Frequently Asked Questions

Questions and answers to expectant mothers' most common pregnancy concerns from conception to delivery.

  • Flu Vaccine During Pregnancy

    Is it safe to get a flu vaccine during pregnancy, even if I have never gotten a flu vaccine before? Are there any risks to mother or baby with the vaccine? Are there any risks to mother or baby from the flu?

    Vaccination against influenza has been shown to be safe in pregnancy. In fact, it is recommended for patients who are at high risk of acquiring influenza in pregnancy, such as women with underlying medical disorders or healthcare providers. Women who are at low risk of acquiring the flu, however, are recommended to delay their flu vaccine until the second trimester. There are no known risks to either the mother or fetus with the flu vaccine. Influenza during pregnancy can lead to pneumonia in the mother. Most of the time this is a self-limiting process, lasting only 3 to 4 days. However, women can develop a superimposed bacterial infection that can be fairly severe and may require hospitalization. There are no proven congenital anomalies (birth defects) associated with influenza infection and pregnancy.

  • How can I tell if I am in labor?

    One of a woman's greatest concerns is "How will I know if I am in labor?" This is especially true in first pregnancies. There are several signs of labor or pregnancy emergencies that should cause you to phone your physician or head to the hospital.


    The first sign of labor is uterine contractions. Uterine contractions are often described as tightening of the uterus or "balling up of the baby." These contractions should be of significant strength to cause you to stop a conversation and take several deep breaths. When contractions are 5 minutes apart from the beginning of one contraction to the beginning of the next contraction, contact your physician.


    The second sign of labor is your water breaking. Some women notice a large gush of fluid, and some women notice a constant leaking of small amounts of fluid. In either case, you should report to the hospital.


    The third sign is vaginal bleeding. If at any point you have bright red bleeding similar in volume to a period, go to the hospital. This is a medical emergency and may be a sign that your placenta is separating from your uterus. If you have a small amount of bleeding mixed with mucus, this is probably your mucus plug. You can lose the mucus plug at many points during pregnancy, but this is not a signal of impending labor.


    Finally, if your baby is not moving normally, contact your physician. At a minimum you should notice at least 10 movements a day. Many people feel that you should notice at least 10 movements in 2 hours.

  • How do you know when it is not Braxton Hicks and time to go (to the hospital)?

    How do you know when it is not Braxton Hicks and time to go (to the hospital)? This is my third child, both of my previous were preemies and my water did not break on them.

    Braxton Hicks contractions are also known as false labor. They usually begin sometime after the 20th week of pregnancy. Sometimes they are felt earlier and are more intense in women who have had a previous pregnancy. The contractions are usually painless, but sometimes uncomfortable. They are actually a contraction of the uterine muscle and last about 30 seconds, but may last as long as a couple of minutes. Around 36 weeks or so, the contractions become more frequent. Changing your position will help stop the contractions.


    So what are the symptoms of 'real labor'? It is probably 'real labor' if: (1) the contractions become stronger, rather than ease up with a change in position and over time, the pain begins in the lower back and spreads to the lower abdomen, (3) the contractions become progressively more frequent and painful, (4) the contractions are accompanied by a pinkish or blood-streaked discharge, (5) or if your water breaks.


    You should begin the trip to the hospital when the contractions are 5 minutes apart for a couple of hours, your water breaks, or if you begin bleeding like a menstrual period.


    Since you have had two premature deliveries, you are at risk for another premature birth. Therefore, you should be a bit more cautious about labor than someone who is already full-term. For you, if there is any question in your mind, you should be evaluated to make certain that you are not in labor.

  • How much weight should I gain during my pregnancy?

    The average recommended weight gain during pregnancy is 25 to 35 pounds. If you are underweight prior to pregnancy, your average weight gain should be 30 to 40 pounds. If prior to your pregnancy you are overweight, your average weight gain should be 20 to 30 pounds. Most women gain approximately 5 to 6 pounds during the first trimester of their pregnancy. After the first trimester (at approximately 13 weeks) weight gain is approximately 1 pound per week.


    During pregnancy it is important to maintain good nutrition and adequate caloric intake. The average caloric intake for a pregnant woman should be approximately 300 calories more per day than usual. If you don't gain an adequate amount of weight during your pregnancy, you run the risk of delivering a low birth weight infant. It is important not to diet during your pregnancy. On the same note, excess weight gain can lead to large babies (macrosomia) with resultant traumatic deliveries. It is important to watch your weight gain closely during pregnancy.

  • How soon after delivery can I have intercourse?

    During delivery, many of your vaginal tissues are stretched and often torn. Your cervix dilates and often undergoes a certain amount of trauma. It takes approximately 6 weeks for your uterus, cervix, and vaginal tissues to return to their normal pre-pregnant state. Because of this, your physician will probably ask you to wait for six weeks after delivery to have intercourse.


    Many women are concerned about pain during their first intercourse after delivery. Most women do not feel significant discomfort if it has been 6 weeks since their delivery. Additionally, if you had an episiotomy, your stitches should have dissolved during this time period. You should notice minimal discomfort at the site of your episiotomy.

  • I am 14 weeks pregnant. Can I go to the dentist? What if I need dental work done?

    Dental work during pregnancy is safe. In fact, it is recommended that women take special care of their teeth and gums during pregnancy so they will be able to maintain adequate food intake.


    It is safe to have x-rays of your teeth during pregnancy. According to the American College of Radiology there is no single diagnostic procedure that results in enough radiation to cause detriment to the developing fetus. Studies have shown that between 8 and 15 weeks the risk of severe mental retardation is approximately 4% for an exposure equal to 10 rads. The exposure from x-rays of your teeth is well below one millionth of a rad. Additionally, your dentist will shield your abdomen during the x-rays.


    It is safe to have your teeth cleaned, cavities filled, root-canal work, or tooth extractions during pregnancy. Some women choose to wait until the second trimester to receive treatment, when the risk of teratogenesis decreases. Be sure to let your dentist know that you are pregnant, so that he or she can avoid certain anesthetic medications. All local anesthetics are safe during pregnancy. Additionally, most antibiotics used during dental procedures are safe during pregnancy. Again, be sure to inform your dentist so he or she can contact your physician if there is a question.


    No association between dental caries and pregnancy has been established. There is no evidence that dental caries worsen with pregnancy. An association between pregnancy and gingival hyperplasia has been proven. This condition causes an enlargement of the gingiva and is related to pregnancy hormones. In association with this, women may notice that their gums bleed. Once the gingiva shrinks back to normal size, bleeding should subside.

  • I am 16 weeks pregnant. I am having pain in both sides of my lower abdomen. Is this normal?

    As pregnancy progresses, your uterus gradually enlarges. Many women have concerns regarding pain during this time period. As you reach 16 weeks, your uterus is significantly enlarged and most women become noticeably pregnant.


    Although there are many reasons for abdominal pain during pregnancy, the most common condition is round ligament pain. The round ligaments are connective tissue ligaments that run from the upper aspect of the uterus down to the groin. As pregnancy progresses these ligaments enlarge and become stretched, and can cause pain. The pain sensation that women often feel involves both sides of the lower abdomen and sometimes the back. The pain is sharp in nature and can be worse on the right side. Certain movements may exacerbate the pain.


    Round ligament pain has not been associated with any adverse outcomes of pregnancy. Treatments include heat on the affected area and rest. Medications often do not alleviate symptoms.


    It is important to discuss any abdominal pain with your physician. There are several other causes of persistent pain. Your physician may need to do a physical exam and run other tests should your pain become severe or be associated with other symptoms.

  • I am 18 1/2 weeks pregnant. My OBGYN suggests an amniocentesis, but I do not wish to risk it.

    I am 18 ½ weeks pregnant and have had a previous pregnancy with trisomy 13, which resulted in fetal demise. I have had a stage II ultrasound this time at 15 ½ weeks and everything looked good. The geniologist looked at the ultrasound and reported there were no stigmata of a trisomy, 13 or otherwise. My question is related to my AFP results, which were abnormal. My OB suggests an amniocentesis, but since 95% to 98% of these results are wrong, I do not wish to risk the amnio. I am scheduled for another ultrasound in 2 weeks. Can I tell or can the doctor see if the baby has Down syndrome by looking at that?

    Diagnosis of chromosomal anomalies by amniocentesis is highly accurate. Although there are no major studies on error of amniocentesis, it has been shown that errors in diagnosis occur only 0.1% to 0.6 % of the time. Therefore, most of the time results from amniocentesis are correct. If you are worried about the potential risks of amniocentesis--which include preterm labor, rupturing of the membranes, and fetal loss--you should keep in mind that these complications occur in 1 in 200 amniocenteses.


    If you decide against amniocentesis, your doctor can look for the stigmata of Down syndrome on your ultrasound. Keep in mind, however, that this is much less specific than amniocentesis. Speak with your doctor further about the risks and benefits of each of these options.

  • I am 30 weeks pregnant and having a lot of sciatic pain. What can I do? Is this common during pregnancy?

    The sciatic nerve is a large nerve that follows a course from the pelvis to the back of the leg. This nerve supplies motor and sensory function to much of the leg. As pregnancy progresses, many women notice pain due to compression of this nerve by the uterus. This pain is called sciatica and often extends from the back of the thigh to the knee. Sciatic pain usually does not extend below the knee. If you have pain below the knee, be sure to contact your physician. Sciatica is a very common condition that usually occurs late in pregnancy and resolves after delivery.


    Sciatic pain usually disappears after delivery. To relieve pain during pregnancy, your physician may have you take Tylenol and rest often. Many women find that sitting in a whirlpool is helpful. Do not set the whirlpool at a high temperature since it is important not to overheat. Hot water bottles may also alleviate pain. Mild pain may persist until delivery. If your pain becomes severe, your physician may have you see a physical therapist for further treatment.

  • I am 39 weeks pregnant. Should I have my labor induced?

    There are several schools of thought on whether it is appropriate for a woman to choose to have her baby early. In medical terms this is known as elective induction of labor. Many factors come into play when physicians decide to induce labor. If you are experiencing medical complications associated with pregnancy, your physician may advise delivery if you are full term (greater than 37 weeks pregnant). Second, the accuracy of your due date will be an issue if plans are made to induce your labor early. If you had an ultrasound in the first trimester that verified the due date calculated by your last menstrual period, then your due date should be accurate, plus or minus one week. If you had a second trimester ultrasound that was consistent with the first, your due date should be accurate, plus or minus two weeks. Therefore, delivery at 39 weeks, even if off by 2 weeks, should still result in the delivery of a full term infant (greater than 37 weeks). Finally, the dilitation and effacement of your cervix prior to the induction of labor will be an issue. If your cervix has started to dilate and has started to efface, your physician may feel that an induction of labor is reasonable. If your cervix has not dilated or effaced, induction of your labor may significantly increase your risk of cesarean section.


    Many physicians feel that electively inducing labor is not appropriate until 41 to 42 weeks, when there may be decreased functioning of the placenta. However, many physicians, including the American College of Obstetrics and Gynecology, feel it is reasonable to induce labor at 39 weeks if the mother has had prior rapid labor or has a long distance to travel to the hospital

  • I am a month pregnant and I'm cramping a lot. Is that bad?

    Many women have cramping during early pregnancy. However, if you have persistent cramping, especially if it is associated with bleeding or spotting, it is important that you see your physician immediately. Although most of the time mild cramping is not urgent in nature, if associated with bleeding it may indicate an abnormal pregnancy. This may include a possible miscarraige or an ectopic pregnancy. An ectopic pregnancy is life-threatening and must be followed very closely. Be certain to contact your physician if your symptoms persist or if you have any associated bleeding.

  • I have had two miscarriages, what are my chances of having another one? Do I need any special testing?

    Miscarriages are also known as spontaneous abortions. Around 50% of pregnancies result in miscarriage. Many women do not realize they are pregnant when they miscarry. They simply have a period that is a bit late or lasts a little longer than usual. Of women who know they are pregnant, approximately 20% have miscarriages.


    Women who have more than one miscarriage in a row are diagnosed as having recurrent abortions. If you have a prior liveborn infant, the risk of recurrent abortion is 20% to 25% after one miscarriage, 25% after two miscarriages, and 30% after three miscarriages. If you have not had a liveborn infant, your risk of miscarriage after three prior pregnancy losses is approximately 40%.


    It is debatable whether testing for reproductive problems should be performed after two miscarriages or after three miscarriages. If you are in your 30s and have a history of infertility, your physician may recommend evaluation after two miscarriages. All women should be evaluated after three consecutive miscarriages. The following tests are included in a formal evaluation.

    • Karyotyping of you and your spouse (an analysis of your chromosomes through blood testing)
    • Hysterosalpingography (an X-ray of your uterus and fallopian tubes taken while dye is being injected into your uterus). This test determines if there are any abnormalities of your uterine cavity that may be attributing to the pregnancy losses. Alternatively, your physician may order a pelvic ultrasound.
    • Blood testing. Tests may include endocrinologic and immunologic tests.
    • Endometrial biopsy (a sample of the lining of your uterus). This test helps determine whether you are ovulating regularly and producing enough progesterone. Inadequate progesterone production after ovulation is known as a luteal phase defect and may be associated with early pregnancy losses.
    • Cervical cultures (testing for infectious agents in the cervix). Pelvic infections have been associated with pregnancy.
  • I recently had a baby. I developed toxemia. What exactly is this and could it have been prevented?

    Toxemia is an old name for a disease process in pregnancy known as preeclampsia. Preeclampsia is characterized by elevated blood pressure, swelling, and protein in the urine. In its most severe form women may notice headaches, blurred vision, right-side abdominal pain, or spots in front of their eyes. Pregnancies complicated by preeclampsia can result in adverse outcomes for both the fetus (including growth restriction and in the worst case death) and the mother (including seizures and in the worst case death). Therefore, you will be monitored very closely if you have been diagnosed with preeclampsia during your pregnancy. Depending on the circumstances it may be recommended that you deliver your baby early. The ultimate cure for preeclampsia is delivery of the infant.


    The cause of preeclampsia is unknown and there is no means of preventing its occurrence at this time. It has been shown that first time pregnancies are at increased risk for developing preeclampsia.

  • I recently had my tubes tied. Now I have the most tremendous pain during my period. Are these two things related?

    What you are describing is a common complaint among women and has been the subject of a number of research studies. The condition is referred to as post tubal ligation syndrome. Typically, women complain of an increased amount of pain during their periods (dysmenorrhea). The most recent studies have shown no increase in painful periods in those women who had a tubal ligation.


    What is found in many women is that prior to the tubal ligation, they were taking birth control pills. After having their tubes tied, the birth control pills are stopped. These women have a return to their "normal" menstrual pattern. While they were on birth control pills, their periods were lighter and not associated with as much pain. This occurs in just about all women who take birth control pills.


    As for what you can do now, there is an excellent article on this site about dysmenorrhea, its causes and treatments. This article should provide a nice overview of the subject.

  • Is it safe to travel by air during pregnancy?

    Many women have concerns about the safety of air travel while pregnant. Flying in airplanes is safe during pregnancy and there is no indication that it causes future complications. The change in barometric pressure noted during flight has no serious effect on pregnancy.


    The biggest issue relates to the timing of your travel and whether there have been complications with the pregnancy prior to that time. Although it is safe to travel at any point during your pregnancy, many airlines have restrictions on air flight beyond 36 weeks. You may need permission from your physician to fly at a later date. Your physician may not want you to travel far distances by airplane after approximately 34 to 35 weeks. Access to medical care is restricted during the plane flight should you need medical attention. In addition, both you and your physician may prefer that you stay closer to home late in your pregnancy to ensure that you receive proper medical attention if you go into labor. If you have had complications during your pregnancy, your physician may prefer that you stay close to home so that prompt intervention may be undertaken if problems arise. Should you choose to travel, it is probably a good idea to take copies of your medical records with in case of an emergency.

  • Is the Consumption of Fish Dangerous During Pregnancy?

    Healthcare officials have issued an advisory on the dangers of eating fish. The advisory concerns the consumption of fish by expectant mothers, nursing mothers and women who are seeking to get pregnant. Healthcare officials are concerned that the level of mercury in fish might pose certain risks to a developing fetus.


    How does Mercury Affect the Nervous System?

    Methyl mercury is highly toxic and dangerous to babies because it can cross the placenta and the blood brain barrier. It is easy for mercury to become concentrated in the brain of the developing fetus because the metal is absorbed quickly and is not excreted efficiently.


    Children exposed to mercury may be born with symptoms that resemble cerebral palsy, or other movement abnormalities. They are also more susceptible to convulsions, visual problems and abnormal reflexes. Autopsy results show loss of neurons in the cerebellum and throughout the cerebral cortex in the brains of children who have died as a result of mercury poisoning.


    Mercury also appears to affect brain development by preventing neurons from finding their appropriate place in the brain. Methyl mercury targets and kills neurons in specific areas of the nervous system including the visual cortex, the cerebellum and the dorsal root ganglia. Several mechanisms have been proposed to explain how mercury kills neurons:

    • Inhibition of protein
    • Disruption of mitochondria function
    • Direct effect on ion exchange
    • Disruption of neurotransmitters
    • Destruction of the structural framework of neurons.

    Each of the above functions is vital in the process of maintenance and interaction on a cellular level.


    How are Fish and Water Contaminated with Mercury?

    Contamination from mercury in fresh waters can occur naturally through environmental factors or by contamination from industrial wastes. Larger fish (such as sharks, swordfish, king mackerel and tilefish), that prey on smaller fish accumulate the highest level of mercury and therefore pose the greatest risk.


    How is Mercury Detected?

    Mercury levels within a person's body can be measured in blood, urine and hair samples. The normal level of mercury for someone who has not been exposed to mercury is about 2 ppm (hair) or 3-4 ug/dl of blood or 25 ug/l or urine. When levels get to about 50 ppm (hair), people may start to experience nerve damage. Because hair continues to grow, it can be used to document when and how much a person has been exposed to mercury. The developing system of a baby and a young child is more sensitive to the effects of mercury than the system of an adult or older child.


    How Much Fish Should I Eat?

    It is recommend that pregnant women and young children limit their consumption of freshwater fish to one meal per week or the equivalent of eight ounces of uncooked fish for adults and three ounces for young children.

  • I was diagnosed with complete placenta previa at my 20-week ultrasound. Should I switch to a high-risk specialist due to this condition?

    Placenta previa is a condition that occurs during pregnancy when the placenta (the sac surrounding the fetus) implants in the lower part of the uterus and blocks the cervical opening to the vagina, therefore preventing normal delivery.


    Q. What causes placenta previa?

    A. It is not certain what causes placenta previa in every case. However, the following may contribute or actually cause placenta previa:

    • Scarring in the uterine lining (endometrium)
    • A large or abnormally shaped placenta
    • Multiple fetus' (twins or more)
    • Multiple prior deliveries (6 or more previous deliveries)
    • Scar tissue from previous cesarean section


    Q. Is there anything I can do to prevent placenta previa?

    A. Currently, nothing is known to prevent placenta previa.


    Q. What are the signs and symptoms of placenta previa?

    A. Some of the visible symptoms are:

    • Spotting: especially during the first and second trimester.
    • Vaginal Bleeding: loss of large quantities of blood during the third trimester; onset is very sudden and often painless.
    • Cramping and labor


    Indications that are not outwardly visible but may be detected through tests such as an abdominal ultrasound are the positioning of the baby. The baby may be lying in an oblique or transverse position with the placenta lying very low in the abdomen. Also, fetal distress may result from abnormally high maternal blood loss, which may affect the mother's heart rate and blood pressure.


    Q. What can be done for placenta previa?

    A. The treatment options depend upon the stage of pregnancy, the position of the baby and placenta, the amount of blood loss, degree of fetal distress, and the presence of labor or not.


    The onset of severe symptoms before the 36th week of pregnancy will prompt the physician to extend the pregnancy as long as possible. The doctor may order blood transfusion to replace lost blood and administer medications and bed rest to halt labor and delivery.


    After the 36th week, most doctors will determine how long delivery can be safely postponed and then deliver the baby by cesarean section. Infant death rate is higher than that of mothers without placenta previa. The higher rate is largely due to the premature births.


    Q. What kind of complications could I experience from placenta previa?

    A. It is important to call your health care provider anytime you experience any of the symptoms listed above, but especially if you are experiencing vaginal bleeding. If gone undetected, placenta previa can cause blood clots, infections, and major hemorrhaging that can lead to shock and death. With placenta previa and on placenta accreta, the placenta may not easily separate from the uterus. As a result, patients are at increased risk of postpartum bleeding. In severe cases, hysterectomy may become necessary.

  • What are Apgar scores and what do they mean?

    Apgar scores measure the need to resuscitate an infant immediately after birth. This scoring system was first coined by Virginia Apgar in 1952. Since that time it has become a common scoring system used during delivery.


    Apgar scores are divided into 5 categories. These include heart rate, respirations, muscle tone, reflexes, and color. Zero to 2 points are scored in each category. Therefore, an infant may score anywhere from 0 to 10 overall. Apgar scores are awarded at 1 and 5 minutes after delivery. If the 5-minute Apgar score is 6 or less, the infant will receive a 10-minute Apgar score as well. Apgar scores are poor indicators of neonatal outcome. They do help determine the effectiveness of resuscitative efforts. Specifically, the 1-minute Apgar score are only a gauge to determine whether immediate support is needed. Low scores (0 to 3) for the 5 and 10 minute intervals, however, have correlated with a slightly increased risk of cerebral palsy.


    Apgar scores alone are poor indicators of long-term outcomes for an infant who experiences hypoxia (lack of oxygenation) at birth. Multiple factors must be used to make these assessments.

  • What are the effects of antibiotic use on birth control pills?

    Q: I have been given antibiotics to treat an upper respiratory tract infection. Will the antibiotics affect the effectiveness of the birth control pills?

    A: Yes, possibly. Some antibiotics and certain other medications have the potential to reduce the effectiveness of birth control pills. Some antibiotics slightly reduce the amount of hormones absorbed by the system.


    Among the suspect antibiotics are those in the penicillin family, including penicillin, amoxicillin, and ampicillin; tetracycline, and related drugs such as doxycycline and erythromycin. Some epilepsy drugs, tranquilizers, barbiturates, anti-inflammatories, and laxatives may also reduce the effectiveness of oral contraceptives. The same effect may also occur if you have an intestinal illness that causes diarrhea or vomiting.

  • What are the symptoms of pregnancy other than morning sickness and missed periods?

    There are other signs and symptoms of pregnancy. You have mentioned two of the most common and the most obvious, an absence of menses. However, you should also remember that early morning nausea and the lack of menses can also occur with other conditions not associated with pregnancy.


    Many women 'just know' when they are pregnant. These women seem to have a sixth sense that alerts them. Also, breast tenderness and breast enlargement are symptoms that are associated with early pregnancy. In addition to these, many women will feel fatigue early in pregnancy that may last into the early second trimester.


    By all means, if you think you are pregnant do a home pregnancy test to confirm your suspicion, and see your physician so that you can begin prenatal care early.

  • What are your chances of being pregnant and still having a period?

    You have asked a very common question, and an important one for all women to understand. Any bleeding during pregnancy is considered abnormal. Your menstrual period each month is triggered by ovulation and the production of progesterone. The progesterone support is then withdrawn and your period begins. Therefore, from a physiologic standpoint it is not possible to continue having a period while you are pregnant. While any bleeding during pregnancy is considered abnormal, it is not unusual to have some spotting early in pregnancy. You may also have some bleeding as a result of a break in one of the superficial blood vessels on the cervix. However, this should be rather minimal and should last only a short time. If you are pregnant, you should not be having any regular bleeding.

  • What are your chances of conceiving after a miscarriage? Are you fertile after a miscarriage?

    Miscarriages are also known as spontaneous abortions in the medical literature. These losses are fairly common. It has been estimated that around 50% of pregnancies result in miscarriage. Many women do not realize that they are pregnant and assume that they are having a delayed period. Of women who know they are pregnant, approximately 20% will have a miscarriage.


    Women who have more than one miscarriage consecutively are known as having recurrent abortions. If you have one prior liveborn infant, the risk of recurrent abortion is 20% to 25 % after one miscarriage, 25% after two miscarriages, and 30% after 3 miscarriages. If you have not had a liveborn infant, your risk of miscarriage after 3 prior pregnancy losses is approximately 40%. Infertility, or the inability to become pregnant, is usually not an issue after miscarriage.


    It is currently debatable at what point testing for reproductive problems should be performed after miscarriage. If you are in your 30s and have a history of infertility, your physician may recommend evaluation after 2 miscarriages. All women should be evaluated after 3 consecutive miscarriages.

  • What is an ectopic pregnancy and how can it be treated?

    Ectopic pregnancy is a serious complication of pregnancy that can result in maternal death. It is a condition where a pregnancy develops outside of its normal position within the uterus, such as in the fallopian tube. Approximately 1 in 60 pregnancies results in ectopic pregnancy. About 9% of pregnancy-related deaths are related to ectopic pregnancy.


    Q. What is an ectopic pregnancy?

    A. The normal site of a pregnancy is inside the uterus. When a woman becomes pregnant, the fertilized egg travels through the fallopian tube and progresses into the uterus. If the fallopian tube is damaged or the contractions of the fallopian (which allows for progression of the egg through the tube) are inadequate, the fertilized egg may get stuck in the fallopian tube and cause an ectopic pregnancy.


    An ectopic pregnancy can be a life threatening condition. The fallopian tube is small, thin, and has a constricted area in which the pregnancy can grow. If an ectopic pregnancy is undiagnosed, the growing embryo could burst through your fallopian tube. If this happens, you will bleed internally and this may ultimately lead to death.


    Q. Who is at risk of having an ectopic pregnancy?

    A. There are several risk factors associated with ectopic pregnancy. Anything that may have caused prior tubal damage, which may obstruct flow of the egg through the fallopian tube, would increase the risk of having an ectopic pregnancy. Some of the common conditions associated with an increased risk of ectopic pregnancy include a history of pelvic inflammatory disease (PID). The inflammation that accompanies this pelvic infection can lead to permanent scarring of the fallopian tubes. A prior history of ectopic pregnancy will increase risk of a subsequent ectopic pregnancy. The reason? Whatever caused the first ectopic pregnancy is most likely still present. Women with a prior history of ectopic pregnancy that has been surgically corrected have a 15% risk of subsequent ectopic pregnancy. History of infertility is associated with an increased risk of ectopic pregnancy. Whenever a patient is seeing a physician for infertility and pregnancy ensues, she should be evaluated for the location of the pregnancy. Any pelvic surgeries will put you at risk of an ectopic pregnancy due to the risk of adhesions or scar tissue from the surgery. Of specific concern is a prior history of a ruptured appendix with which there is often significant inflammation and scarring. Finally, a patient with a history of a prior tubal ligation or the use of progesterone contraceptives such as the Norplant implants is at increased risk of ectopic pregnancy should she become pregnant while using these methods.


    Q. How is an ectopic pregnancy diagnosed?

    A. There are several signs and symptoms of an ectopic pregnancy that may be helpful in making an early diagnosis. Women with abdominal cramping and vaginal bleeding early in pregnancy should be suspected of having an ectopic pregnancy until proven otherwise. Therefore, if you have the abovementioned symptoms, contact your physician immediately. If you notice severe abdominal pain, shoulder pain (which can be referred pain if you have an ectopic pregnancy that has already burst through the tube), or experience dizziness and fainting, contact your physician immediately and go to the nearest emergency room.


    Your physician will run several tests to diagnose an ectopic pregnancy. Initially he or she will confirm pregnancy with a pregnancy test. He or she may then order certain other blood tests, including a quantitative human chorionic gonadotropin level (hCG), which is a measure of the amount of this hormone in your blood. Your physician may measure several of these hormone levels at 48-hour intervals. Your physician is looking for the increase in this hormone level that is normally seen in pregnancy. If the level does not increase normally, you may have an ectopic pregnancy.


    Your physician may also order ultrasound studies to determine if you have an ectopic pregnancy. By approximately 5 to 6 weeks, the radiologist should be able to see your pregnancy on ultrasound evaluation. Certain findings are expected on ultrasound examination based on hCG levels. To get the most accurate ultrasound evaluation, your physician/radiologist may need to do the ultrasound evaluation through your vagina (known as a transvaginal ultrasound).


    With the above information, your physician may be able to diagnose an ectopic pregnancy. If it is still unclear after the above tests, and especially if you are still having pain, your physician may need to do surgery to further diagnose (and sometimes to treat) your problem. He or she may suggest a dilitation and curettage (where the intrauterine contents are scraped out and sent to the pathologist) to determine if you are having a miscarriage rather than an ectopic pregnancy. The physician may suggest laparoscopy. A small incision is made under your navel and a small camera is placed within the abdomen. This allows your physician to directly examine your fallopian tubes.


    Q. How is an ectopic pregnancy treated?

    A. Once you have been diagnosed with an ectopic pregnancy, there are several treatment options that may be recommended by your physician. There are both medical (drug therapy) options and surgical options for the treatment of ectopic pregnancy. Regardless of what type of treatment you and your doctor choose, the most important thing to remember is that some form of treatment must undertaken.


    Your physician may recommend drug treatment of the ectopic pregnancy with methotrexate. This medicine is normally used to treat cancer and arthritis. The dose will be much lower than that used to treat cancer, therefore there will be very few side effects. This medicine is administered by injection and works by preventing cell division. Your physician will then closely follow your hormone levels to make sure that the pregnancy is resolving. If the levels do not decrease appropriately, you may need a second injection or surgery.


    If you do not meet the criteria for methotrexate, your physician may recommend surgery to treat your ectopic pregnancy. Two approaches to surgery can be used depending on the seriousness of the situation, and whether your ectopic has already burst through the tube. The first option is laparoscopy, where a small incision is made under your navel and a small light inserted into your abdomen. Your fallopian tube can then be examined. Your physician will then make a few other small incisions lower on your abdomen through which he or she can insert instruments. The physician will then be able to either remove the ectopic pregnancy by making an incision on the fallopian tube, or remove the entire fallopian tube.


    The second surgical approach is called a laparotomy. This involves making a larger incision lower on your abdomen and removing the ectopic pregnancy or fallopian tube. If your ectopic pregnancy has already ruptured (burst through the tube) this will be the quickest way to remove your fallopian tube and stop the bleeding.


    After surgery, you will be monitored closely by your physician, and if only the ectopic pregnancy was removed, hormone levels will be followed to make sure that all of the pregnancy was removed.


    Subsequent Pregnancies

    Should you decide to get pregnant in the future, it is imperative that you consult a physician as soon as you get a positive pregnancy test. The risk of subsequent ectopic pregnancy is significantly higher after you have already had one.

  • What is the possibility of my passing herpes to my child during labor/delivery?

    Five years ago I was diagnosed with herpes and have been fortunate to not have had many outbreaks. Down the road, when I choose to become pregnant, can this STD hurt my newborn during the pregnancy or labor/delivery?

    Twenty-five percent of American women have genital herpes. Eighty percent of herpes infections are asymptomatic, and therefore many women do not know that they have been exposed to herpes. If you have your initial herpes infection at the time of delivery and deliver vaginally, your infant has a 40% to 50% risk of being infected. If you have had herpes before and have a herpes recurrence at the time of delivery and deliver vaginally, your infant has a 1 in 2000 chance of being infected. Because of the risk of transmission to your infant, the American College of OB/GYN recommends cesarean section if any herpes lesions are present at the time of your delivery.


    If your infant develops herpes at the time of delivery, the consequences can range from asymptomatic disease to severe eye and neurologic injury that may even result in death. Therefore it is very important to inform your obstetrician of your history of genital herpes and to notify him if you notice any lesions or have any symptoms close to the time of delivery.

  • What types of pain relief are available during and after childbirth?

    Every pregnant woman is faced with the decision of whether she will use a form of pain relief during labor and delivery. Some women are very certain that they will want pain relief, while others are unsure. There are also those women who prefer to give birth without any form of pain relief. For women who do not desire any form of analgesia during labor, it is important that they understand the options. During an emergency delivery, some form of analgesia or anesthesia may be necessary.


    Under ideal circumstances, an anesthetic agent would allow you to deliver your baby with minimal pain, minimal risk, and would allow you to push when it is time to do so. The ideal anesthetic would also not stop your contractions or make you or your baby sleepy. There are a variety of anesthesias that can be used during labor and delivery.


    • Local anesthesia: Local anesthesia requires a series of injections in the vaginal outlet. It is generally used for women who need an episiotomy or who require the placement of sutures after delivery.
    • Intravenous Sedation: Sedatives are administered as an injection or intravenously. Can help reduce the pain of labor but will not eliminate the pain entirely.
    • Pudendal block: The pudendal nerve is one of the primary nerves that provide sensation to the vaginal outlet. Pudendal block is administered using an injection of local anesthesia through the vagina and into the pudendal nerve. It is given just prior to delivery and may be supplemented with local anesthesia.
    • Epidural: An epidural is an anesthetic delivered through a tiny catheter placed in the lower part of the back in the epidural space. A woman will continue to feel touch and pressure, but the pains of labor are significantly reduced.
    • Spinal: The spinal is similar to the epidural, but the anesthetic is actually placed within the spinal fluid. Spinal anesthetics are sometimes used at the time of delivery (Saddle block) or at the time of cesarean section. Like an epidural, a spinal cannot be used if you are using blood thinners, have an infection in the back or the blood, or have an unusual spinal abnormality.
    • General: General anesthesia is administered by giving an anesthetic intravenously and through breathing an anesthetic gas. A general anesthesia may be needed for an emergency, or if a cesarean section is required and the patient cannot have an epidural or spinal. Because it carries additional risks, it is not the first choice of pain relief during labor and delivery.

Vanessa M. Givens, MD

Sherri Li, MD

Frank W. Ling, MD

Thomas G. Stovall, MD

Margaret Z. Summitt, MD

Robert L. Summitt, Jr., MD

Val Y. Vogt, MD

Phone: 901-682-9222

Fax: 901-682-9505

Women's Health Specialists

7800 Wolf Trail Cove

Germantown, TN 38138