amount of blood is drawn from mom; and an ultrasound
measurement of the nuchal fold, an area in the neck which can accumulate fluid in abnormal fetuses, is taken.
The information from this test provides you with your risk of having a baby with Down syndrome and
Trisomy 18. If this test shows an increased risk, you will be offered a diagnostic study (CVS-chorionic villus
sampling) to confirm the results of the initial screening test.
**This test alone detects approximately 70% of babies with Down syndrome and 80% of babies with
Trisomy 18.

Part Two: If part one deems you as “low risk” you will have additional blood work between 15 and 22
weeks. These results will be combined with the part one screening information to give a final risk assessment.
This will have screening information regarding Down syndrome, trisomy 18 and open neural tube defects. If
this final screen shows an elevated risk, then you will be offered a diagnostic study (amniocentesis) to
confirm the results.
**This test detects approximately 90% of babies with Down syndrome, 90% of babies with trisomy 18
and 80% of babies with open neural tube defects.
**If your “part-one” screen is positive and you go on to have a diagnostic test performed in the first trimester,
a blood test will be recommended in the second trimester called the AFP test which screens for neural tube
defects -- part one of the sequential screen alone does not estimate the risk for this finding.
We understand that the choice for this testing is confusing and sometimes frustrating. Please give some thought to the
above options before your initial visit. We are happy to discuss them further, answer your questions and provide any
additional information to ease the decision making process.
********************************************
Prenatal Genetic Testing
Page 3 of 3
Genzyme Genetics’ Comprehensive
Maternal Serum Screening Program
Providing a range of prenatal screening options
Screening Parameters
Down syndrome
detection rate
False positive rate
Trisomy 18
detection rate
Biochemical markers
NT (nuchal fold)
Timing
Neural tube
detection rate
Sequential Screen
Part one
Sequential Screen
Parts One and Two
70%
5%
90%
3.7%
80%
PAPP-A
hCG
NT
1st Trimester
90%
PAPP-A
AFP
hCG
uE3
Inhibin
NT
1st and 2nd Trimester
***
80%
Detection rates are based on statistical results of large multi-center prospective studies.
See, e.g., SURUSS J Med Screen 2003 10:56-104
Revised: 02-17-2011
LVPG-COLLEGE HEIGHTS OBSTETRICAL & GYNECOLOGICAL ASSOCIATES
PRENATAL GENETIC DIAGNOSIS
The chance of having a birth defective or abnormal baby can relate to the mother's age. Some babies have abnormalities
of chromosomes that result in various diseases, the most common of which is Down's syndrome. Children with Down's
syndrome can have a wide spectrum of problems including heart defects, bowel abnormalities, mental retardation as well
as the characteristic physical appearance of the mongoloid face. In addition to Down's syndrome, there are other
chromosome problems that can affect your baby, although these are generally more rare than Down's syndrome.
The chance of having a baby with chromosome abnormalities, especially Down's syndrome increases with the mother's
age according to the following chart:
Mother's Age
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
Revised: 08-22-2007
Down's Syndrome
1/1,667
1/1,667
1/1,429
1/1,429
1/1,250
1/1,250
1/1,176
1/1,111
1/1,053
1/1,000
1/952
1/909
1/769
1/602
1/485
1/378
1/289
1/224
1/173
1/136
1/106
1/82
1/63
1/49
1/38
1/30
1/23
1/18
1/14
1/11
Any Chromosomal Disease
1/526
1/526
1/500
1/500
1/476
1/476
1/476
1/455
1/435
1/417
1/385
1/385
1/322
1/286
1/238
1/192
1/156
1/127
1/102
1/83
1/66
1/53
1/42
1/33
1/26
1/21
1/16
1/13
1/10
1/8
CYSTIC FIBROSIS INFORMED CONSENT / REFUSAL
Genetic Carrier Testing
Cystic fibrosis (CF) is a genetic disease that causes thick, sticky mucus to build up in the lungs and digestive system and other
organs of the body. This mucus leads to chronic lung infections and difficulty digesting food and nutrients. The treatment of CF
depends upon the severity of symptoms and the organs involved. Using genetic information, tests can be offered to determine if
a person might have a child that may have certain diseases or healthcare needs, such as cystic fibrosis (CF).
A genetic test is most often given to expectant parents. It can be used to confirm a diagnosis of CF, but the test to diagnose CF
is the sweat test. For someone to have the disease, two copies of the defective CF gene must be inherited – one from each
parent. A carrier has only one copy of the CF gene mutation and, thus, does not have the disease or symptoms.
Genetic carrier testing can be used to tell if a person carries one or more mutations of the CF gene and how many copies of each
mutation. The test looks at a person’s DNA (genetic material) which is taken from cells in a blood sample or from cells that are
gently scraped from inside the mouth.
Although only about one of every 3,000 Caucasian newborns has CF, there are more than 1,000 known mutations of the gene
that causes CF. Current tests look for the most common mutations.
The mutations screened by the test vary according to a person’s race or ethnic group, or by the occurrence of CF already in the
family. More than 10 million Americans, including one in 29 Caucasian Americans, are carriers of one mutation of the CF
gene. In other races or ethnicities, one in 46 Hispanic Americans, one in 65 African Americans, and one in 90 Asian Americans
carry a mutation of the CF gene.
If you have a relative with CF or who is known to carry a mutation of the CF gene, your chances of carrying a mutation are
greater because of your family’s history. If you are pregnant or planning to have a child, you should discuss this test and the
results with a health professional who is knowledgeable about genetic testing, such as a genetic counselor.
Genetic Carrier Testing: More than 10 million Americans who are without symptoms are carriers of the defective CF gene.
This test can help detect carriers who could pass CF onto their children. To have cystic fibrosis, a child must inherit one copy
of the defective CF gene from each parent.
Each time two carriers of the CF gene have a child, the chances are:
 25% the child with have CF
 50% the child will carry the CF gene but not have CF
 25% the child will not carry the gene and not have CF.
I understand that carrier tests can only determine if a person might have a child that may have cystic fibrosis; the tests
cannot guarantee that a child will or will not have this disease.
I have read the above information and I understand that I can be tested for CF or that both parents may be tested. I further
understand that if I am a carrier and the other parent is not, there is still a possibility that the newborn may have CF. If both
parents are carriers, additional testing can be done. I further understand that I can withdraw this consent prior to the test being
performed.
I have had the opportunity to ask questions, and all of my questions have been answered.

I want Cystic Fibrosis Screening
_________________________________________
Patient Signature
_________________________________________
Date
Copied: 06-30-2010

I do not want Cystic Fibrosis Screening
_________________________________________
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