Thomas Jefferson UniversitySidney Kimmel Medical College

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An Introduction to Our Practice

Welcome to our practice and congratulations on your pregnancy! Thank you for choosing us to care for you during this exciting time. We will do our utmost to make this unique experience pleasant and rewarding for you. On the following pages you will find answers to some of the questions we are commonly asked by our patients. We hope you will find this a helpful reference.

Our Practice

  • Currently, the Maternal Fetal Medicine Practice is staffed by three full-time perinatologists: Dr Vincenzo Berghella, Dr. Stuart Weiner, and Dr. Jason Baxter.
  • In addition to our perinatologists, six Maternal-Fetal Medicine fellows actively assist in the care of our patients. Fellows are fully trained, board certified or board eligible obstetrician/gynecologists who have completed their Ob/Gyn training and are now completing an additional three years of education and training to become perinatologists.
  • Carol Sudtelgte is a nurse-midwife and will help coordinate your care, answer your questions outside of your office visits, and see you for some of your routine OB care.
  • Alexa Herman is the nurse in our Fetal Therapy Center. She cares for our patients whose pregnancies are affected by a wide range of possible and diagnosed genetic and anatomic abnormalities. She also coordinates prenatal screening procedures, such as Sequential Screening, CVS, and amniocentesis.
  • In addition, our team also includes highly trained utltrasonographers, genetic counselors, and an antenatal testing nurse who are all available to provide you with the specialized care you may need.
  • During nights and weekends, we share emergency hospital call with our colleagues in Jefferson Women's Medical Specialties. One of our perinatologists is always available, however, to care for patients with high-risk issues.

Important Phone Numbers

Emergencies: 215-955-7500

If you have an emergency during office hours or at any time when the office is closed and you need to speak with a physician immediately, call (215) 955-7500. An operator will respond and have a physician return your call. In the event of a true emergency and if you are unable to wait for the doctor to return your call, please call and leave a message stating the nature of your emergency and proceed directly to the Emergency Department or Labor and Delivery at Jefferson Hospital, located at 10th and Sansom Streets. Go to the nearest hospital if the nature of your emergency makes it unsafe to travel to Jefferson.

Appointments: 215-955-7500

You can schedule appointments for follow-up and postpartum visits, non-stress tests, and ultrasounds by calling the number above. You can also schedule your return visits at the front desk when you check out after your appointment. Should you need frequent visits, we encourage you to schedule several appointments in advance so we can best accommodate your needs.

Non-Emergency Questions and Problems: 215-955-7697

If you have a question or problem that is not an emergency, you can call Carol at (215) 955-7697. Most calls are returned within several hours and all calls that are of a non-urgent nature are returned within 24 hours.

Prenatal Screening Tests and Genetic Counseling & Education: 215-955--2112

Alexa Herman will help you schedule prenatal screening procedures and tests (CVS, amniocentesis, Sequential Screens, First Trimester Screens) as well as genetic counseling and education. Please leave a message on her voice mail and she will contact you to arrange the appropriate testing. Please be sure to include your daytime telephone number(s), your due date, and the screening testing or counseling that you wish to schedule in your message.

Fetal Therapy: 215-955-1606

Alexa Herman, our fetal therapy coordinator. Her voice mail will give you instructions for reaching her by pager if you are unable to wait for a return call.

Important Symptoms

Many women experience various discomforts and physical changes during pregnancy. We are happy to answer your questions and suggest comfort measures and remedies. Please call us promptly, however, if you experience any of the following symptoms:

  • Bleeding or leaking fluid from the vagina
  • Severe abdominal pain or cramping
  • Pain, burning, or difficulty urinating
  • A fever of 101 degrees or greater
  • Vomiting and inability to keep liquids in your stomach for more than 12 hours
  • A noticeable decrease in the baby's movements once it has begun to move regularly
  • Contractions or frequent tightening of the uterus before 37 weeks of pregnancy
  • Severe or constant headaches unrelieved by rest
  • Sudden visual changes or spots or flashing lights in front of your eyes

Routine Visits

  • Generally, office visits are monthly until about 28 weeks, then every two weeks until about 35-36 weeks, and every week during the last month of pregnancy. This is a very general schedule, however, and some women may be seen more often or less depending on their condition.
  • Ultrasounds, fetal heart studies, non-stress tests, genetic counseling and testing, and office visits are all scheduled with different divisions of our practice. Each requires its own individual appointment with the appropriate professional in our department. If you need to schedule more than one kind of appointment on the same day, please be sure to tell the person who is scheduling your follow-up visit. She will make every effort to coordinate your appointments and schedule them back-to-back.

Routine Tests

  • On your first visit, we will check your blood count, blood type and Rh factor, your immunity to rubella, and for possible exposure to Hepatitis B, HIV, and syphilis. We will offer you Cystic Fibrosis carrier screening. Other tests may be done according to your particular needs.
  • We will discuss the various options available to you for screening for Down Syndrome and Trisomy 18 in the first or second trimester as well as screening for neural tube defects (such as spina bifida) and open abdominal wall defects (where skin and muscles do not properly cover the baby's internal abdominal organs) in the second trimester. We will offer you genetic counseling and testing when it is indicated.
  • Between 24 and 28 weeks, we will do a glucose tolerance test to be sure you are not developing diabetes during your pregnancy. At the same time, we will check your blood count for anemia.
  • Between 26 and 28 weeks, for those women whose blood type is Rh negative, we will check your blood for antibodies and give you a shot called "Rhogam" to keep you from becoming sensitized.
  • At about 36 weeks of pregnancy, we will do a swab of your vagina to check for a germ called Group B Strep (GBS). This is an organism that is harmless to mothers but can cause infections in newborns.

Ultrasounds

  • An ultrasound is usually done in the early weeks of your pregnancy to help us confirm your "due date".
  • Another ultrasound is generally done between 18 and 20 weeks of pregnancy to do a basic check of the baby's anatomy and to look at the location of your placenta. We can often see if you are carrying a boy or girl during this ultrasound, and we will tell you only if you want to know. You must keep in mind, however, that ultrasound is not 100% accurate in determining the sex of your baby.
  • Your partner and family are always welcome to join you for your ultrasound and you are usually given a picture to keep. We are, however, unable to videotape your ultrasound.
  • Additional ultrasounds are scheduled when we need more information to help us safely manage your pregnancy. Follow-up ultrasounds are determined on an individual basis.

The Baby's Heartbeat

  • We will look for the baby's heartbeat whenever you have an ultrasound. You will see the heart beating on the ultrasound screen, or the technician may adjust the ultrasound machine so that you can hear the heartbeat.
  • We can usually hear the baby's heartbeat for the first time between about 10-12 weeks. We will listen with a doptone, a form of ultrasound that converts sound waves into signals you can hear. It sounds like a microphone. We will listen for the heartbeat at every visit if you are not having an ultrasound on the same day.
  • The baby's heartbeat is about twice as fast as that of an adult. The normal range is about 120-160 beats per minute. It is absolutely normal for the baby's heart rate to change from visit to visit. Sometimes it may sound louder than others. This is normal, too, and is not an indication of the strength of the baby's heartbeat. The loudness relates to where we listen on your abdomen and how loud we turn up the volume! We cannot tell if the baby is a boy or a girl from the heart rate.

Dental Care

  • Absolutely fine during pregnancy! In fact, we recommend regular dental checkups and cleaning during pregnancy. If your dentist requires a note to treat you during pregnancy, we are happy to provide you with one.
  • X-rays are fine as long as your abdomen is shielded with a lead apron
  • Local anesthesia, such as lidocaine or novocaine is perfectly acceptable.
  • Procedures such as fillings, root canals, and tooth repairs are safe during pregnancy
  • If you need an antibiotic for a dental procedure or problem, have the dentist give us a call. Many antibiotics, such as penicillin, erythromycin, and cephalosporins are safe to use during pregnancy.
  • Pain medications, such as acetaminophen (Tylenol) and codeine are safe to use in pregnancy.

General Medical Care

  • As your obstetricians, we are skilled at managing your pregnancy and understanding how medical conditions, such as diabetes, thyroid disease, asthma, and hypertension can affect your pregnancy. We also know how pregnancy can impact on any ongoing medical problem you might have. To best care for you and your unborn baby, we will often involve other medical specialists, such as cardiologists, endocrinologists, and renal specialists in your care. We may help you arrange for special testing, such as an EKG, to give us information to better care for you. We will share information and test results with your other doctors so that together we can do our best to ensure the best possible outcome for you and your baby.
  • During your pregnancy, should you develop a medical problem that is unrelated to pregnancy, we will often refer you to your primary medical doctor for evaluation and treatment. Colds, ear infections, upper respiratory infections, and sore throats are usually best managed by your primary physician. Should he or she have a question regarding your management, such as deciding on an appropriate medication to treat your problem, we are always available for consultation.

Exercise

  • We encourage regular exercise of moderate intensity during pregnancy. Physically active women with uncomplicated pregnancies should be able to remain active during pregnancy. Women with certain medical conditions such as poorly controlled hypertension, lung problems, or heart disease might be advised not to exercise. Should you develop complications during your pregnancy, such as preterm labor, bleeding, or hypertension, or if your baby is not growing well, we might advise you to reduce your activity.
  • Many activities are safe in pregnancy. Yoga, brisk walking (including hiking and backpacking), jogging, swimming, biking, cross-country skiing and using fitness equipment such as an elliptical trainer, treadmill, or Nordic track are fine. Pregnancy is not, however, a time to take up a new sport that demands significant coordination such as rollerblading or step aerobics. Walking is a great beginning exercise that you and your baby can continue after your delivery.
  • Many hospitals, YMCAs, and fitness centers offer special pregnancy exercise and yoga classes. As your pregnancy progresses, you will need to adjust your exercise routine and pace to meet the changing needs of your body. Avoid prolonged periods of exercise on your back after your fifth month. You will notice that your center of gravity changes as your pregnancy progresses. The weight you gain is not evenly distributed. In addition, pregnancy hormones loosen and soften the ligaments that support your joints. As a result of these changes, your balance becomes less stable and you are more prone to falls. You may need to curtail or modify activities that you can usually do comfortably, such as biking, skating, playing tennis or participating in aerobics classes. Low impact activities are generally preferable in pregnancy.
  • Use common sense to guide you. Stop exercising if you become short of breath, overheated, dizzy, dehydrated, or uncomfortable. Avoid exercise periods in extreme heat and humidity. Modify the pace and length of your exercise sessions according to your tolerance.
  • Although there are lots of activities that are safe, sports that can result in trauma to the mother or baby should be avoided. Contact sports, like ice hockey, soccer, or basketball are not recommended. Activities that increase your risk of falling or for abdominal trauma, such as gymnastics, water or snow skiing, snowboarding, rock climbing, vigorous racquet sports and horseback riding should also be avoided. Scuba diving is discouraged because of the potential danger from air bubbles that can form in your bloodstream as you surface.
  • Activities that involve rapid starts and stops or forceful landings should be avoided – things like roller coasters and waterslides.
  • Some pregnancy and exercise related websites that you might find helpful include:
    www.babycenter.com www.yoga.about.com/od/prenatalyoga
    www.strollerfit.com www.babybootcamp.com
  • You should stop exercising and call us if you notice:
    √ Leakage of fluid or bleeding from the vagina
    √ Sudden chest pain, muscle weakness, dizziness, headache, or fainting
    √ Pain, swelling or tenderness in one calf or leg
    √ Extreme fatigue, palpitations, shortness of breath, or a persistently elevated pulse
        after you stop exercising
    √ Contractions or abdominal pain
    √ Decreased fetal movement

Sex & Sexual Intercourse

  • Most women can have sex until shortly before the baby is born. You should feel free to enjoy sexual relations as long as you are comfortable. Sex will not hurt your baby, who is safe and well cushioned by the amniotic fluid within your uterus.
  • We will tell you if we want you to avoid intercourse (for example, if your pregnancy is complicated by premature labor, bleeding, or an abnormal location of your placenta).
  • You should not have intercourse if you have any reason to believe that your bag of water is leaking or broken.
  • During pregnancy, your sex drive might be greater, less, or the same as before pregnancy.

Childbirth Classes and Labor & Delivery Tours

  • Thomas Jefferson University Hospital offers many classes for expectant parents. In addition to childbirth preparation and refresher courses, the hospital offers many other classes such as breastfeeding, infant CPR, sibling preparation, car seat safety, baby care, grandparenting, and "Marvelous Multiples". Classes are offered at a variety of times and dates – some meet only once while others meet several times over a series of weeks. You can also feel free to attend childbirth classes at a facility closer to your home.
  • For information and schedules for classes and tours, call 1-800-JEFF-NOW or Terry O'Brien, the Parent Education Coordinator at (215) 955-6713.
  • We recommend prepared childbirth classes even for those patients who are sure that they do not want a "natural" (no medication) birth. These classes give you valuable information about the labor and delivery process as well as options for comfort and pain relief during labor and delivery. We have patients who go through childbirth without any medication and others who choose to have anesthesia during the birth process. It can be difficult to predict exactly what kind of pain relief will be the best choice for you and your baby until labor is in progress. We will be happy to discuss the various options that are available to you.
  • Labor and Delivery tours are generally offered twice monthly on the second and fourth Wednesday evenings. There are no tours on holidays. No reservation is necessary. Flyers with times and dates are posted around our office.
  • If you have specific questions or needs related to your hospital stay or delivery at Jefferson, there are many services available to help you. The maternity care coordinators, Martha Puleo and Cheryl Albertson, are available to answer your questions regarding your hospitalization. They can be reached at (215) 955-0705. They are a valuable resource for questions you might have regarding your hospital stay, birth plans, and classes available to you at Jefferson. They distribute an educational packet and DVD or videotape to all our patients and can also help if you anticipate any special needs during your delivery and postpartum period.
  • When needed, we can arrange for you to meet with members of our intensive care nursery and pediatric subspecialties to help you plan for your delivery

Travel During Pregnancy

  • Always wear your seatbelt and shoulder harness! Some women worry that the belt will hurt the baby if the car stops quickly or there is an accident. Studies show that the baby almost always recovers quickly from seat belt pressure. Risks to the mother and her baby who are not protected by seat belts during an accident are usually far more serious than those inflicted by the lap belt. Keep your lap belt low and under you abdomen, adjust the shoulder harness between your breasts, and keep them both as snug as possible. Do not wear your seat belt above your abdomen or slip your shoulder harness off of your shoulder.
  • Generally, the best time to enjoy a special trip or cruise is during the middle months of your pregnancy. Please tell us if you plan to travel out of the country so that we can let you know if we have any special recommendations.
  • Usually, the quickest form of transportation to your destination is best. Air travel is fine, but talk with us if you plan a long (cross country) flight.
  • We discourage motorcycle travel during pregnancy.
  • Some insurance companies will not cover you for out-of-town emergencies or deliveries after a certain point in the pregnancy. Check with your insurance carrier for any restrictions.
  • We can give you a handout with suggestions for travel during pregnancy. Basically, you'll want to stay well hydrated during your travels and allow for plenty of stops to use the restroom and to stretch your legs. If you are on an airplane, get up and walk up the aisle a bit if you can. You can also flex your foot to stretch your calf muscles and rotate your ankles and wiggle your toes while you are in your seat. Aisle seats will make getting up and to the bathroom easier for you.
  • It is safe to walk through metal detectors at security checkpoints.

General Nutrition Guidelines

  • We encourage a healthy diet during pregnancy. The typical weight gain in pregnancy for a woman who is of average height and weight is about 25-35 pounds. This is only an average, however, and any individual woman may have special needs. Our focus is not on a specific number of pounds to gain each month or a total to gain by the end of the pregnancy. Rather, we want to help you meet your own nutritional needs as well as those of your baby. Every woman gains weight at her own particular rate. We've enclosed a brochure on general recommendations for nutrition in pregnancy.
  • During pregnancy, you need a wide variety of nutrients to meet the needs of you and your baby. A balanced diet and a vitamin and mineral supplement will help you meet those needs. The principles of a good diet in pregnancy are not much different from those of an everyday healthy diet. You'll want to choose foods that are low in fat and sugar, high in fiber and protein, and plenty of fruits, vegetables, and whole grains.
  • A woman who begins her pregnancy at an average weight needs only about 300 extra calories/day beyond her normal intake – that is equivalent to the calories contained in 3 cups of skim milk. Individual needs vary, however, and moms who are carrying more than one baby or are significantly overweight or underweight will have special requirements.
  • You should use products containing caffeine judiciously. Try to limit yourself to no more than 60mg of caffeine daily (one average cup).
  • Try to take your prenatal vitamin daily. It is generally best tolerated when taken on a full stomach. These vitamins are frequently constipating, so you'll want to look over our help sheet on constipation. If you can't swallow or tolerate your vitamin, please call us. We can prescribe an alternative or advise you to purchase a folic acid supplement to take until you feel well enough to tolerate a vitamin.
  • We are sometimes asked for suggestions to help a mother make food choices that provide good nutrition but minimize "empty calories". Here are a few recommendations.
    √ Drink skim or 1% milk instead of whole or 2% milk
    √ Choose lowfat or skim milk dairy products, such as cheese, cottage cheese, and yogurt
    √ Eat fresh fruit instead of fruit juice. A small amount of fruit juice is fine, but fresh fruit
       is more filling and is a valuable source of fiber, too.
    √ Drink water instead of fruit juice, juice drinks, sweetened ice tea and soda. If you drink
       a great deal of fruit juice, consider mixing it half-and-half with water
    √ Choose reduced fat salad dressings and replace mayonnaise with flavored mustards
       or reduced fat mayonnaise spreads on sandwiches
    √ Purchase leaner cuts of meat and poultry and trim off visible skin and fat
    √ Watch your choice of cereals – granolas and cereals containing coconut and nuts
       can be high in fat and calories. Sugar sweetened cereals are often high in calories, too.

General Food Safety

  • Thoroughly cook all meat such as beef, pork, or poultry as well as seafood and shellfish.
  • Don't use recipes with raw or partially cooked eggs unless you use pasteurized eggs.
  • Wash raw fruits and vegetables thoroughly before eating.
  • Keep uncooked meats separate from vegetables and from prepared foods.
  • Avoid unpasteurized (raw) milk or foods made from unpasteurized milk.
  • Wash hands, knives, and cutting boards after handling uncooked foods.
  • Consume perishable and ready-to-eat foods as soon as possible
  • Wash your hands thoroughly before and after handling food and after using the bathroom, changing diapers, or touching pets.
  • For more information go to www.cfsan.fda.gov/pregnancy.html.

Toxoplasmosis

  • Toxoplasmosis is an infection from a parasite that can infect humans who eat contaminated raw or undercooked meat (especially lamb or mutton), unwashed fruits or vegetables, or who come in contact with cat feces. Toxoplasmosis is a rare disease in the United States, but when it does occur, it's not likely to be transmitted by the family cat. Although the disease-causing parasite is found in the feces of cats who ingest raw meat, birds, mice or contaminated soil, toxoplasmosis is more likely to be transmitted when women eat raw or undercooked meat or come into contact with surfaces that have been contaminated by such meats—or even when women come into contact with contaminated soil
  • Make sure that your meat is thoroughly cooked and that you wash all fresh produce. Wash your hands after handling raw meat and unwashed produce and clean cutting boards, counters, plates, and utensils that have been in contact with raw meat.
  • Keep your cat indoors and away from wildlife. Feed cats only commercially prepared cat food.
  • Wear gloves when gardening outdoors, especially in areas where there may be cat feces. Wash your hands well after touching soil, especially if you have not been wearing gloves.
  • Have someone else change your litter box or make sure you wear gloves and a mask if you must change the litter. Scoop feces as soon as you can, and at least daily, since it takes one to five days for feces to become infectious.
  • Enjoy your cat – continue to hold it and pet it and keep it as a part of your household.
  • For more information: www.cdc.gov/ncidod/dpd/parasites/toxoplasmosis/ToxoWomen.pdf.

Listeriosis & Pregnancy

  • Soft, moist cheeses and some ready-to-eat meats can harbor a bacteria called listeria. This organism usually only produces a mild illness in adults, but it can be a serious risk for mothers who contract the infection while they are pregnant.
  • Do not drink raw (unpasteurized) milk or eat foods that contain unpasteurized milk.
  • Official CDC guidelines suggest that you do not eat hot dogs, luncheon meats, or deli meats unless they are reheated to steaming hot.
  • Do not eat soft cheeses such as feta, Brie, Camembert, blue-veined cheeses, and Mexican-style cheeses such as "queso blanco" or "queso fresco" unless they are labeled as made with pasteurized milk. Check the label. Hard cheeses, semi-soft cheeses (such as mozzarella), pasteurized processed cheese slices and spreads, cream cheese, and cottage cheese are perfectly safe.
  • Do not eat refrigerated smoked seafood unless it is an ingredient in a cooked dish such as a casserole. Some examples of refrigerated smoked seafood include salmon, trout, whitefish, cod, tuna, and mackerel which are most often labeled as "nova-style," lox," "kippered," "smoked," or "jerky." This kind of fish is usually found in the refrigerated section or sold at deli counters. Canned fish like salmon or tuna and shelf-stable smoked seafood is safe to eat.
  • Do not eat refrigerated pâte' or meat spreads
    For more information: www.fsis.usda.gov/OA/pubs/lm_tearsheet.pdf.

Fish & Mercury

  • Fish and shellfish are an important part of your diet but some varieties contain levels of mercury that might be harmful to your growing baby. We have enclosed a booklet that provides recommendations for you so that you can make healthy choices.
  • For more information: www.cfsan.fda.gov/seafood1.html.
  • Most women who are pregnant have heard warnings about eating sushi due to the risk of certain bacteria and increased exposure to mercury. But remember that not all sushi is uncooked, and most fish contains important nutrients and vitamins. Eating fish that is cooked can help reduce the risk of exposure to certain bacteria. Eating fish that is not on the "high" mercury list is also a way to eat fish safely.

Umbilical Cord Blood Banking

  • We do not make recommendations regarding specific commercial umbilical cord blood banks. Should you choose to contract with a company to bank your baby's cord blood, we are comfortable using the collection system of any company.
  • Because this is a complex and financially costly decision, you may find the following website helpful in making your decision: www.parentsguidecordblood.com
  • If you are interested in public donation of cord blood, you can obtain information about the process from www.parentsguidecordblood.com (click on bank lists on the top bar, then public cord blood banks on the left bar) or the National Marrow Donor Program at www.marrow.org.

Helpful Sources of Information

  • The Pregnancy Healthline can answer questions about medication, chemical, infectious, physical, and drug exposures during pregnancy. They can be reached by calling 1-888-722-2903 and their informational website is www.snjpc.org. You can also call the Organization of Teratology Information Services at 866-626-6847 and their website is www.otispregnancy.org.
  • The March of Dimes has a very helpful website with a great deal of information on pregnancy and newborn health. In addition to information on "typical" pregnancies, their website also includes information on prematurity and other complications of pregnancy. Their website is www.marchofdimes.com.
  • The American College of Obstetrics and Gynecology has a website with some areas that can be accessed by the public. That address is www.acog.org.
  • www.medem.com provides information on a variety of topics related to pregnancy and newborns from reputable professional medical sources.
  • www.medlineplus.gov is a public website administered by the National Library of Medicine. It provides quality information for patients and physicians.
  • We recommend the book, Your Pregnancy and Birth, Fourth Edition, by the American College of Obstetrics and Gynecology. It is available at www.amazon.com or www.acog.org/books. Many bookstores will also order a copy for you if it is not available on the shelf. You can also order it by calling ACOG at 1-800-762-2264 ext 319. This book provides balanced and accurate information on all aspects of pregnancy and childbirth.
  • Although many of our patients read What to Expect When You Are Expecting, please keep in mind that while some find it helpful and educational, many women tell us that they find its approach to pregnancy anxiety provoking or condescending.

Miscellaneous Information

  • We know you already know this, but for the record - no smoking, drinking alcoholic beverages, or using recreational drugs while pregnant.
  • Please do not take any extra vitamins or herbal supplements without checking with us first
  • Avoid hot tubs and whirlpool baths. Indoor and outdoor swimming pools are fine as are warm tub baths and showers. Use water no hotter than body temperature – 98.6°F.
  • It is acceptable to color and perm your hair while you are pregnant – sometimes perms don't "take" well during pregnancy, so ask your hairdresser for advice.
  • It is ok to paint with latex paint while you are pregnant. Work in a well ventilated room and leave the area if you don't feel well while you are working.

Good prenatal care is important to make sure that you and your growing baby are as healthy as possible. During your visits, we will discuss many aspects of your care and you should feel free to ask questions. We look forward to sharing in your care during this pregnancy.

Resources

Evidence Based Guidelines OBSTETRIC Evidence Based Guidelines
Evidence Based Guidelines MATERNAL-FETAL Evidence Based Guidelines

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