Pregnancy/Obstetric Services

Obstetrics

• We provide care for normal and high-risk pregnancies.  We feel strongly that you and your family be an integral part of the decision making process during your pregnancy, labor and the birth of your child.  We will always provide you with the necessary information and help guide you through all the important decisions to insure you have a healthy and happy pregnancy.  Our main goal is to help you have a healthy baby while also providing a good experience. 

Ultrasound

• We have onsite ultrasound services.  You will generally get 4 ultrasounds during your pregnancy. On you first visit we will do a confirmation ultrasound where we make sure that your baby has a heart beat and confirm your due date.  The second ultrasound is a screening for Down’s syndrome called the Nuchal Skin Fold/Nuchal Translucency or First Trimester Screen.  The third ultrasound (the one you have been waiting for) is the anatomy scan where we look at all the baby’s organs and parts to make sure everything looks normal (including the sex).  The fourth ultrasound is done around 28-30 weeks just to check the baby’s growth and position.  Occasionally other ultrasounds will be indicated but this would be determined by necessity. Visit our Ultrasound Page

Prenatal Care - Click here to visit our Prenatal page

High-risk pregnancies

• Diabetes: There are two kinds of diabetes in pregnancy.  The first is “pre gestational” meaning that you already have diabetes prior to becoming pregnant.  In this case you will likely be very familiar with taking care of your blood sugars.  There are some differences however when you are pregnant, so you will have a referral to a high risk MD and a dietician who will review these differences and help you keep good control of your blood sugar.  You will still see us in the office and be delivered by us.  The other type is “Gestational Diabetes” which is diabetes that develops in pregnancy.  We screen every pregnancy for this between 26-30 weeks.  If you have an abnormal screen then you will have another test, which is a “diagnostic test”, and if that test is abnormal then you have gestational diabetes.  At that point you will have a dietary evaluation and a consultation with a high-risk doctor.  Most women can control their blood sugar with their diet.  If blood sugar is not well controlled with diet, then we will start a pill or as a last resort insulin injections.
  
  
• High Blood Pressure: High blood pressure (hypertension) is one of the more common complications we deal with during pregnancy.  Women who have elevated blood pressure prior to the 20th week generally have what is called Chronic Hypertension and occasionally require treatment with oral medication.  Women who develop hypertension after the 20th week of gestation have what is called pregnancy-induced hypertension.  If you develop this we will want to watch you closely to make sure you do not develop Preeclampsia.  This is achieved with frequent visits for blood pressure checks and checking the urine for protein as well as blood work. Occasionally if you do develop Preeclampsia it could mean that your baby will need to be delivered.  Hypertension related to pregnancy generally resolves after delivery.
  
  
• Advanced Maternal Age: Anyone who delivers a baby after the age of 35 is considered advance maternal age and is increased risk for certain complications of pregnancy.  Patients who are older when they become pregnant are at a greater risk for certain birth defects such as Down’s syndrome.  They also are more likely to have other medical problems that complicate pregnancy such as hypertension, diabetes, thyroid disease etc.
  
  
• Thyroid disease: There are two types of thyroid disease, Hyperthyroidism (too much thyroid hormone) and Hypothyroid (too little thyroid hormone).   Hyperthyroidism is relatively rare in pregnancy and can be treated with medications.  Hypothyroidism is much more common and is treated with replacement thyroid hormone.  If you have hypothyroidism we will check your thyroid level at least every 2-3 months to be sure that you have enough.
  
  
• Multiples: With the advent of assisted reproduction the incidence of twins, triplets and higher order multiples are increasing.  Multiple pregnancies considered high risk because they are at increased risk for certain complications such as pre term labor/delivery, preeclampsia and diabetes.  We monitor twin pregnancies very closely with ultrasound and consultation with the perinatologist if necessary. 

Blood Clotting Disorders

• There are many diseases that cause your blood to clot more easily than it normally should. Many are genetic, some are acquired. There are blood tests to check for them that we can do in the office. Drs. Moore and Boulton have had many successful pregnancies of patients with these conditions.  As more and more of these diseases are discovered, the panel of labs gets more involved. In fact, two of the disorders we check for have been discovered in the past ten years and there are probably more to be discovered. These diseases have not been well studied in pregnancy. Most of the research is in the cardiovascular realm, but we think these diseases can cause miscarriage or even stillbirth. The theory is that clotting happens in the placenta or uterus blocking the blood supply to the developing baby. There are many safe treatments for them and Drs. Moore and Boulton are well versed in treating these various disorders.

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Women's Health

Gynecologic

• We offer full service gynecology, and can take care of most gynecologic issues.  We offer the latest office procedures for contraception, as well as abnormal bleeding.  We also perform surgery at Northside hospital ranging from minimally invasive surgery to complete hysterectomy. 

Annual Examinations

• This is a comprehensive exam where we will review your entire medical history focusing on any gynecologic issues.  We will discuss prevention, screening and treatments.  Screening tests that we offer are typically dependant on your age.   We can screen for sexually transmitted infections (Gonorrhea/Chlamydia/Trichamonas are done vaginally and HIV/Hepatitis/syphilis are done with a blood test).  We can also do your health maintenance screening for diabetes, cholesterol (please come fasting if you want this done), vitamin D level and thyroid and many other blood tests in the office. 

Vaccinations

• We offer vaccinations for Hepatitis A and B, Influenza, H1N1 (2009 flu season), HPV (guardasil), Tetanus, Diphtheria, and Pertussis (TDaP).

Birth Control

• We offer comprehensive contraception services in the office. 

Oral Contraceptives (birth control pills)

• There are many different choices on the market and we will consider your particular situation to find the pill that suites you the best.  They ALL provide contraception when taken correctly, however there are some differences that may make one pill a better choice for a particular person.  These have a daily dosing schedule.

Transdermal Contraceptive

• “The Patch” this works similarly to “the pill” but has some different side effects and weekly dosing schedule.

Vaginal Contraception

• “The Ring” aka Nuvaring also works similarly to the pill but has much lower side effects because of a lower dose of hormones.  The ring is inserted vaginally by you and lasts for one month.  If you are comfortable with the insertion process (it’s easier than a tampon), this is a great contraception for those who have trouble remembering to take a pill every day.

Intramuscular contraception

• “The shot” aka Depo-Provera works differently than the pill in that there is no estrogen with this method.  It is associated with abnormal bleeding especially in the first 6-9 months but eventually you may cease to have cycles at all.  This type of contraception has been associated with reversible bone loss (likely because of the lack of estrogen) and generally can only be used for 2 consecutive years

Intrauterine Contraceptives

• “The IUD” aka Mirena or Copper IUD – these are devices that are placed in your uterus  by a doctor in our office.  The Mirena IUD uses progesterone for contraception and lasts for up to five years.  The Copper IUD uses copper and is good for up to ten years.  Placement is similar to a pap smear but a little more uncomfortable.  We help decrease this pain with local anesthesia. If you have complications or want the IUD out prior to it’s life expectancy, we can take it out at any time in our office.  (maybe link to Mirena here-www.Mirena-us.com)

Permanent Contraception

• “tubes tied”- We provide this procedure in the office with the “Essure device”  (link to Essure).  It is a procedure that is done through the vagina with local anesthesia.  No incisions are involved.  We can also tie your tubes in the hospital under general anesthesia (“going to sleep”) using a laparoscopy. 

Colposcopy

• This a procedure done in the office to evaluate abnormal pap smears.  It is a very detailed examination of the cervix.  A speculum will be placed just like a normal pap smear, then we will put vinegar on the cervix and evaluate it with a special microscope designed to look at the cervix.  The vinegar makes abnormal cells turn white therefore making them easier to see.  If there are any abnormalities a biopsy will be taken of that area.  This procedure is generally not considered painful, other than some mild menstrual type cramping. 

Abnormal Bleeding

• This is a VERY common problem that has many different causes.  We will take a detailed history about your bleeding and based on your age and history will decide what testing you need.  Generally you will have an ultrasound, blood count and thyroid check or other testing if necessary.  Based on those findings we will discuss a treatment plan with you in detail.  Generally we can treat this problem medically with hormones/birth control or with a minimally invasive surgery occasionally it will require major surgery. 

PMS

• “Premenstrual syndrome” also is a very common problem.  It is generally characterized by mood swings/irritability around the time preceding the menstrual cycle.  Other symptoms are bloating/breast tenderness/abdominal discomfort in general just not feeling well around the time of the cycle.  Most of these symptoms are normal signs that your period is coming but occasionally they can become debilitating which is when evaluation and treatment become necessary.

Endometriosis

• This is a condition that we deal with frequently.  It is usually marked by pelvic pain that may or may not get worse around the time of the cycle.  It is caused by endometrial tissue (the tissue that causes you to bleed when you are on your cycle) that has migrated out of the uterus usually into the abdominal cavity.  It is generally a diagnosis that is made just upon your history however if you have had greater than 6 months of pain that is unrelenting with medical treatment it may mean that you need a laparoscopy to confirm the diagnosis or treatment with a laser.  There is also a medication called Lupron that had been used with good success to treat this condition.  (maybe link to lupron website)

Polycystic Ovary Syndrome (PCOS)

• This is a disorder where the ovaries do not produce an egg each month.  Ovulation is what drives the menstrual cycle so when an egg is not produced it throws off the entire cycle making menses irregular.  Other symptoms of this can be acne, obesity, abnormal hair growth (usually male pattern such as facial hair) and infertility.  Treatment for this disorder generally depends on desire for fertility, if you are attempting pregnancy you will take a fertility medication, if not you will take progesterone or birth control pills.  If you have PCOS it is vitally important that you have regular periods unless you are taking medications to suppress your periods.

Menopausal evaluation/treatment

• Menopause can be a very difficult time for women.  There are many changes in hormone levels and changes in your body.  This is a time of life when it is good to have a doctor with whom you are comfortable discussing these changes and coming up with a treatment plan that is right for you and your body.  Hormone replacement therapy is not right for everyone, but will definitely benefit some.  We treat each patient on a case-by-case basis and make a decision with you based on your symptoms, medical issues and family history.  We will also evaluate and treat you for osteoporosis/osteopenia (low bone mass). 
  
  

There are also many other gynecologic issues that we care for that were not mentioned, but we welcome you to discuss any issues or questions you may have at your appointment, if it is something that we do not take care of we could certainly point you in the right direction.

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Surgery

Luckily, modern medicine has made surgery less necessary than it was fifty years ago. We can handle many problems that required surgery in the past with medicines or less invasive procedures. When surgery becomes the best option, Dr. Moore is well trained in the most complicated of surgeries as well as the latest minimally invasive techniques.

Laparoscopy is a technique used to treat many gynecologic problems. It is a non-evasive surgery that is done through tiny abdominal incisions. The largest is about a half-inch long and is inside the navel. Through this incision we place a long tube with a camera and light called a 'laparacope,' to perform the surgery. Using this technique we can do things such as remove ovarian cysts, laser endometriosis, diagnose many causes of pelvic pain, and remove scar tissue.

Hysteroscopy is another modern technique that involves no incisions and can treat many problems that traditionally required a large incision. The hysteroscope is similar to the laparoscope but is inserted into the cervix which is the opening of the uterus that dilates when you're having a baby. Using this technique, we can remove polyps, fibroids, and other abnormalities inside the uterus.

These are just a small sample of the surgical procedures we provide our patients. Please feel free to call the office if there is a procedure you have specific questions about.

Pregnancy/Obstetric Services

• Obstetrics
• Prenatal care
• Ultrasound (4D and 3D)
• High risk pregnancies
  
• Blood Clotting Disorders

Women's Health

• Gynecologic
• Anual Examinations
• Vaccinations
• Birth Control
• Oral Contraceptives
• Transdermal Contraceptives
• Intramuscular Contraception
• Intrauterine Contraception
• Permanent Contraception
• Colposcopy
• Adnormal Bleeding
• PMS
• Endometriosis
• Polycystic Ovary Syndrome
• Menopausal Evaluation

Infertility

• Evaluation
• Treatment
• Referral

Surgery

• Office
• Minor/Outpatient    
• Major Surgery