Educational Information

There are many resources that patients can turn to for information on various topics related to their health.  We hope to provide some basic facts on a variety of women’s health issues that can be a starting point for your research.


Topics in this section will continue to be added. If you have a particular topic

that you think would be interesting, please do not hesitate to let us know.

Alpha-fetoprotein (AFP)

Alpha-fetoprotein (AFP) is a protein released by the liver of the fetus. The amount of AFP circulating in the mother’sblood can be used as a screening test for defects in the neural tube development of the fetus such as anencephaly (scant or absent skull) or spina bifida (open spinal cord defect).  It can also be elevated in pregnancies complicated by abnormal closure of the abdominal cavity of the fetus. AFP is measured by a blood test drawn between 15-20 weeks of gestation.If the value is abnormal, you will be sent to the maternal-fetal medicine specialists for a targeted ultrasound that will look closely at the baby’s skull, spine, and abdomen, and offered an amniocentesis that is diagnostic. The false positive rate for AFP screening alone is quite low.


AFP can also be used in combination with other hormonal markers, between 15-20 weeks, to screen for Down syndrome (Trisomy 21) and Trisomy 18. Commonly known as the “quad screen” for the 4 hormones measured, this test has a higher false positive rate and a lower sensitivity than first trimester screening done by ultrasound and hormone screening (Ultrascreen®).  We prefer to do first trimester screening for this reason. However, if prenatal care is started after the window of opportunity for Ultrascreen®, this is an option for screening for trisomies 21 and 18.


Gestational Diabetes

Gestational diabetes is high blood sugar that starts or is first diagnosed during pregnancy. During your pregnancy, hormonal changes can cause the body to be less sensitive to the effect of insulin. These changes can lead to high blood sugar and diabetes. High blood sugar levels in pregnancy are dangerous for both mother and baby. Between 2 and 5 percent of expectant mothers develop gestational diabetes, making it one of the most common health problems during pregnancy.

Blood glucose levels return to normal after pregnancy in most women with gestational diabetes. 
Gestational diabetes rarely causes symptoms. For that reason, we routinely recommend a glucose screening test (also called a glucose challenge test or GCT) between 24 and 28 weeks of pregnancy to check for gestational diabetes.

Rho Gam®
Rh Negative Blood and Pregnancy

At your first prenatal visit, a blood sample will be drawn to assess your blood type and Rh factor. Blood types are A, B, AB and O.  The Rh (Rhesus) factor is an inherited trait that refers to a specific protein located on the surface of the red blood cells. Those who have the protein are Rh positive; without it, Rh negative.  The large majority of people are Rh positive.  It does not affect your health in any way, but it becomes important while you are pregnant.


During pregnancy, or even more likely, during delivery, there may be some of the baby’s red blood cells that mix with your blood. If you are Rh positive, there is no problem. However, if you are Rh negative and the baby’s blood is Rh positive, your body may build up antibodies after exposure to the baby’s red blood cells.  This usually does not affect the first pregnancy. However, there is a possibility with subsequent pregnancies that if your baby is RH positive, your antibodies may cross the placenta and attack the baby’s red blood cells.  This can cause Rh disease, which can include anemia and other potentially life threatening effects on the fetus.


If you are Rh negative, you have an option to test the blood of the baby’s father. If he is also Rh negative, then your baby will be Rh negative also. You then do not need to receive RhoGam®. However, if he is Rh positive (or not available to have blood drawn), and you are Rh negative,

we will draw your blood again around 28 weeks of gestation to check for antibodies in your blood.

If there are none, you will receive an injection of Rhesus immunoglobulin (commonly known as RhoGam®) to prevent antibody development during the remainder of your pregnancy. Common side effects include soreness at the injection site or a slight fever.  There are no harmful effects

to the baby.  RhoGam® does not contain preservatives such as mercury or thimerisol.


If your baby is Rh positive, you will receive another injection at the hospital after your delivery;

if the baby is Rh negative, no further medication is needed.


If you are Rh negative, there are other occasions when a dose of RhoGam® may be needed.

These include: miscarriage, ectopic pregnancy, chorionic villi sampling (CVS), amniocentesis,

or bleeding during pregnancy.


RhoGam® is administered at Morristown Medical Center. Your midwife will give you instructions

on taking your prescription there to obtain your injection.


Ask your midwife if you have any other questions about your Rh negative status.

Trial of Labor After Cesarean

After delivery by Cesarean section, a woman may choose to have a planned Cesarean birth

or choose a trial of labor for vaginal birth (VBAC-vaginal birth after Cesarean). It is likely that

70-80% of women who have a trial of labor after Cesarean (TOLAC) will be successful. Your provider's at Avalon want you to understand the risks and benefits of your choices. There is a certain amount of risk with every pregnancy. We share the same goals as you and your partner

- a healthy baby and a healthy mom. We will make every effort to ensure this outcome.