Vitamin K Prophylaxis and Erythromycin Ophthalmic Ointment

You may have heard the term “eyes and thighs,” which is commonly used in hospitals and obstetrics settings across the country.  What Nurses, Midwives, and Doctors are referring to is Vitamin K Prophylaxis and Erythromycin Ophthalmic Ointment. These are two procedures that occur typically during the first hour of life for the newborn. 

Vitamin K is an injection given to the newborn, in the thigh, “immediately” after birth, in an effort to prevent hemorrhagic disease of the newborn also known as Vitamin K Deficiency Bleeding (VKDB), which can produce serious health problems and possibly death.  Newborn babies are especially at risk due to inadequate prenatal storage of Vitamin K as well as insufficient availability of Vitamin K in the breastmilk (regardless of how much is consumed by the mother).  Newborns begin to develop Vitamin K stores shortly after birth, however, the level found in their blood, up to the age of 6 months, can be inadequate.  A one time injection of Vitamin K into the thigh reduces the risk of VKBD by 81%, according to the Centers for Disease Control (CDC)

Erythromycin Ophthalmic Ointment is a medication administered to the eyes of the newborn within an hour after birth to prevent ophthalmia neonatorum otherwise known as Newborn Conjunctivitis.  Newborn babies are at risk for developing eye infections from various pathogens (bacteria) found in the mothers vagina at birth.  This “vaseline like” ointment which contains Erythromycin is used to specifically combat Gonorrhea or Chlamydia, which may have been passed to the newborn through the birth process.  Newborn conjunctivitis can lead to blindness, meningitis and bacterial infections of the blood stream.  A single bead of Erythromycin administered to each eye reduced the risk of transmission by 80%, according to the Centers for Disease Control (CDC).

Group Beta Strep (GBS) Prophylaxis

Group B Streptococcus is a bacteria that naturally comes and goes within the body, and is commonly found in the GI tract.  During pregnancy, it is the standard of care to screen all women for a colonization of this bacteria within the vagina and rectum.  Approximately 25-31% of women will have a colonization of GBS at 36 weeks of their pregnancy.  By identifying this bacteria within the vagina/rectum, we can adequately treat the mother with antibiotics during labor and birth to prevent the transmission of GBS to the newborn.  

Treatment of the mother with beta-lactum antibiotics, such as Ampicillin, will reduce the newborn’s risk of transmission from 1 in 200 to 1 in 4,000, according to the Centers for Disease Control (CDC). Newborns who contract GBS from their mothers, are at risk of developing fever, difficulty feeding, difficulty breathing, lethargy and bluish skin color.  These signs of GBS infection will need to be treated immediately in a hospital setting to prevent systemic infections from occurring in the newborn.  

Newborn Metabolic Screening

When the Midwife returns to your home for your first Postpartum visit within 48 hours of delivery, a full health assessment will be performed on your baby.  This will include a head-to-toe physical exam, measuring and weighing the baby, as well as assessing breastfeeding.  Additionally, a blood sample will be obtained from the newborn to screen for metabolic disorders.  The Newborn Metabolic Screen is a simple test, developed to identify metabolic disorders which with early intervention, can be treated or cured.  We start by warming the infants heel with a warm wash cloth or hot pack, then cleaning it with alcohol, using a sterile lancet to incise the skin by approximately 1mm, at that time 5 drops of blood are collected on a card with the baby’s identifying information.  This information is sent to the Florida State Laboratory and is tested for 55 metabolic disorders.  More information about the procedure can be found here

The second component of the metabolic screening is a screening for Congenital Heart Defects

This procedure is simple and non-invasive and is performed with a Newborn Pulse Oximeter, which the Midwife will bring to your postpartum exam. By measuring both post- and pre-ductal pulse oxygen saturation levels, we are able to identify approximately 75% of Congenital Heart Defects, according to the American Academy of Pediatrics (AAP)

Non-Invasive Prenatal Testing (NIPT)

NIPT is a method of determining the risk that your fetus will be born with a certain genetic abnormality.  This information is obtained via a maternal blood draw, just like routine blood work at your health care providers office, or in your home.  This specimen is sent to a specialized lab with your identifying information, as well as specific information about your pregnancy.  The specimen is then analyzed for cell-free DNA from the placenta, which can be used to identify chromosomal abnormalities like Trisomy 21 (Down Syndrome), Trisomies 13 and 18, as well as deletions or additions in sex chromosomes X and Y.  

We can offer this testing as early as 10 weeks into your pregnancy and anytime thereafter.  While this test is usually covered by your insurance provider, there may be some criteria for inclusion of testing.  

Glucose Challenge Test (GCT)

During your pregnancy, around 26-28 weeks, you will be screened for Gestational Diabetes. Gestational Diabetes Mellitus (GDM) is a condition that can affect any woman during their pregnancy. While their are specific risk factors, a screening is offered to all women upon entering the third trimester, to identify those at risk.  Gestational Diabetes can lead to an increased risk of developing Type II Diabetes for both mother and baby, hypertension during your pregnancy, the fetus growing larger than recommended, increased risk of a cesarean delivery, neonatal hypoglycemia, and respiratory distress syndrome.  

This test will be performed during a routine lab draw upon entering the third trimester.  Your Midwife will bring a specially measured beverage called Glucola to your appointment, and have you drink it when she arrives.  Then an hour after you have finished the glucola, she will draw your blood.  Once analyzed at the lab, this test will determine how well your body metabolizes glucose in one hour.  If your lab results are below a specific threshold, then you have “passed” and your risk of developing Gestational Diabetes is relatively low, if the result is high, then a diagnostic test will be performed to rule out Gestational Diabetes. 

Pap Screening 

You may have experienced a pap during your annual exam in the past.  A pap test or Papanicolaou test is a screening for cervical cancer.  This is an important early intervention tool for women of childbearing age and beyond. We offer pap testing both at the beginning of your pregnancy and at your 6 week postpartum visit.  Everyone, regardless of personal history or risk factors, should be screened, however, there are guidelines that are recommended through the American College of Obstetricians and Gynecologists ACOG and the American Society for Colposcopy and Cervical Pathology ASCCP.  

This simple procedure can be completed in the privacy of your home or at our office location. 

Rho (D) immune globulin

If your initial blood work indicates that you are Rh factor negative, then you will be counseled on administration of Rho(D) immune globulin, sometimes referred to as RhoGAM.  RhoGAM is a prescription medicine that is used to prevent Rh isoimmunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood.

Routine Laboratory Testing

In accordance with the American College of Obstetricians and Gynecologists (ACOG), as well as the regional standard of care, there are routine laboratory tests that we offer to all clients in our care.  Below, you will find a comprehensive list of what is offered.  Keep in mind that throughout pregnancy, certain symptoms may warrant additional or further testing.  If that is the case, the Midwife will discuss the specific testing that is recommended and discuss risks and benefits of testing with you. 

  • Antibody screen will be obtained in the first trimester, at 28 weeks and at 36 weeks if you are Rh factor negative, depending on administration of Rhogam. 
  • STI Panel at 28 weeks is recommended but elective. 
  • TSH may need to be re-screened if low in first trimester. 

At each routine prenatal visit you should expect, in addition to obtaining a verbal history of symptoms, recall of nutrition and exercise, evaluation of mental well-being and fetal well being (kick counts), education and information, the following basic “procedures” are obtained:

  • Maternal weight (obtained to ensure proper weight gain)
  • Urine sample (to analyze components of urine which are indicative of concerns)
  • Temperature (to screen for fever and disease process)
  • Pulse (to screen for appropriate oxygen saturation and pulse)
  • Blood Pressure (for evaluation and screening of hypertension)
  • Fundal height (to determine fetal growth)
  • Leopolds palpation (to determine fetal lie and size)
  • Fetal Heart Tones (to determine fetal well being and heart rate)