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Pregnancy Questions

Infertility

What is an infertility evaluation?

An infertility evaluation includes exams and tests to try to find the reason why you and your partner have not become pregnant. If a cause is found, treatment may be possible. In many cases, infertility can be successfully treated even if no cause is found.

When should I consider having an infertility evaluation?

You should consider having an infertility evaluation if any of the following apply to you:

  • You have not become pregnant after 1 year of having regular sexual intercourse without the use of birth control.
  • You are older than age 35 years and have not become pregnant after trying for 6 months without using birth control.
  • You are older than age 40 years and have not become pregnant within 6 months of trying without using birth control.
  • Your menstrual cycle is not regular.
  • You or your partner have a known fertility problem.

Can lifestyle affect fertility?

In women, being underweight, being overweight, or exercising too much may be associated with infertility. In both men and women, drinking alcohol at moderate or heavy levels may be a factor in infertility. In men, smoking cigarettes and marijuana can reduce sperm count and movement.

How does age affect fertility?

For healthy couples in their 20s or early 30s, the chance that a woman will become pregnant is about 25–30% in any single menstrual cycle. This percentage decreases rapidly after age 37 years. By age 40 years, a woman’s chance of getting pregnant drops to less than 10% per menstrual cycle. A man’s fertility also declines with age, but not as predictably.

What causes infertility?

The most common cause of female infertility is lack of or irregular ovulation. The most common causes of male infertility are problems in the testes that affect how sperm are made or how they function.

Other factors in women include problems with the reproductive organs or hormones. Scarring or blockages of the
fallopian tubes may contribute to infertility. This may be the result of past sexually transmitted infections (STIs) or endometriosis. Problems with the thyroid gland or pituitary gland also may contribute to infertility. In men, blockage of the tubes that carry sperm from the testes may be a cause of infertility.

What type of doctor does an infertility evaluation?

Your obstetrician–gynecologist (ob-gyn) usually will do the first assessment. You also may choose to see a specialist. Infertility specialists are ob-gyns with special training in evaluating and treating infertility in women and men. These specialists are called reproductive endocrinologists. Men also may be evaluated and treated by a urologist. Some urologists have special training in male infertility.

What should I expect during my first visit for infertility?

The first visit with a fertility specialist usually involves a detailed medical history and a physical exam. You will be asked questions about your menstrual period, abnormal bleeding or discharge from the vagina, pelvic pain, and disorders that can affect reproduction such as thyroid disease. You and your partner will be asked about the following health issues:

  • Medications (both prescription and over-the-counter) and herbal remedies
  • Illnesses, including STIs and past surgery
  • Birth defects in your family
  • Past pregnancies and their outcomes
  • Use of tobacco, alcohol, and illegal drugs
  • Occupation

You and your partner also will be asked questions about your sexual history:

  • Methods of birth control
  • How long you have been trying to become pregnant
  • How often you have sex and whether you have difficulties
  • If you use lubricants during sex
  • Prior sexual relationships

What tests are done for infertility?

Tests for infertility include laboratory tests, imaging tests, and certain procedures. Imaging tests and procedures look at the reproductive organs and how they work. Laboratory tests often involve testing samples of blood or semen.

What does the basic testing for a woman include?

Laboratory tests may include a urine test, a progesterone test, thyroid function tests, a prolactin level test, and tests of ovarian reserve. Imaging tests and procedures may include an ultrasound exam, hysterosalpingography, sonohysterography, hysteroscopy, and laparoscopy. You may not have all of these tests and procedures. Some are done based on results of previous tests and procedures. You also may track your basal body temperature (BBT) at home.

What is the purpose of tracking basal body temperature?

A woman’s temperature increases around the time of ovulation and stays elevated for the rest of her menstrual cycle. To track ovulation, you will need to take your temperature by mouth every morning before you get out of bed. You record your temperature on a chart for two or three menstrual cycles.

Charting monthly temperature changes can confirm ovulation but it cannot predict it. Some women also monitor their cervical mucus while charting BBT. Just before ovulation, a woman’s cervical mucus becomes thin, slippery, and stretchy. Cervical mucus monitoring is a natural way to help a woman identify her most fertile days.

What do results from a urine test determine?

A urine test determines when and if you ovulate by detecting an increase in the levels of luteinizing hormone (LH) in the urine. A surge in the level of LH triggers the release of an egg. If the test result is positive, it suggests that ovulation will occur in the next 24–48 hours. This gives you an idea of the best time to have sex to try to get pregnant.

How is a progesterone test done?

For a progesterone test, a sample of blood is taken about 1 week before you expect your menstrual period. The level of progesterone is measured. An increased level shows that you have ovulated.

Why would a thyroid function test be done?

Problems with the thyroid gland may cause infertility problems. If a thyroid problem is suspected, levels of hormones that control the thyroid gland are measured to see if it is working normally.

What is a prolactin level test?

This test measures the level of the hormone prolactin. A high prolactin level can disrupt ovulation.

What are tests of ovarian reserve?

The term ovarian reserve refers to a woman’s supply of eggs. Blood tests are used to check the remaining number of eggs.

Why are imaging tests and procedures done?

Different imaging tests and procedures are used to look at the uterus, ovaries, and fallopian tubes to find problems. Some procedures also are used to treat certain problems if they are found. The procedures that you may have depend on your symptoms as well as the results of other tests. Common imaging tests for female infertility include the following:

  • Ultrasound exam—This test can predict when ovulation will occur by viewing changes in the follicles.
  • Sonohysterography—This special ultrasound exam looks for scarring or other problems inside the uterus.
  • Hysterosalpingography—This X-ray procedure shows the inside of the uterus and whether the fallopian tubes are blocked.
  • Hysteroscopy—The procedure uses a camera with a thin light source that is inserted through the cervix and into the uterus. This can show problems inside the uterus and help guide minor surgery.
  • Laparoscopy—This procedure uses a camera with a thin light source that is inserted through the abdomen. This can show the fallopian tubes, ovaries, and the outside of the uterus.

Infertility Glossary of Terms

Basal Body Temperature (BBT): The temperature of the body at rest.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Follicles: The sac-like structures that form inside an ovary when an egg is produced.

Hormones: Substances made in the body by cells or organs that control the function of cells or organs.

Hysterosalpingography: A special X-ray procedure in which a small amount of fluid is placed into the uterus and fallopian tubes to detect abnormal changes in their size and shape or to determine whether the tubes are blocked.

Hysteroscopy: A procedure in which a slender device called a hysteroscope is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Infertility: A condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Luteinizing Hormone (LH): A hormone produced by the pituitary gland that helps an egg to mature and be released.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Ovaries: The paired organs in the female reproductive system that contain the eggs released at ovulation and produce hormones.

Ovulation: The release of an egg from one of the ovaries.

Pituitary Gland: A gland located near the brain that controls growth and other changes in the body.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Scrotum: The external genital sac in the male that contains the testes.

Semen: The fluid made by male sex glands that contains sperm.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called “having sex” or “making love”).

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Sonohysterography: A procedure in which sterile fluid is injected into the uterus through the cervix while ultrasound images are taken of the inside of the uterus.

Sperm: A cell produced in the male testes that can fertilize a female egg.

Testes: Paired male organs that produce sperm and the male sex hormone testosterone.

Thyroid Gland: A butterfly-shaped gland located at the base of the neck in front of the trachea (or windpipe). It makes, stores, and releases thyroid hormone and thyroid-releasing hormone that control the rate at which every part of the body works.

Ultrasound Exam: A test in which sound waves are used to examine internal structures.

Urologist: A physician who specializes in treating problems of the kidneys, bladder, and male reproductive system.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

How long does it take to complete an infertility evaluation?

An infertility evaluation can be finished within a few menstrual cycles in most cases. Some insurance companies may cover the cost of an infertility evaluation. It is a good idea to call your insurance company to find out before you start your evaluation.

What does the basic testing for a man include?

Testing for a man often involves a semen analysis. This analysis is done to assess the amount of sperm, the shape of the sperm, and the way that the sperm move. Blood tests for men measure levels of male reproductive hormones. Too much or too little of these hormones can cause problems with making sperm or with having sex. In some cases, an ultrasound exam of the scrotum may be done to look for problems in the testes.

Diabetes

What is diabetes mellitus?

Diabetes mellitus (also called “diabetes”) is caused by a problem with insulin. Insulin moves glucose out of the blood and into the body’s cells where it can be turned into energy (see the FAQ Diabetes and Women). Pregnancy health care providers often call diabetes that is present before pregnancy “pregestational diabetes.”

When the body does not make enough insulin or does not respond to it, glucose cannot get into cells and instead stays in the blood. As a result, the level of glucose in the blood increases. Over time, high blood glucose levels can damage the body and cause serious health problems, such as heart disease, vision problems, and kidney disease.

How can pregestational diabetes affect my pregnancy?

If your diabetes is not managed well, you are at increased risk of several of the complications associated with diabetes. The following problems can occur in women with diabetes:

  • Birth defects
  • High blood pressure
  • Hydramnios—In this condition, there is an increased amount of amniotic fluid in the amniotic sac that surrounds the baby. It can lead to preterm labor and delivery.
  • Macrosomia (very large baby)—The baby receives too much glucose from the mother and can grow too large. A large baby can make delivery more difficult. A large baby also increases the risk of having a cesarean delivery.

How can pregestational diabetes affect my baby?

Babies born to mothers with pregestational diabetes may have problems with breathing, low glucose levels, and jaundice. Most babies do well after birth, although some may need to spend time in a special care nursery. The good news is that with proper planning and control of your diabetes, you can decrease the risk of these problems.

If I have diabetes and wish to become pregnant, is it important to tell my health care provider?

Yes, your health care provider will help you get your blood glucose level under control before you become pregnant (if it is not already). Controlling your glucose level is important because some of the birth defects caused by high glucose levels happen when the baby’s organs are developing in the first 8 weeks of pregnancy—before you may know you are pregnant. Getting your glucose level under control may require changing your medications, diet, and exercise program.

How does my health care provider know if my blood glucose level has been well controlled?

A blood test called a hemoglobin A1C test may be used to track your progress. This test result gives an estimate of how well your blood glucose level has been controlled during the past 4–6 weeks.

Can pregnancy affect my glucose level?

Women with diabetes are more likely to have low blood glucose levels, known as hypoglycemia, when they are pregnant. Hypoglycemia can occur if you do not eat enough food, skip a meal, do not eat at the right time of day, or exercise too much. Make sure you and family members know what to do if you think you are having symptoms of hypoglycemia, such as dizziness, feeling shaky, sudden hunger, sweating, or weakness.

How can my diet affect my pregnancy?

Eating a well-balanced, healthy diet is a critical part of any pregnancy because your baby depends on the food you eat for its growth and nourishment (see the FAQ Nutrition During Pregnancy). In women with diabetes, diet is even more important. Not eating properly can cause your glucose level to go too high or too low.

How can exercise help during my pregnancy?

Exercise helps keep your glucose level in the normal range and has many other benefits, including controlling your weight; boosting your energy; aiding sleep; and reducing backaches, constipation, and bloating.

Will I take medications to control my diabetes during pregnancy?

If you took insulin before pregnancy to control your diabetes, your insulin dosage usually will increase while you are pregnant. Insulin is safe to use during pregnancy and does not cause birth defects. If you used an insulin pump before you became pregnant, you probably will be able to continue using the pump. Sometimes, however, you may need to switch to insulin shots.

If you normally manage your diabetes with oral medications, your health care provider may suggest a change in your dosage or that you take insulin while you are pregnant.

How will diabetes affect labor and delivery?

Labor may be induced (started by drugs or other means) earlier than the due date, especially if problems with the pregnancy arise. While you are in labor, your glucose level will be monitored closely—typically every hour. If needed, you may receive insulin through an intravenous (IV) line. If you use an insulin pump, you may use it during labor.

If I have diabetes, can I breastfeed my baby?

Experts highly recommend breastfeeding for women with diabetes. Breastfeeding gives the baby the best nutrition to stay healthy, and it is good for the mother as well. It helps new mothers shed the extra weight that they may have gained during pregnancy and causes the uterus to return more quickly to its prepregnancy size.

Diabetes Glossary of Terms

Amniotic Fluid: Water in the sac surrounding the fetus in the mother’s uterus.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Glucose: A sugar that is present in the blood and is the body’s main source of fuel.

Hydramnios: A condition in which there is an excess amount of amniotic fluid in the sac surrounding the fetus.

Insulin: A hormone that lowers the levels of glucose (sugar) in the blood.

Preterm: Born before 37 weeks of pregnancy.

HIV

What is human immunodeficiency virus (HIV)?

Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS).

How do you get HIV?

HIV enters the bloodstream by way of body fluids, such as blood or semen. Once in the blood, the virus invades and kills CD4 cells. CD4 cells are key cells of the immune system. When these cells are destroyed, the body is less able to fight disease.

How do you get AIDS?

AIDS occurs when the number of CD4 cells decreases below a certain level and the person gets sick with diseases that the immune system would normally fight off. These diseases include pneumonia, certain types of cancer, and harmful infections.

How long does it take for HIV to develop into AIDS?

It can take months or years before HIV infection might develop into AIDS. Unless a woman gets tested, she may never know she is infected with HIV until she gets sick.

Can HIV be treated?

HIV infection can be treated, but not cured. Taking anti-HIV drugs can help people with HIV infection stay healthy for a long time and can decrease the chance of passing the virus to others. There is no vaccine to prevent HIV infection.

If I am infected with HIV and pregnant, can I pass HIV to my baby?

  • During pregnancy, HIV can pass through the placenta and infect the fetus.
  • During labor and delivery, the baby may be exposed to the virus in the mother’s blood and other fluids. When a woman goes into labor, the amniotic sac breaks (her water breaks). Once this occurs, the risk of transmitting HIV to the baby increases. Most babies who get HIV from their mothers become infected around the time of delivery.
  • Breastfeeding also can transmit the virus to the baby.

What can I do to reduce the risk of passing HIV on to my baby?

You and your health care professional will discuss things you can do to reduce the risk of passing HIV to your baby. They include the following:

  • Take a combination of anti-HIV drugs during your pregnancy as prescribed.
  • Have your baby by cesarean delivery if lab tests show that your level of HIV is high.
  • Take anti-HIV drugs during labor and delivery as needed.
  • Give anti-HIV drugs to your baby after birth.
  • Do not breastfeed.

By following these guidelines, 99% of HIV-infected women will not pass HIV to their babies.

Why is HIV treatment recommended during pregnancy?

Treatment during pregnancy has two goals: 1) to protect your own health, and 2) to help prevent passing HIV to your fetus. Many combinations of drugs are used to manage HIV infection. This is called a “drug regimen.” Anti-HIV drugs decrease the amount of HIV in the body.

Are there any side effects of HIV drugs?

Drugs used to treat HIV infection may cause side effects. Common side effects include nausea, diarrhea, headaches, and muscle aches. Less common side effects include anemia, liver damage, and bone problems such as osteoporosis. While unusual, drugs used to treat HIV may affect the development of the fetus. However, not taking medication greatly increases the chances of passing the virus to your fetus.

What is my viral load?

Your viral load is the amount of HIV that you have in your body.

Why is it important for my viral load and CD4 cell count to be monitored?

Both a high viral load and a low number of CD4 cells mean there is a greater risk of passing HIV to your fetus and a greater risk of you becoming sick. However, even if you have a low viral load, it is still possible to pass HIV to the fetus.

Should I still use condoms during sex even though I am pregnant?

If your partner also is infected with HIV, condoms help protect you and your partner from other infections. If your partner is not infected with HIV, in addition to using condoms, there are some drugs that partners can take that may decrease their risk of becoming infected.

Are there extra risks for me if I am HIV positive and I have a cesarean delivery?

Having a cesarean delivery may carry extra risks if you are HIV positive. Women with low CD4 cell counts have weak immune systems, so they are at greater risk of infection after surgery. The incision may heal more slowly. Drugs to prevent infection are given during cesarean delivery.

After I give birth, how will I know if my baby is infected with HIV?

Babies who are born to HIV-positive mothers are tested for HIV several times in the first few months. The test looks for the presence of the virus in the baby’s blood. The baby has HIV infection if two of these test results are positive. The baby does not have HIV infection if two of these test results are negative. Another type of HIV test is done when the baby is 12–18 months old.

HIV Glossary of Terms

Acquired Immunodeficiency Syndrome (AIDS): A group of signs and symptoms, usually of severe infections, occurring in a person whose immune system has been damaged by infection with human immunodeficiency virus (HIV).

Amniotic Sac: Fluid-filled sac in the mother’s uterus in which the fetus develops.

Anemia: Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron.

Cesarean Delivery: Delivery of a baby through an incision made in the mother’s abdomen and uterus.

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Hepatitis B and C in Pregnancy

What extra risks are caused by hepatitis B and hepatitis C infections during pregnancy?

Not only does a pregnant woman face the risks of hepatitis herself, she also can pass the viruses to her baby. Many pregnant women may not even know that they are infected because infection sometimes causes no signs or symptoms.

What is acute hepatitis B virus infection?

Infection with hepatitis B virus can be acute or chronic. Acute infection is a short-term illness that happens in the first 6 months after a person is infected. Symptoms may include the following:

  • Tiredness
  • Loss of appetite
  • Nausea and vomiting
  • Jaundice (yellowing of the skin and eyes)
  • Stomach pain
  • Pain in the muscles and joints

The infection can clear up completely in a few weeks without treatment. Those who do get rid of the hepatitis B virus become immune to it. They cannot get the virus again.

How is hepatitis B virus infection spread?

Hepatitis B virus is spread by direct contact with the body fluids (such as blood, semen, or vaginal fluids) of an infected person. This can happen during unprotected sex or while sharing needles used to inject (“shoot”) drugs. A baby can be infected during birth if the mother has hepatitis B. Hepatitis B virus also can be spread if you live with an infected person and share household items that may come into contact with body fluids, such as toothbrushes or razors. Hepatitis B is not spread by casual contact with people and objects. Hepatitis B is not spread by breastfeeding.

What is chronic hepatitis B virus infection?

A small number of adults and many children younger than 5 years who are infected never get rid of the hepatitis B virus. This is called chronic infection. These people keep the virus for the rest of their lives. They are known as carriers. Most carriers do not have any symptoms. In a small number of carriers, chronic infection can lead to serious complications, such as cirrhosis of the liver, liver cancer, and early death.

Can hepatitis B virus infection be cured?

There is no cure for hepatitis B virus infection, but symptoms can be managed. There also is a vaccine that prevents hepatitis B virus infection. People who have had recent contact with the hepatitis B virus and are not vaccinated can be given a shot called hepatitis B immune globulin (HBIG) along with the vaccine. HBIG contains antibodies to the virus. It can give additional protection against infection in certain situations.

If I am pregnant and infected with the hepatitis B virus, how likely is it that I will pass the virus to my baby?

About 90% of pregnant women with acute hepatitis B virus infection will pass the virus to their babies. Between 10% and 20% of women with chronic infection will do so.

How does hepatitis B virus infection affect babies?

Hepatitis B virus infection can be severe in babies. It can threaten their lives. Infected newborns have a high risk (up to 90%) of becoming carriers. They, too, can pass the virus to others. When they become adults, they have a 25% risk of dying of cirrhosis of the liver or liver cancer.

How can I find out if I am infected with the hepatitis B virus?

All pregnant women are tested for hepatitis B. There are different blood tests for hepatitis B virus infection. They can tell whether you have been infected recently or whether you are a carrier. They also can tell whether you have had the hepatitis B virus in the past and are now immune to it or whether you have had the hepatitis B vaccine.

What if my test result is positive for hepatitis B virus infection?

If your test result shows that you are infected with the hepatitis B virus, you may have additional tests to check the function of your liver and your general health. Your other children, your sexual partners, and others living in your household are at risk of infection. They should be told about testing and vaccination.

Will having the hepatitis B virus affect how I will give birth?

Having hepatitis B infection does not affect how you will give birth. You still can have a vaginal delivery if you are infected with the hepatitis B virus.

If I am infected with the hepatitis B virus, can I breastfeed?

Yes. You still can breastfeed your baby if you are infected with the hepatitis B virus.

If I am infected with the hepatitis B virus, what can be done to prevent my baby from becoming infected?

Within a few hours of birth, your baby will receive the first dose of the hepatitis B vaccine. A shot of HBIG is given as well. Two more doses of the vaccine are given over the next 6 months. After the vaccine series is complete, your baby will be tested for hepatitis B virus infection.

What if my baby tests positive for hepatitis B virus infection?

If test results show that the baby is infected with the hepatitis B virus, he or she will need to have ongoing medical care. Regular visits with a health care provider will be needed to assess the baby’s health and how well the liver is working.

If I am not infected with the hepatitis B virus, when should my baby be vaccinated?

All babies are vaccinated against the hepatitis B virus. If you are not infected with the hepatitis B virus, your baby should get the first dose of vaccine before you leave the hospital. If it cannot be given by then, it should be given within 2 months of birth. The remaining doses are given within the next 6–18 months.

Can I be vaccinated against hepatitis C virus infection?

There is no vaccine to protect against the hepatitis C virus. Avoiding certain types of behavior is the only way to prevent infection. Hepatitis C is most common in people born between 1945 and 1965. For this reason, all people in this age group should be tested for hepatitis C infection.

How is hepatitis C virus infection spread?

The hepatitis C virus is spread by direct contact with infected blood. This can happen while sharing needles or sharing household items that come into contact with blood. A baby can be infected during birth if the mother has hepatitis C infection. It also can be spread during unprotected sex, but it is harder to spread the virus this way. It is not spread by casual contact or breastfeeding.

What are signs and symptoms of hepatitis C virus infection?

Hepatitis C virus infection causes signs and symptoms similar to those of hepatitis B virus infection. It also can cause no symptoms. Unlike hepatitis B virus infection, most adults infected with the hepatitis C virus—75% to 85%—become carriers. Most carriers develop long-term liver disease. A smaller number will develop cirrhosis of the liver and other serious, life-threatening liver problems.

If I am infected with the hepatitis C virus, how likely is it that I will pass the virus to my baby?

About 4% of women who are infected with the hepatitis C virus will pass it to their babies. The risk is related to how much of the virus a woman has and whether she also is infected with HIV.

If I am infected with the hepatitis C virus, how soon after I give birth will my baby be tested?

If you are infected with the hepatitis C virus, your baby usually will be tested when he or she is at least 18 months of age

If I am infected with the hepatitis C virus, can I breastfeed?

Yes. You still can breastfeed your baby if you are infected with the hepatitis C virus.

Glossary of Terms for Hepatitis

Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Carriers: People who are infected with the organism of a disease without showing symptoms and who can transmit the disease to another person.

Cirrhosis: A disease caused by loss of liver cells, which are replaced by scar tissue that impairs liver function.

Hepatitis B Immune Globulin (HBIG): A substance given to provide temporary protection against infection with hepatitis B virus.

Jaundice: A buildup of bilirubin that causes a yellowish appearance.

Semen: The fluid made by male sex glands that contains sperm.

Opioid Use and Pregnancy

What are opioids?

Opioids are a type of medication that relieves pain. They also release chemicals in the brain that have a calming effect. Doctors may prescribe opioids for people who have had surgery, dental work, or an injury. Prescribed opioids include oxycodone, hydromorphone, hydrocodone, fentanyl, and codeine. Heroin is an illegal opioid drug. Fentanyl also can be made illegally.

How does opioid use during pregnancy affect a newborn?

A baby born to a woman who used opioids during pregnancy is no longer getting the drug after delivery. As a result, the baby may have temporary withdrawal symptoms. This is called neonatal abstinence syndrome (NAS). Symptoms of NAS can include the following:

  • Shaking and tremors
  • Poor feeding or sucking
  • Crying
  • Fever
  • Diarrhea
  • Vomiting
  • Sleep problems

Swaddling, breastfeeding, skin-to-skin contact, and sometimes medications can help babies with NAS feel better. NAS usually lasts days or weeks. There are no known lasting physical or intellectual problems for babies born with NAS.

What are the risks of opioid use disorder during pregnancy?

Pregnant women with opioid use disorder have an increased risk of serious complications, including the following:

  • Placental abruption
  • Fetal growth problems
  • Preterm birth
  • Stillbirth

When you have an opioid use disorder during pregnancy, you may not take care of yourself before and after the baby is born. You may miss prenatal care appointments.

Anyone with opioid use disorder is at risk of overdose. If you take too much of the drug, you can pass out. Your breathing may slow down or stop, and you can die.

How can taking a prescription opioid become an opioid use disorder?

Most people who use a prescription opioid have no trouble stopping their use, but some people develop an opioid use disorder. Repeated opioid use can cause changes in your brain that make it hard to stop using opioids. Some people are more likely to have these brain changes than others. Your risk can vary based on your genes, environment, and age.

People who have an opioid use disorder may look for other ways to get opioids when their prescription runs out. They may go from doctor to doctor to ask for new prescriptions. Some people use the illegal drug market to find opioids.

What is opioid use disorder?

Opioid use disorder is a treatable disease that can be caused by frequent opioid use. It is sometimes called opioid addiction. Symptoms of opioid use disorder include

  • feeling a strong desire for opioids
  • feeling unable to stop or reduce opioid use
  • having work, school, or family problems caused by your opioid use
  • needing more opioids to get the same effect
  • spending a lot of time trying to find and use opioids
  • feeling unwell after stopping or reducing use

How is opioid use disorder treated during pregnancy?

The best treatment for opioid use disorder during pregnancy includes opioid replacement medication, behavioral therapy, and counseling. The medications that are given are long-acting opioids. This means that they stay active in the body for a long time. These opioids, called methadone and buprenorphine, reduce cravings but do not cause the good feelings that other opioids cause. Behavioral therapy and counseling help people avoid and cope with situations that might lead to relapse.

How is opioid replacement medication given during pregnancy?

Methadone is given by health care professionals in special clinics. Buprenorphine may be available from any doctor who has had special training, including some primary care doctors, ob-gyns, or mental health physicians.

You will be monitored throughout your treatment to make sure the dosage is right. If you have withdrawal symptoms, your dosage may need to be changed. Do not take more medication than is prescribed for you.

What are the benefits of treatment?

In the right amount, both methadone and buprenorphine prevent withdrawal, reduce cravings, and block the effects of other opioids. Treatment with either medication makes it more likely that your fetus will grow normally and not be born too early. During treatment, you also will receive counseling, support, and prenatal care. These services can help you have a healthier pregnancy and start you on the road to recovery.

What are the risks of treatment?

Babies born to women taking methadone or buprenorphine can have temporary withdrawal symptoms. Not all babies will go through withdrawal. Swaddling, breastfeeding, skin-to-skin contact, and sometimes medications can be used to make babies feel better. If a baby is treated with medications, the dosage will be decreased over time until the symptoms have stopped. Your baby may need to stay in a neonatal intensive care unit (NICU) after birth.

Does opioid replacement medication cause birth defects?

Based on many years of research, opioid replacement medication has not been found to cause birth defects.

Can I breastfeed while taking opioid replacement medication?

Breastfeeding usually is encouraged for women who are taking methadone or buprenorphine. Women who should not breastfeed include those who

  • take certain medicines that are not safe during breastfeeding
  • actively use street drugs
  • have human immunodeficiency virus (HIV)

What if I am prescribed opioids for pain relief during pregnancy?

If you are prescribed an opioid during pregnancy, you and your health care professional should discuss the risks and benefits of this treatment. When taken under a doctor’s care, opioids can be safe for you and your fetus, but they still may cause NAS. It is important to take the medication only as prescribed. Continue to see your obstetrician–gynecologist
(ob-gyn)
or other health care professional throughout pregnancy. Your health and your fetus’s health should be monitored.

What else should I know about opioid use disorder during pregnancy?

When you are pregnant and have an opioid use disorder, you should not stop using the drug without medical supervision. Quitting without a doctor’s help, especially when done suddenly, often leads to relapse (return to drug use). Relapse can be harmful for you and your fetus.

Naloxone is a drug that can save your life if you overdose. You can get naloxone over the counter in some states. You should always have a supply of naloxone with you if you have an opioid use disorder or if you have friends or family with this disorder. Naloxone may cause fetal stress when given to a pregnant woman, but it should still be used to save the woman’s life.

How can I get help?

If you need help with an opioid use disorder, you can find resources on the website of the Substance Abuse and Mental Health Services Administration (SAMHSA): www.samhsa.gov. SAMHSA also has a 24-hour treatment referral line:
800-662-HELP (4357).

I have a problem with opioids and I’m afraid to ask for help. What should I know?

Telling a health care professional about how you use opioids is important, especially when you are pregnant. If you have opioid use disorder, treatment can start you on the road to recovery and a healthier pregnancy. Remember, opioid use disorder is a treatable disease.

It also is important to know that states have different laws and policies. Some states consider opioid use during pregnancy a form of child abuse or neglect. Some states have created treatment programs specifically for pregnant women. Other states have policies that give pregnant women priority in general treatment programs. It may be helpful to learn about your state’s laws and policies. You can visit this site for more information: www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy.

The American College of Obstetricians and Gynecologists believes that pregnant women who have an opioid use disorder should receive medical care and counseling services, not punishment. Seeking help is the first step in recovering from addiction and making a better life for you and your family.

Glossary of Terms for Opioid Use

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Genes: Segments of DNA that contain instructions for the development of a person’s physical traits and control of the processes in the body. They are the basic units of heredity and can be passed down from parent to child.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).

Neonatal Intensive Care Unit (NICU): A special part of a hospital in which sick newborns receive medical care.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Opioid Use Disorder: A treatable disease that can be caused by frequent opioid use. It is sometimes called opioid addiction.

Placental Abruption: A condition in which the placenta has begun to separate from the uterus before the fetus is born.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Preterm: Less than 37 weeks of pregnancy.

Stillbirth: Birth of a dead fetus.

Tobacco and Pregnancy

Why is smoking dangerous during pregnancy?

When a woman smokes cigarettes during pregnancy, her fetus is exposed to many harmful chemicals. Nicotine is only one of 4,000 toxic chemicals that can pass from a pregnant woman to her fetus. Nicotine causes blood vessels to narrow, so less oxygen and fewer nutrients reach the fetus. Nicotine also damages a fetus’s brain and lungs. This damage is permanent.

How can smoking during pregnancy put my fetus at risk?

Several problems are more likely to occur during pregnancy when a woman smokes. These problems may include preterm birth, which is birth that occurs before 37 weeks of pregnancy. Babies that are born too early may not be fully developed. They may be smaller than babies born to nonsmokers, and they are more likely to have colic (uncontrollable crying and irritability). These babies are at increased risk of sudden infant death syndrome (SIDS). They also are more likely to develop asthma and obesity in childhood.

If you are smoking when you find out you are pregnant, you should stop. The American Lung Association offers information on how to quit on its website: www.lung.org. You also can contact 1-800-QUIT-NOW, a national network that can connect you to a counselor in your state.

Why should I avoid secondhand smoke during pregnancy?

Secondhand smoke—other people’s smoke that you inhale—can increase the risk of having a low-birth-weight baby by as much as 20%. Infants who are exposed to secondhand smoke have an increased risk of SIDS. These babies are more likely to have asthma attacks and ear infections. If you live or work around smokers, take steps to avoid secondhand smoke.

Are e-cigarettes safe to use during pregnancy?

Electronic cigarettes (known as “e-cigarettes”) are used by some people as a substitute for traditional cigarettes. Using e-cigarettes is called “vaping.” E-cigarettes contain harmful nicotine, plus flavoring and a propellant that may not be safe for a fetus. E-cigarettes are not safe substitutes for cigarettes and should not be used during pregnancy.

Marijuana and Pregnancy

What is marijuana?

Marijuana is a plant that contains a chemical called tetrahydrocannabinol (THC). THC can cause relaxation and the typical “high” associated with marijuana use. Marijuana has other chemicals that affect different organs in the body, including the brain, lungs, blood vessels, heart, and liver.

What is medical marijuana?

Medical marijuana is the use of marijuana that is prescribed by a doctor. The U.S. Food and Drug Administration (FDA) has not approved medical marijuana for the treatment of any medical condition.

People may confuse medical marijuana with FDA-approved drugs that contain a form of THC. These FDA-approved drugs have a form of THC that does not produce a high. These drugs also require a doctor’s prescription.

Is marijuana use legal?

Recreational marijuana use is legal in some states, and 20 states have legalized medical marijuana. But both are illegal under federal law.

Is edible marijuana safer than smoked marijuana?

Edible marijuana is processed differently in the body than marijuana that is smoked. Because edible marijuana is eaten and digested, the effects take longer to be felt. This leads some users to eat more marijuana to feel the effects more quickly. It is not possible to tell how strong the marijuana is before eating it. For these reasons, there is a higher risk of overdose with edible marijuana than with marijuana that is smoked.

Is marijuana safe to use during pregnancy?

When marijuana is smoked or eaten, the chemicals reach the fetus by crossing the placenta. Research is limited on the harms of marijuana use during pregnancy. But there are possible risks of marijuana use, including babies that are smaller at birth and stillbirth. Using marijuana also can be harmful to a pregnant woman’s health. The American College of Obstetricians and Gynecologists recommends that pregnant women not use marijuana.

Is marijuana an effective treatment for morning sickness?

There is no evidence that marijuana is helpful in managing morning sickness. If you have morning sickness, tell your obstetrician–gynecologist (ob-gyn) or other health care professional. Diet and lifestyle changes may help. There also is a drug approved by the FDA to treat the nausea and vomiting of pregnancy.

I use medical marijuana. Should I use it during pregnancy?

No. Medical marijuana is no different than nonmedical marijuana. It is not safer. It has all of the harmful effects of nonmedical marijuana. It is important to let your ob-gyn or other health care professional know if you are using medical marijuana and to discuss other treatments you can try that are safe to use during pregnanc

I’m planning to get pregnant. Do I need to stop using marijuana?

Yes, it is recommended that you stop using marijuana before trying to get pregnant. The effects of marijuana on the fetus may occur even during the first trimester.

What does current research suggest about the effects of marijuana during pregnancy?

Researchers are still learning about the effects of marijuana during pregnancy. Studies are not always clear, but researchers and doctors think the following:

  • Marijuana exposure may disrupt normal brain development of a fetus.
  • Babies whose mothers used marijuana during pregnancy may be smaller at birth.
  • Research suggests an increased risk of stillbirth. It is not known if this is only because of marijuana use or due to use of other substances, such as cigarettes.
  • Some studies suggest that using both marijuana and cigarettes during pregnancy can increase the risk of preterm birth.

What does current research suggest about the effects of marijuana on children?

Research suggests the following:

  • Children whose mothers used marijuana during pregnancy may have learning and behavioral problems later in life.
  • Secondhand smoke from marijuana may be as harmful as secondhand smoke from cigarettes, especially for young children.

How can marijuana use affect my own health, especially if I am pregnant?

Marijuana can make people dizzy and fall. Falls can be dangerous for pregnant women. Marijuana also can alter your judgment, putting you at risk of injury. Smoking marijuana lowers your body’s level of oxygen, which increases the risk of breathing problems. Smoking marijuana also can damage your lungs.

How does marijuana affect breastfeeding babies?

Little is known about the effects of marijuana on breastfeeding babies. Because it is not clear how a baby may be affected by a woman’s marijuana use, the American College of Obstetricians and Gynecologists recommends that women who are breastfeeding not use marijuana.

Is marijuana addictive?

Yes, marijuana is addictive. Current estimates are that 1 in 10 marijuana users fit the definition of addiction. With addiction, a person has difficulty stopping use of a substance even though it causes problems with relationships, work, or school.

Marijuana users also can develop marijuana use disorder. This disorder can cause withdrawal symptoms when you try to stop using marijuana. Symptoms include irritability, trouble sleeping, cravings, and restlessness. About 1 in 3 users have a marijuana use disorder.

Will my ob-gyn or other health care professional ask if I use marijuana?

Your ob-gyn or other health care professional may ask about your use of substances, including alcohol, tobacco, marijuana, illegal drugs, and prescription drugs used for a nonmedical reason. Doctors ask about these substances to learn if you have any behaviors that could harm you or your fetus. If you are having trouble with substance use, your ob-gyn or other health care professional can offer advice or resources to help you quit. The American College of Obstetricians and Gynecologists believes women who have a substance use problem should receive medical care and counseling services to help them quit.

How can I get help for marijuana use disorder or addiction?

If you want to quit marijuana and need help, you can find resources on the website of the Substance Abuse and Mental Health Services Administration (SAMHSA): www.samhsa.gov. SAMHSA also has a 24-hour treatment referral line: 800-662-HELP (4357).

Marijuana Glossary of Terms

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Oxygen: A gas that is necessary to sustain life.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Preterm: Born before 37 weeks of pregnancy.

Stillbirth: Birth of a dead fetus.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

Genetic Disorders

What are genes?

A gene is a small piece of hereditary material called DNA that controls some aspect of a person’s physical makeup or a process in the body. Genes come in pairs.

What are chromosomes?

Chromosomes are the structures inside cells that carry genes. Chromosomes also come in pairs. Most cells have 23 pairs of chromosomes for a total of 46 chromosomes. Sperm and egg cells each have 23 chromosomes. During fertilization, when the egg and sperm join, the two sets of chromosomes come together. In this way, one half of a baby’s genes come from the baby’s mother and one half come from the baby’s father.

What determines my baby’s sex?

Your baby’s sex is determined by sex chromosomes. There are two sex chromosomes: X and Y. Egg cells only contain an X chromosome. Sperm cells can carry an X or a Y. A combination of XX results in a girl and XY results in a boy.

What causes genetic disorders?

Genetic disorders may be caused by problems with either chromosomes or genes.

What causes chromosome disorders?

A chromosome disorder is caused by problems with chromosomes. Most children with chromosome disorders have physical defects and some have intellectual disabilities.

What is aneuploidy?

Having missing or extra chromosomes is a condition called aneuploidy. The risk of having a child with an aneuploidy increases as a woman ages.

Trisomy is the most common aneuploidy. In trisomy, there is an extra chromosome. A common trisomy is trisomy 21 (Down syndrome). Other trisomies include trisomy 13 (Patau syndrome) and trisomy 18 (Edwards syndrome). Monosomy is another type of aneuploidy in which there is a missing chromosome. A common monosomy is Turner syndrome, in which a female has a missing or damaged X chromosome.

What is an inherited disorder?

An inherited disorder is caused by defective genes that can be passed down by parents to their children. Defective genes can occur on any of the chromosomes. A genetic disorder can be autosomal dominant, autosomal recessive, or sex linked.

What is an autosomal dominant disorder?

An autosomal dominant disorder is caused by just one defective gene from either parent. “Autosomal” means that the defective gene is located on any of the chromosomes that are not the sex chromosomes (X or Y). If one parent has the gene, each child of the couple has a 50% chance of inheriting the disorder. An example of an autosomal dominant disorder is Huntington disease.

What is an autosomal recessive disorder?

Autosomal recessive disorders only happen when both parents carry the gene. An example of an autosomal recessive disorder is cystic fibrosis.

What is a carrier?

A carrier of a recessive disorder is a person who carries one copy of a gene that works incorrectly and one that works normally. A carrier may not have symptoms of the disorder or may have only mild symptoms. If both parents are carriers of an abnormal gene, there is a 25% chance that the child will get the abnormal gene from each parent and will have the disorder. There is a 50% chance that the child will be a carrier of the disorder—just like the carrier parents. If only one parent is a carrier, there is a 50% chance that the child will be a carrier of the disorder.

What are sex-linked disorders?

Sex-linked disorders are caused by defective genes on the sex chromosomes. An example of a sex-linked disorder is hemophilia. This disease is caused by a defective gene on the X chromosome.

What are multifactorial disorders?

Multifactorial disorders are caused by a combination of factors. Some factors are genetic, while some are nongenetic. A few of these disorders can be detected during pregnancy.

Do certain people have an increased risk of having a child with a birth defect compared with others?

Most babies with birth defects are born to couples without risk factors. However, the risk of birth defects is higher when certain factors are present. Screening for birth defects begins by assessing your risk factors, such as whether you have a genetic disorder, whether you have a child with a genetic disorder, or whether there is a family history of a genetic disorder. Some genetic disorders are more common in certain ethnic groups.

What is genetic counseling?

In some situations, you may be referred to a genetic counselor. A genetic counselor has special training in genetics. In addition to studying your family health history, he or she may refer you for physical exams and tests. Using this information, the counselor will assess your baby’s risk of having a problem, discuss your options, and talk about any concerns you may have.

What types of prenatal tests are available to address concerns about genetic disorders?

Screening tests assess the risk that a baby will be born with a specific birth defect or genetic disorder. Diagnostic tests can detect if a specific birth defect or genetic disorder is present in the fetus.

When are screening tests offered during pregnancy and what kinds of disorders do they assess?

Screening tests often are part of routine prenatal care and are done at different times during the first and second trimesters of pregnancy. Screening tests include blood tests that measure the level of certain substances in the mother’s blood combined with an ultrasound exam. These tests assess the risk that a baby will have Down syndrome and other trisomies, as well as neural tube defects.

What are carrier tests?

Carrier tests are a type of screening test that can show if a person carries a gene for an inherited disorder.

For whom is carrier testing recommended?

Carrier testing often is recommended for people with a family history of a genetic disorder or people from certain races or ethnic groups who are at increased risk of having a child with a specific genetic disorder. Cystic fibrosis carrier screening is offered to all women of reproductive age because it is one of the most common genetic disorders.

When is carrier testing done?

Carrier tests can be done before (preconception) or during pregnancy.

When are diagnostic tests offered during pregnancy and what kinds of disorders do they detect?

Diagnostic tests may be recommended if a screening test shows an increased risk of a birth defect. Diagnostic testing also is offered as a first choice to all pregnant women, even those who do not have risk factors. Diagnostic tests can detect if a specific birth defect or genetic disorder is present.

How are diagnostic tests done?

Diagnostic tests are done on cells from the fetus obtained through amniocentesis, chorionic villus sampling, or, rarely, fetal blood sampling. The chromosomes and genes in the cells then can be analyzed using different techniques to diagnose certain inherited defects and many chromosomal defects.

Are there risks associated with diagnostic tests?

Diagnostic tests carry risks, including an increased risk of pregnancy loss.

How do I know which tests to have?

Your health care professional or a genetic counselor can discuss all of the testing options with you and help you decide based on your individual risk factors.

Do I have to have these tests?

Whether you want to be tested is a personal choice. Some couples would rather not know if they are at risk or whether their child will have a disorder, but others want to know in advance. Knowing beforehand gives you time to prepare for having a child with a particular disorder and to organize the medical care that your child may need. You also may have the option of not continuing the pregnancy.

Glossary of Terms for Genetic Testing

Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells from the sac surrounding the fetus.

Aneuploidy: Having an abnormal number of chromosomes.

Autosomal Dominant Disorder: A genetic disorder caused by one defective gene; the defective gene is located on one of the chromosomes that is not a sex chromosome.

Autosomal Recessive Disorder: A genetic disorder caused by two defective genes, one inherited from each parent; the defective genes are located on one of the pairs of chromosomes that are not the sex chromosomes.

Carrier: A person who shows no signs of a particular disorder but could pass the gene on to his or her children.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Chorionic Villus Sampling: A procedure in which a small sample of cells is taken from the placenta and tested.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person’s physical makeup.

Cystic Fibrosis: An inherited disorder that causes problems in digestion and breathing.

Diagnostic Tests: Tests that look for a disease or cause of a disease.

DNA: The genetic material that is passed down from parents to offspring. DNA is packaged in structures called chromosomes.

Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Fertilization: Joining of the egg and sperm.

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Gene: A segment of DNA that contains instructions for the development of a person’s physical traits and control of the processes in the body. They are the basic units of heredity and can be passed down from parent to offspring.

Genetic Counselor: A health care professional with special training in genetics and counseling who can provide expert advice about genetic disorders and prenatal testing.

Hemophilia: A disorder caused by a mutation on the X chromosome. Affected individuals are usually males who lack a substance in the blood that helps it clot and are at risk of severe bleeding from even minor injuries.

Huntington Disease: An autosomal dominant disorder that causes loss of control of body movements and mental function. Symptoms typically start between the ages of 35 years and 50 years.

Monosomy: A condition in which there is a missing chromosome.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Screening Tests: Tests that look for possible signs of disease in people who do not have signs or symptoms.

Sex-Linked Disorder: A genetic disorder caused by a change in a gene or genes that are located on the sex chromosomes.

Sperm: A cell produced in the male testes that can fertilize a female egg.

Trimesters: The three 3-month periods into which pregnancy is divided.

Trisomy: A condition in which there is an extra chromosome.

Trisomy 13 (Patau Syndrome): A chromosomal disorder that causes serious problems with the brain and heart as well as extra fingers and toes, cleft palate and lip, and other defects. Most infants with trisomy 13 die within the first year of life.

Trisomy 18 (Edwards Syndrome): A chromosomal disorder that causes severe intellectual disability and serious physical problems such as a small head, heart defects, and deafness. Most of those affected with trisomy 18 die before birth or within the first month of life.

Trisomy 21 (Down Syndrome): A chromosomal disorder in which abnormal features of the face and body, medical problems such as heart defects, and intellectual disability occur. Many children with Down syndrome live to adulthood.

Turner Syndrome: A condition affecting females in which there is a missing or damaged X chromosome. It causes a webbed neck, short height, and heart problems but does not usually cause developmental delays.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Carrier Screening

What is carrier screening?

Carrier screening is a type of genetic test that can tell you whether you carry a gene for certain genetic disorders. When it is done before or during pregnancy, it allows you to find out your chances of having a child with a genetic disorder.

What is a carrier?

For some genetic disorders, it takes two genes for a person to have the disorder. A carrier is a person who has only one gene for a disorder. Carriers usually do not have symptoms or have only mild symptoms. They often do not know that they have a gene for a disorder.

How is carrier screening done?

Carrier screening involves testing a sample of blood, saliva, or tissue from the inside of the cheek. Test results can be negative (you do not have the gene) or positive (you do have the gene). Typically, the partner who is most likely to be a carrier is tested first. If test results show that the first partner is not a carrier, then no additional testing is needed. If test results show that the first partner is a carrier, the other partner is tested. Once you have had a carrier screening test for a specific disorder, you do not need to be tested again for that disorder.

What are the chances of having a child with a genetic disorder?

If both parents are carriers of a recessive gene for a disorder, there is a 25% (1-in-4) chance that their child will get the gene from each parent and will have the disorder. There is a 50% (1-in-2) chance that the child will be a carrier of the disorder—just like the carrier parents. If only one parent is a carrier, there is a 50% (1-in-2) chance that the child will be a carrier of the disorder.

When can carrier screening be done?

Some people decide to have carrier screening before having children. Carrier screening also can be done during pregnancy. Getting tested before pregnancy gives you a greater range of options and more time to make decisions.

Do I have to have carrier screening?

Carrier screening is a voluntary decision. You can choose to have carrier screening, or you can choose not to. There is no right or wrong choice.

What carrier screening tests are available?

Carrier screening is available for a limited number of diseases, including cystic fibrosis, fragile X syndrome, sickle cell disease, and Tay–Sachs disease. Some of these disorders occur more often in certain races or ethnic groups. For example, sickle cell disease occurs most frequently in African Americans. Tay–Sachs disease is most common in people of Eastern or Central European Jewish, French Canadian, and Cajun descent. But anyone can have one of these disorders. They are not restricted to these groups.

Who should have carrier screening?

All women who are thinking about becoming pregnant or who are already pregnant are offered carrier screening for cystic fibrosis, hemoglobinopathies, and spinal muscular atrophy (SMA). You can have screening for additional disorders as well. There are two approaches to carrier screening for additional disorders: 1) targeted screening and 2) expanded carrier screening.

What is targeted carrier screening?

In targeted carrier screening, you are tested for disorders based on your ethnicity or family history. If you belong to an ethnic group or race that has a high rate of carriers for a specific genetic disorder, carrier screening for these disorders may be recommended. This also is called ethnic-based carrier screening. If you have a family history of a specific disorder, screening for that disorder may be recommended, regardless of your race or ethnicity.

What is expanded carrier screening?

In expanded carrier screening, many disorders are screened using a single sample. This type of screening is done without regard to race or ethnicity. Companies that offer expanded carrier screening create their own lists of disorders that they test for. This list is called a screening panel. Some panels test for more than 100 different disorders. Screening panels usually focus on severe disorders that affect a person’s quality of life from an early age.

Is one approach better than the other?

Before testing, you and your obstetrician–gynecologist (ob-gyn) or other health care professional can discuss the benefits and limitations of each carrier screening approach. In some cases, both approaches can be used to tailor screening to your individual situation.

What choices do I have if my partner and I are carriers of a genetic disorder?

If you have carrier screening before you become pregnant, you have several options. You can become pregnant and have prenatal diagnostic tests to see if the fetus has the disorder. You can choose to use in vitro fertilization (IVF) with donor eggs or sperm to become pregnant. With this option, the embryo can be tested before it is transferred to the uterus. You also may choose not to become pregnant. If you have carrier screening after you become pregnant, your options are more limited. In either case, a genetic counselor, your ob-gyn, or other health care professional can explain your risks of having a child with the disorder.

How accurate is carrier screening?

No test is perfect. In a small number of cases, test results can be wrong. A negative test result when you have a gene for the disorder tested is called a false-negative result. A positive test result when you do not have a gene for a disorder is called a false-positive result.

Are results of carrier screening confidential?

The Genetic Information Nondiscrimination Act of 2008 (GINA) makes it illegal for most health insurers to require genetic testing results or use results to make decisions about coverage, rates, or preexisting conditions. GINA also makes it illegal for employers to discriminate against employees or applicants because of genetic information. GINA does not apply to life insurance, long-term care insurance, or disability insurance.

If you find out that you are a carrier of a gene for a genetic disorder, you may want to tell other family members. They may be at risk of being carriers themselves. There is no law that states that you have to do so. If you choose to tell family members, your ob-gyn or genetic counselor can advise you about the best way to do this. It cannot be done without your consent.

Carrier Screening Glossary of Terms

Carrier: A person who shows no signs of a disorder but could pass the gene to his or her children.

Carrier Screening: A test done on a person without signs or symptoms to find out whether he or she carries a gene for a genetic disorder.

Cystic Fibrosis: An inherited disorder that causes problems with breathing and digestion.

Diagnostic Tests: Tests that look for a disease or cause of a disease.

Eggs: The female reproductive cells made in and released from the ovaries. Also called the ova.

Embryo: The stage of development that starts at fertilization (joining of an egg and sperm) and lasts up to 8 weeks.

Fragile X Syndrome: A genetic disease of the X chromosome that is the most common inherited cause of mental disability.

Gene: A segment of DNA that contains instructions for the development of a person’s physical traits and control of the processes in the body. The gene is the basic unit of heredity and can be passed from parent to child.

Genetic Counselor: A health care professional with special training in genetics who can provide expert advice about genetic disorders and prenatal testing.

Genetic Disorders: Disorders caused by a change in genes or chromosomes.

Hemoglobinopathies: Any inherited disorder that affects the number or shape of red blood cells in the body. Examples include sickle cell disease and the different forms of thalassemia.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Sickle Cell Disease: An inherited disorder in which red blood cells have a crescent shape, which causes chronic anemia and episodes of pain. The disease occurs most often in African Americans.

Sperm: A cell made in the male testes that can fertilize a female egg.

Spinal Muscular Atrophy (SMA): An inherited disorder that causes wasting of the muscles and severe weakness. SMA is the leading genetic cause of death in infants.

Tay–Sachs Disease: An inherited disorder that causes mental disability, blindness, seizures, and death, usually by age 5. It most commonly affects people of Eastern or Central European Jewish backgrounds, as well as people of French Canadian and Cajun backgrounds.

Back Pain During Pregnancy

What causes back pain during pregnancy?

The following changes during pregnancy can lead to back pain:

  • Strain on your back muscles
  • Abdominal muscle weakness
  • Pregnancy hormones

How do my back muscles become strained during pregnancy?

The main cause of back pain during pregnancy is strain on your back muscles. As your pregnancy progresses, your uterus becomes heavier. Because this increased weight is carried in the front of your body, you naturally bend forward. To keep your balance, your posture changes. You may find yourself leaning backward, which can make the back muscles work harder. This extra strain can lead to pain, soreness, and stiffness.

How can weakened abdominal muscles affect my back during pregnancy?

Your abdominal muscles support the spine and play an important role in the health of the back. During pregnancy, these muscles become stretched and may weaken. These changes also can increase your risk of hurting your back when you exercise.

How can pregnancy hormones contribute to back pain?

To prepare for the passage of the baby through the birth canal, a hormone relaxes the ligaments in the joints of your pelvis. This loosening allows the joints to become more flexible, but it also can cause back pain if the joints become too mobile.

What can I do to prevent back pain during pregnancy?

To help prevent back pain, be aware of how you stand, sit, and move. Here are some tips that may help:

  • Wear shoes with good arch support. Flat shoes usually provide little support unless they have arch supports built in. High heels can further shift your balance forward and make you more likely to fall.
  • Consider investing in a firm mattress. A firm mattress may provide more support for your back during pregnancy.
  • Do not bend over from the waist to pick things up—squat down, bend your knees, and keep your back straight.
  • Sit in chairs with good back support, or use a small pillow behind the low part of your back. Special devices called lumbar supports are available at office- and medical-supply stores.
  • Try to sleep on your side with one or two pillows between your legs or under your abdomen for support.

What can I do to ease back pain?

Get regular exercise. Exercises for the back strengthen and stretch muscles that support your back and legs and promote good posture. They not only ease back pain but also help prepare you for labor and childbirth. You also can try applying heat or cold to the painful area.

When should I contact my health care professional about back pain during pregnancy?

If you have severe pain, or if pain persists for more than 2 weeks, you should contact your obstetrician or other member of your health care team. Back pain is a symptom of preterm labor, and it also can be a sign of a urinary tract infection. Contact your health care professional right away if you have a fever, burning during urination, or vaginal bleeding in addition to back pain.

Back Pain During Pregnancy Glossary of Terms

Hormones: Substances made in the body by cells or organs that control the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Ligaments: Bands of tissue that connect bones or support large internal organs.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Bleeding During Pregnancy

Does bleeding during pregnancy always mean that there is a problem?

Vaginal bleeding during pregnancy has many causes. Some are serious, whereas others are not. Bleeding can occur early or later in pregnancy. Bleeding in early pregnancy is common. In many cases, it does not signal a major problem. Bleeding later in pregnancy can be more serious. It is best to contact your obstetrician–gynecologist (ob-gyn) or other health care professional if you have any bleeding at any time during pregnancy.

How common is bleeding during early pregnancy?

Bleeding in the first trimester happens to about 15–25% of pregnant women. Light bleeding or spotting can occur 1–2 weeks after fertilization when the fertilized egg implants in the lining of the uterus. The cervix may bleed more easily during pregnancy because more blood vessels are developing in this area. It is not uncommon to have spotting or light bleeding after sexual intercourse or after a Pap test or pelvic exam.

What problems can cause bleeding during early pregnancy?

Problems that can cause bleeding in early pregnancy include infection, early pregnancy loss, and ectopic pregnancy.

What is early pregnancy loss?

Loss of a pregnancy during the first 13 weeks of pregnancy is called early pregnancy loss or miscarriage. It happens in about 10% of known pregnancies. Bleeding and cramping are signs of early pregnancy loss. However, about one half of women who have a miscarriage do not have any bleeding beforehand.

If you have had an early pregnancy loss, some of the pregnancy tissue may be left in the uterus. This tissue needs to be removed. You can allow the tissue to pass naturally, or it can be removed with medication or surgery

What is an ectopic pregnancy?

An ectopic pregnancy occurs when the fertilized egg does not implant in the uterus but instead implants somewhere else, usually in one of the fallopian tubes. If the fallopian tube ruptures, internal bleeding can occur. Blood loss may cause weakness, fainting, pain, shock, or even death.

Sometimes vaginal bleeding is the only sign of an ectopic pregnancy. Other symptoms may include abdominal, pelvic, or shoulder pain. These symptoms can occur before you even know you are pregnant. If you have these symptoms, call your ob-gyn or other health care professional. The pregnancy will not survive, and it must be removed with medication or surgery.

What can cause bleeding later in pregnancy?

Common problems that may cause light bleeding later in pregnancy include inflammation of or growths on the cervix. Heavy bleeding is a more serious sign. Heavy bleeding may be caused by a problem with the placenta. Any amount of bleeding also may signal preterm labor. If you have any bleeding late in pregnancy, contact your ob-gyn right away or go immediately to the hospital.

What problems with the placenta can cause bleeding during pregnancy?

Several problems with the placenta later in pregnancy can cause bleeding:

  • Placental abruption—In placental abruption, the placenta detaches from the wall of the uterus before or during birth. The most common signs and symptoms are vaginal bleeding and abdominal or back pain. Placental abruption can cause serious complications if it is not found early. The baby may not get enough oxygen, and the pregnant woman can lose a large amount of blood.
  • Placenta previa—When the placenta lies low in the uterus, it may partly or completely cover the cervix. This is called placenta previa. It may cause vaginal bleeding. This type of bleeding often occurs without pain. Some types of placenta previa resolve on their own by 32–35 weeks of pregnancy as the lower part of the uterus stretches and thins out. Labor and delivery then can happen normally. If placenta previa does not resolve, you may need to have the baby early by cesarean delivery.
  • Placenta accreta—When the placenta (or part of the placenta) invades and is inseparable from the uterine wall, it is called placenta accreta. Placenta accreta can cause bleeding during the third trimester and severe blood loss during delivery. Most cases can be found during pregnancy with a routine ultrasound exam. Sometimes, though, it is not discovered until after the baby is born. If you have placenta accreta, you are at risk of life-threatening blood loss during delivery. Your ob-gyn will plan your delivery carefully and make sure that all needed resources are available. You may need to have your baby at a hospital that specializes in this complication. Hysterectomy often needs to be done right after delivery to prevent life-threatening blood loss.

Can bleeding be a sign of preterm labor?

Late in pregnancy, vaginal bleeding may be a sign of labor. If labor starts before 37 completed weeks of pregnancy, it is called preterm labor. Other signs of preterm labor include the following:

  • Change in vaginal discharge (it becomes watery, mucus-like, or bloody) or increase in amount of vaginal discharge
  • Pelvic or lower abdominal pressure
  • Constant, low, dull backache
  • Mild abdominal cramps, with or without diarrhea
  • Regular or frequent contractions or uterine tightening, often painless (four times every 20 minutes or eight times an hour for more than 1 hour)
  • Ruptured membranes (your water breaks—either a gush or a trickle)

How preterm labor is managed is based on what is thought to be best for your health and your baby’s health. In some cases, medications may be given. When preterm labor is too far along to be stopped or there are reasons that the baby should be born early, it may be necessary to deliver the baby.

Bleeding During Pregnancy Glossary of Terms

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the woman’s abdomen and uterus.

Early Pregnancy Loss: Loss of a pregnancy that occurs in the first 13 weeks of pregnancy; also called a miscarriage.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Fertilization: Joining of the egg and sperm.

Hysterectomy: Removal of the uterus.

Inflammation: Pain, swelling, redness, and irritation of tissues in the body.

Miscarriage: Loss of a pregnancy that occurs in the first 13 weeks of pregnancy.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Oxygen: A gas that is necessary to sustain life.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Placenta Accreta: A condition in which part or all of the placenta attaches abnormally to and is inseparable from the uterine wall.

Placental Abruption: A condition in which the placenta has begun to separate from the inner wall of the uterus before the baby is born.

Placenta Previa: A condition in which the placenta partially or completely covers the opening of the uterus.

Preterm: Born before 37 completed weeks of pregnancy.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Preterm Labor and Birth

What is preterm labor?

Preterm labor is defined as regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. Changes in the cervix include effacement (the cervix thins out) and dilation (the cervix opens so that the fetus can enter the birth canal). In some cases preterm labor can lead to a baby being born too soon.

Which preterm babies are at greatest risk of health problems?

The risk of health problems is greatest for babies born before 34 weeks of pregnancy. But babies born between 34 weeks of pregnancy and 37 weeks of pregnancy also are at risk.

Why is preterm birth a concern?

Preterm birth is a concern because babies who are born too early may not be fully developed. They may be born with serious health problems. Some health problems, like cerebral palsy, can last a lifetime. Other problems, such as learning disabilities, may appear later in childhood or even in adulthood.

What is preterm birth?

When birth occurs between 20 weeks of pregnancy and 37 weeks of pregnancy, it is called preterm birth.

What are risk factors for preterm birth?

Factors that increase the risk of preterm birth include the following:

  • Having a previous preterm birth
  • Having a short cervix
  • Short time between pregnancies
  • History of certain types of surgery on the uterus or cervix
  • Certain pregnancy complications, such as multiple pregnancy and vaginal bleeding
  • Lifestyle factors such as low prepregnancy weight, smoking during pregnancy, and substance abuse during pregnancy

Can anything be done to prevent preterm birth if I am at high risk?

If you have had a prior preterm birth and you are planning another pregnancy, a prepregnancy care checkup can help you get in the best possible health before you become pregnant. When you become pregnant, be sure to start prenatal care early. You may be referred to a health care professional who has expertise in managing high-risk pregnancies. In addition, you may be given certain medications or other treatment to help prevent preterm birth if you have risk factors. Treatment is given based on your individual situation and your risk factors for preterm birth.

What are the signs and symptoms of preterm labor and what should I do if I have any of them?

Call your obstetrician or other health care professional right away if you notice any of these signs or symptoms:

  • Change in type of vaginal discharge (watery, mucus, or bloody)
  • Increase in amount of discharge
  • Pelvic or lower abdominal pressure
  • Constant low, dull backache
  • Mild abdominal cramps, with or without diarrhea
  • Regular or frequent contractions or uterine tightening, often painless
  • Ruptured membranes (your water breaks with a gush or a trickle of fluid)

How is preterm labor diagnosed?

Preterm labor can be diagnosed only when changes in the cervix are found. Your obstetrician or other health care professional may perform a pelvic exam to see if your cervix has started to change. You may need to be examined several times over a period of a few hours. Your contractions also may be monitored.

Your obstetrician or other health care professional may do certain tests to determine whether you need to be hospitalized or if you need immediate specialized care. A transvaginal ultrasound exam may be done to measure the length of your cervix. The level of a protein called fetal fibronectin in the vaginal discharge may be measured. The presence of this protein is linked to preterm birth.

If I have preterm labor, will I have a preterm birth?

It is difficult for health care professionals to predict which women with preterm labor will go on to have preterm birth. Only about 1 in 10 women with preterm labor will give birth within the next 7 days. For about 3 in 10 women, preterm labor stops on its own.

What happens if my preterm labor continues?

If your preterm labor continues, how it is managed is based on what is thought to be best for your health and your fetus’s health. When there is a chance that the fetus would benefit from a delay in delivery, certain medications may be given. These medications include corticosteroids, magnesium sulfate, and tocolytics.

What are corticosteroids?

Corticosteroids are drugs that cross the placenta and help speed up development of the fetus’s lungs, brain, and digestive organs. Corticosteroids are most likely to help your fetus when they are given between 24 weeks of pregnancy and 34 weeks of pregnancy. They also may be given between 23 and 24 weeks of pregnancy.

What is magnesium sulfate?

Magnesium sulfate is a medication that may be given if you are less than 32 weeks pregnant, are in preterm labor, and are at risk of delivery within the next 24 hours. This medication may help reduce the risk of cerebral palsy that is associated with early preterm birth.

What are tocolytics?

Tocolytics are drugs used to delay delivery for a short time (up to 48 hours). They may allow time for corticosteroids or magnesium sulfate to be given or for you to be transferred to a hospital that offers specialized care for preterm infants. In addition to its role in protecting against cerebral palsy, magnesium sulfate also can be used as a tocolytic drug.

Preterm Birth Glossary of Terms

Cerebral Palsy: A disorder of the nervous system that affects movement, posture, and coordination. This disorder is present at birth.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Corticosteroids: Drugs given for arthritis or other medical conditions. These drugs also are given to help fetal lungs mature before birth.

Fetal Fibronectin: A protein that is produced by fetal cells. It helps the amniotic sac stay connected to the lining of the uterus.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Magnesium Sulfate: A drug that may help prevent cerebral palsy when it is given to women in preterm labor who may deliver before 32 weeks of pregnancy.

Neonatologist: A doctor who specializes in the diagnosis and treatment of disorders that affect newborn infants.

Obstetrician: A doctor who cares for women during pregnancy and their labor.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Placenta: An organ that provides nutrients to and takes waste away from the fetus.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Tocolytics: Drugs used to slow contractions of the uterus.

Transvaginal Ultrasound Exam: A type of ultrasound in which the device is placed in your vagina.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

What happens if my labor does not stop?

If your labor does not stop and it looks like you will give birth to your baby early, you and the baby usually will be cared for by a team of health care professionals. The team may include a neonatologist, a doctor who specializes in treating problems in newborns. The care your baby needs depends on how early he or she is born. High-level neonatal intensive care units (NICUs) provide this specialized care for preterm infants.

Extremely Preterm Birth

When is a baby considered “preterm” or “extremely preterm?”

A normal pregnancy with one baby lasts about 40 weeks. Babies born before 37 completed weeks of pregnancy are called “preterm” or “premature.” Babies born before 28 completed weeks of pregnancy are considered extremely preterm. The earlier a baby is born, the less likely he or she is to survive. Those who do survive often have serious, sometimes long-term health problems and disabilities.

What are the health outcomes for extremely preterm babies?

Medical advances have helped some preterm babies survive and overcome health challenges. However, the chances that a baby born extremely early will survive without disability are still small. With very rare exceptions, babies born before 23 weeks of pregnancy do not survive. Although survival rates increase for babies born between 23 weeks and 25 weeks of pregnancy, most survivors face serious, often lifelong disabilities. As gestational age increases, the outlook for preterm babies improves.

What is gestational age?

Gestational age is the “age” of the pregnancy. It often is counted in weeks and days. For example, “24 and 2/7 weeks of pregnancy” refers to 24 completed weeks and the next 2 days of pregnancy.

Is there specialized health care for women and babies at risk of extremely preterm birth?

Extremely preterm birth usually is managed by a team of specialized health care professionals. In addition to your obstetrician or other pregnancy care professional, the team may include a maternal–fetal medicine subspecialist, a neonatologist, and other pediatric subspecialists. You may be transferred to a hospital that offers specialized care for extremely preterm infants. If time allows, this transfer may take place before delivery. High-level neonatal intensive care units (NICUs) provide care for infants with serious health problems. High-level maternal care facilities manage women with high-risk pregnancies.

What will happen if my baby is expected to be born extremely preterm?

You and your health care team will work together to form a plan about the care you and your baby will receive. This involves weighing the risks and benefits of the available treatment options for both you and your baby. Your personal beliefs and values and what your wishes are for your baby also are important in forming the care plan.

It is important to remember that this care plan may change as circumstances change. For instance, care plans may be adjusted after the baby is born when more information is known about the baby’s condition. Care decisions also may change depending on how the baby responds to treatment.

If my baby is born extremely preterm, will he or she need resuscitation?

Extremely preterm infants will not survive without resuscitation. Often this means helping the baby breathe by inserting a tube into his or her airway. Steps may be taken to start the baby’s heart. Even with resuscitation efforts, some babies will not survive. Those who do may have severe disabilities. Babies born before 23 weeks of pregnancy typically do not survive even with resuscitation. In some cases, after discussion with the health care team, a family may decide that resuscitation is not the best option for their baby. In situations like this, medical care will focus on keeping the baby warm, comfortable and free from pain.

What medications can be given to improve an extremely preterm baby’s chance of survival?

If resuscitation of the baby is planned or being considered, medications given to the pregnant woman may improve the baby’s chances of survival and reduce the risk of disability. These medications include the following:

  1. Corticosteroids to help the baby’s lungs and other organs mature
  2. Magnesium sulfate to decrease the risk of cerebral palsy
  3. Tocolytic medications to help prolong pregnancy for a few hours or days to give time for the first two drugs to work
  4. Antibiotics to prevent infection

Recommendations for giving these medications are made on a case-by-case basis. For example, corticosteroids are not recommended when delivery is expected at 22 weeks of pregnancy or earlier because they have not been found to be helpful. At 23 weeks of pregnancy, corticosteroids may be considered, but whether they will help is uncertain.

Will I need to have a cesarean delivery if my baby is born extremely preterm?

Not necessarily. Some babies at risk of extremely preterm birth may not be in a good position in the uterus to allow for a safe vaginal delivery. In these cases, a cesarean delivery may be recommended depending on gestational age. Cesarean delivery is rarely recommended before 23–24 weeks of pregnancy because it is unlikely to affect the outcome.

How can extremely preterm delivery affect my health?

A cesarean delivery can increase the risk of complications in future pregnancies. Prolonging pregnancy may worsen some medical conditions, such as preeclampsia, or put you at risk of infection. These health consequences also should be considered in care decisions.

Who can I turn to for support?

Your health care team is trained to give medical guidance and to include your and your family’s wishes and preferences in the decision-making process. Because your culture, values, and religious beliefs are important to consider when making these decisions, you also may want to seek support from family, trusted friends, and clergy. The hospital may offer counseling services and other programs for you and your family.

What will happen if it is decided to withdraw or withhold life-saving care?

If you decide to withdraw or withhold life-saving care, measures will be taken to make sure the baby is kept warm and comfortable. You will be able to spend as much time as you want with your baby. Nurses and other staff can help you create keepsakes, such as taking pictures and making footprints. Your health care team will make sure that you get the help and support you need.

What is involved in caring for an extremely preterm baby after leaving the hospital?

Most extremely preterm babies spend months in the hospital. After they are discharged, many will need ongoing, specialized medical care. There are pediatricians who specialize in the care of preterm babies from birth through childhood. Some clinics focus on follow-up care for preterm babies. The doctor will closely watch how your baby grows and check to see if any other problems develop during childhood.

Many agencies provide help for parents caring for preterm babies. It is a good idea to become as informed as you can so you can give your baby the best care. As your child reaches school age, you may need to find a special school or teachers to help with any learning problems.

Extreme Preterm Birth Glossary of Terms

Antibiotics: Drugs that treat certain types of infections.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Corticosteroids: Medications given to help fetal lungs mature, for arthritis, or for other medical conditions.

Gestational Age: The age of a pregnancy, usually calculated from the number of weeks that have elapsed from the first day of the last normal menstrual period and often using findings from an ultrasound examination performed in the first or second trimester of pregnancy.

Magnesium Sulfate: A drug that may help prevent cerebral palsy when it is given to women in preterm labor who are at risk of delivery before 32 weeks of pregnancy.

Maternal–Fetal Medicine Subspecialist: An obstetrician–gynecologist with additional training in caring for women with high-risk pregnancies; also called a perinatologist.

Neonatal Intensive Care Units (NICUs): Specialized area of a hospital in which ill newborns receive complex medical care.

Neonatologist: A pediatrician who specializes in the diagnosis and treatment of disorders that affect newborn infants.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Preterm: Born before 37 completed weeks of pregnancy.

Resuscitation: Medical procedures that restore life to someone who appears to be dead.

Tocolytic: A drug used to slow contractions of the uterus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Induction of Labor at 39 Weeks

What is labor induction?

Labor induction is the use of medications or other methods to start (induce) labor.

Can induction be done before 39 weeks?

When a woman and her fetus are healthy, induction should not be done before 39 weeks. Babies born at or after 39 weeks have the best chance at healthy outcomes compared with babies born before 39 weeks. When the health of a woman or her fetus is at risk, induction before 39 weeks may be recommended.

Can I have an induction at 39 weeks?

You and your obstetrician–gynecologist (ob-gyn) or other health care professional may talk about induction at 39 weeks if

  • this is your first full-term pregnancy
  • you are carrying only one fetus
  • you and your fetus are healthy

Why would I want to avoid a cesarean birth?

Cesarean delivery is surgery and comes with certain risks, including

  • bleeding, infection, and injury to the bowel or bladder
  • longer recovery time than vaginal delivery

Cesarean delivery also increases risks for future pregnancies, including placenta problems, rupture of the uterus, and hysterectomy.

Are there other reasons to have labor induction?

Yes. In addition to some conditions for which labor induction is recommended, new research suggests that induction for healthy women at 39 weeks in their first full-term pregnancies may reduce the risk of cesarean birth.

Why is labor induced?

Labor is induced to start contractions of the uterus for a vaginal birth. Labor induction may be recommended when there are concerns about the health of the woman or the fetus. It also may be recommended when labor has not started on its own.

Will my hospital offer induction at 39 weeks?

Your hospital may offer induction at 39 weeks if it has the staff and resources to do so. If your hospital offers this option, your ob-gyn or other health care professional will coordinate your care with hospital staff.

This is my first full-term pregnancy. Why else would I consider induction at 39 weeks?

You might consider induction at 39 weeks to reduce the risk of certain health problems. Healthy women whose labor is induced at 39 weeks may have lower rates of preeclampsia and gestational hypertension than women who do not have induction at 39 weeks.

How is induction done?

There are several methods to start labor if it has not started naturally. The ways to start labor may include the following:

  • Ripening the cervix
  • Stripping the membranes
  • Oxytocin
  • Rupturing the amniotic sac

How is cervical ripening done?

Ripening of the cervix may be done in the following ways:

  • Using medications that contain prostaglandins. These drugs can be inserted into the vagina or taken by mouth.
  • Using a thin tube that has an inflatable balloon on the end. The tube is inserted into the cervix and then expanded. This helps widen the cervix.

What is “ripening the cervix”?

Ripening the cervix is a procedure that helps the cervix soften and thin out so that it will dilate (open) during labor. Before inducing labor, your ob-gyn or other health care professional may check to see if your cervix is ready using the Bishop score. With this scoring system, a number ranging from 0 to 13 is given to rate the condition of the cervix. A score of 6 or less means that your cervix is not yet ready for labor. If the cervix is not ready, ripening may be done.

What is “stripping the membranes”?

To “strip the membranes,” your ob-gyn or other health care professional sweeps a gloved finger over the thin membranes that connect the amniotic sac to the wall of your uterus. This also is called “sweeping the membranes.” This action is done when the cervix is partially dilated. It may cause your body to release natural prostaglandins, which soften the cervix further and may cause contractions.

What is oxytocin?

Oxytocin is a hormone that causes contractions of the uterus. It can be used to start labor or to speed up labor that began on its own. Contractions usually start about 30 minutes after oxytocin is given.

What is “rupturing the amniotic sac”?

To rupture the amniotic sac, an ob-gyn or other health care professional makes a small hole in the sac with a special tool. This procedure, called an amniotomy, may be done after a woman has been given oxytocin. Amniotomy is done to start labor when the cervix is dilated and thinned and the fetus’s head has moved down into the pelvis. Most women go into labor within hours after the amniotic sac breaks (their “water breaks”).

What are the risks of labor induction?

With some induction methods, the uterus can be overstimulated, causing it to contract too often. Too many contractions may lead to changes in the fetal heart rate. Other risks of cervical ripening and labor induction can include infection in the woman or her fetus.

Is labor induction always effective?

Sometimes labor induction does not work. Early labor is the time when a woman’s contractions start and her cervix begins to open. Women who have induction at 39 weeks should be allowed up to 24 hours or longer for the early phase of labor. They also should be given oxytocin at least 12–18 hours after stripping of the membranes. If a woman’s labor does not progress, it may be considered a failed attempt at induction.

Labor Induction Glossary of Terms

Amniotic Sac: Fluid-filled sac in a woman’s uterus. The fetus develops in this sac.

Amniotomy: Artificial rupture (bursting) of the amniotic sac.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Cesarean Birth: Birth of a fetus from the uterus through an incision made in the woman’s abdomen.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Gestational Hypertension: High blood pressure that is diagnosed after 20 weeks of pregnancy.

Hysterectomy: Surgery to remove the uterus.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Oxytocin: A hormone made in the body that can cause contractions of the uterus and release of milk from the breast.

Placenta: An organ that provides nutrients to and takes waste away from the fetus.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Prostaglandins: Chemicals that are made by the body that have many effects, including causing the muscles of the uterus to contract, usually causing cramps.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

What happens if induction does not work?

If your labor does not progress, and if you and your fetus are doing well after attempting induction, you may be sent home. You can schedule another appointment to try induction again. If your labor starts, you should go back to the hospital. If you or your fetus are not doing well after attempting induction, a cesarean delivery may be needed.

When Pregnancy Goes Past Your Due Date

What is the due date?

The date your baby is due—your estimated due date (EDD)—is calculated from the first day of your last menstrual period (LMP). The EDD is used as a guide for checking your pregnancy’s progress and tracking the growth of the fetus.

What is postterm pregnancy?

The average length of pregnancy is 280 days, or 40 weeks, counted from the first day of your LMP. A pregnancy that lasts 41 weeks up to 42 weeks is called “late term.” A pregnancy that lasts longer than 42 weeks is called “postterm.”

How is the due date determined?

An ultrasound exam often is used to confirm the due date. Your obstetrician–gynecologist (ob-gyn) will evaluate the dating from your ultrasound exam and compare it with your due date based on your LMP. Once a due date has been selected, it does not change no matter how many additional ultrasound exams you may have during your pregnancy.

What causes a postterm pregnancy?

The causes of postterm pregnancy are unknown, but there are several factors that may increase your chances of having a postterm pregnancy. These factors include the following:

  • This is your first baby.
  • You are carrying a male fetus.
  • You have had a prior postterm pregnancy.
  • You are obese.

What are the risks associated with postterm pregnancy?

The health risks for you and your fetus may increase if a pregnancy is late term or postterm, but problems occur in only a small number of postterm pregnancies. Most women who give birth after their due dates have uncomplicated labor and give birth to healthy babies. Risks associated with postterm pregnancy include the following:

  • Stillbirth
  • Macrosomia
  • Postmaturity syndrome
  • Meconium in the lungs of the fetus, which can cause serious breathing problems after birth
  • Decreased amniotic fluid, which can cause the umbilical cord to pinch and restrict the flow of oxygen to the fetus

Other risks include an increased chance of an assisted vaginal delivery or cesarean delivery. There also is a higher chance of infection and postpartum hemorrhage when your pregnancy goes past your due date.

When should I have testing in a postterm pregnancy?

A pregnancy between 40 weeks and 41 weeks of gestation does not necessarily require testing, but at 41 weeks your ob-gyn or other health care professional may recommend testing. These tests may be done weekly or twice weekly. The same test may need to be repeated or a different test may need to be done. In some cases, delivery may be recommended.

What is electronic fetal monitoring?

Tests of fetal well-being use electronic fetal monitoring and sometimes an ultrasound exam. During electronic fetal monitoring, two belts are placed around your abdomen to hold sensors. These sensors measure fetal heart rate and the frequency of uterine contractions.

What is a nonstress test?

The nonstress test (NST) measures the fetus’s heart rate for a specific period of time, usually 20 minutes. Results of the NST are noted as reactive (reassuring) or nonreactive (nonreassuring). A nonreactive result does not necessarily mean that the fetus is not healthy. Nonreactive nonstress test results often are followed by other tests to give more information.

What is a biophysical profile?

A biophysical profile (BPP) involves monitoring the fetal heart rate as well as an ultrasound exam. It checks the fetal heart rate, breathing, movement, and muscle tone. The amount of amniotic fluid also is assessed.

What is a contraction stress test?

A contraction stress test (CST) assesses how the fetus’s heart rate changes when the uterus contracts. To make your uterus contract mildly, you may be given oxytocin through an intravenous (IV) tube in your arm. Results are noted as reassuring or nonreassuring. Results also can be equivocal (the results are not clear) or unsatisfactory (there were not enough contractions to produce a meaningful result).

What is labor induction?

Labor induction may be recommended if your pregnancy reaches 41 weeks. Induction is started using medications or other methods. To induce labor, your cervix needs to have started softening in preparation for delivery. This is called cervical ripening. Medications or other methods may be used to start this process.

How is labor induced?

Methods for inducing labor may include the following:

  • Stripping or sweeping the amniotic membranes—Your ob-gyn or other health care professional sweeps a gloved finger over the thin membranes that connect the amniotic sac to the wall of your uterus.
  • Rupturing the amniotic sac—Your ob-gyn or other health care professional makes a small hole in the amniotic sac to release the fluid (“breaking the waters”).
  • Oxytocin—A drug form of oxytocin can be given through an IV tube in your arm. This will cause the uterus to contract. The dosage may be slowly increased over time and is carefully monitored.
  • Prostaglandin analogs—These are medications placed in your vagina to start cervical ripening.
  • Cervical ripening balloon—Your ob-gyn or other health care professional may place a small balloon-like device in your cervix to mechanically dilate it and help start labor.

Past Due Glossary of Terms

Amniotic Fluid: Water in the sac surrounding the fetus in the mother’s uterus.

Amniotic Sac: Fluid-filled sac in the mother’s uterus in which the fetus develops.

Assisted Vaginal Delivery: Vaginal delivery of a baby performed with the use of forceps or vacuum.

Cervical Ripening: The process by which the cervix softens in preparation for labor.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Estimated Due Date (EDD): The estimated date that a baby will be born.

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Macrosomia: A condition in which a fetus is estimated to weigh between 9 pounds and 10 pounds.

Meconium: A greenish substance that builds up in the bowels of a growing fetus. If meconium is passed, it may get into the lungs of the fetus through the amniotic fluid. This can cause serious breathing problems.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Oxygen: A gas that is necessary to sustain life.

Oxytocin: A hormone used to help bring on contractions of the uterus.

Postmaturity Syndrome: A condition in which a postterm fetus is born with a long and lean body, an alert look on the face, lots of hair, long fingernails, and thin wrinkled skin.

Postpartum Hemorrhage: Heavy bleeding that occurs after delivery of a baby and placenta.

Stillbirth: Delivery of a dead baby.

Ultrasound Exam: A test in which sound waves are used to examine the fetus.

Umbilical Cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What are the risks of labor induction?

The risks of labor induction may include changes in fetal heart rate, infection, and contractions of the uterus that are too strong. You and your fetus will be monitored throughout the process. Another possibility is that labor induction may not work. The method used to induce labor may need to be repeated. In some cases, you may need to have an assisted vaginal delivery or a cesarean delivery.

Repeated Miscarriages

What is recurrent pregnancy loss?

Recurrent pregnancy loss is defined as having two or more miscarriages. After three repeated miscarriages, a thorough physical exam and testing are recommended.

Are there other genetic problems associated with repeated miscarriages?

In a small number of couples who have repeated miscarriages, one partner has a chromosome in which a piece is transferred to another chromosome. This is called a translocation. People who have a translocation usually do not have any physical signs or symptoms, but some of their eggs or sperm will have abnormal chromosomes. If an embryo gets too much or too little genetic material, it often leads to a miscarriage.

What is the most common cause of miscarriage?

Most miscarriages (about 60%) occur randomly when an embryo receives an abnormal number of chromosomes during fertilization. This type of genetic problem happens by chance; there is no medical condition that causes it. However, it becomes more common in women of increased reproductive age.

What is the likelihood of having repeated miscarriages?

A small number of women (1%) will have repeated miscarriages.

Are problems with reproductive organs associated with repeated miscarriages?

Certain congenital problems of the uterus are linked to repeated miscarriages. Although there are many such disorders, one of the most common that has been associated with miscarriage is a septate uterus. In this condition, the uterus is partially divided into two sections by a wall of tissue.

Asherman syndrome, in which adhesions and scarring form in the uterus, may be associated with repeated miscarriages that often occur before a woman even knows she is pregnant. Fibroids and polyps, which are benign (noncancer) growths of the uterus, also may play a role in recurrent pregnancy loss.

Can medical conditions increase the risk of repeated miscarriages?

Women who have certain medical conditions may have an increased risk of repeated miscarriages. Antiphospholipid syndrome (APS) is an autoimmune disorder in which a person’s immune system mistakenly makes antibodies to certain substances involved in normal blood clotting. APS is associated with repeated miscarriages and fetal deaths. Another disease that can lead to miscarriage is diabetes mellitus. In this disease, high levels of a sugar called glucose are present in the blood. Women with diabetes, especially those in whom the disease is poorly controlled, have an increased risk of pregnancy loss. Women with a condition called polycystic ovary syndrome also have an increased risk of miscarriage.

How common is it that a cause for repeated miscarriages cannot be identified?

In 50–75% of women with repeated miscarriages, no cause can be found for the pregnancy loss. There may be clues about what the problem is, but there is no sure answer.

What tests and exams are available to help find the cause of repeated miscarriages?

To help find the cause of repeated miscarriages, your health care professional will ask about your medical history and past pregnancies. A complete physical exam, including a pelvic exam, may be done. You may have blood tests to detect problems with the immune system. Testing may be done to help detect genetic causes of repeated miscarriages. Imaging tests may be considered to find out if a uterine problem is causing repeated miscarriages.

Is treatment available if the cause of my repeated miscarriages can be identified?

If a specific cause of your repeated miscarriages can be identified, your health care professional may suggest a treatment that addresses the cause.

What can be done if I have a chromosome translocation?

If you have a chromosome translocation, genetic counseling may be recommended. Results of genetic testing can help clarify your options. In vitro fertilization with special genetic testing called preimplantation genetic diagnosis may be done to select unaffected embryos.

How can problems with reproductive organs be treated?

Corrective surgery may be able to increase the chances for a successful pregnancy. For example, a septum in the uterus can be removed.

What treatment is available if I have antiphospholipid syndrome?

Use of a medication that prevents blood clots, such as heparin, sometimes combined with low-dose aspirin, may be prescribed throughout pregnancy and for a few weeks afterward. This treatment can increase the rates of successful pregnancy in women with this condition.

What are my chances of having a successful pregnancy if I have repeated miscarriages and no cause is found?

About 65% of women with unexplained recurrent pregnancy loss have a successful next pregnancy.

Misscarriage Glossary of Terms

Adhesions: Scarring that binds together the surfaces of tissues.

Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Antiphospholipid Syndrome (APS): A disorder in which proteins called antibodies are mistakenly made against certain substances in the blood involved in normal blood clotting. It can lead to abnormal blood clotting and pregnancy complications, including pregnancy loss.

Autoimmune Disorder: A condition in which the body attacks its own tissues.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person’s physical makeup.

Congenital: A condition that is present in a person from birth.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Eggs: The female reproductive cells produced in and released from the ovaries; also called the ova.

Embryo: The developing organism from the time it implants in the uterus up to 8 completed weeks of pregnancy.

Fertilization: Joining of the egg and sperm.

Glucose: A sugar that is present in the blood and is the body’s main source of fuel.

In Vitro Fertilization: A procedure in which an egg is removed from a woman’s ovary, fertilized in a dish in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Polycystic Ovary Syndrome: A condition characterized by two or three of the following criteria: the presence of growths called cysts on the ovaries, irregular menstrual periods, and an increase in the levels of certain hormones.

Preimplantation Genetic Diagnosis: A type of genetic testing that can be done during in vitro fertilization. Tests are performed on the fertilized egg before it is transferred to the uterus.

Recurrent Pregnancy Loss: Two or more pregnancy losses.

Sperm: The male sex cell produced in the testes that can fertilize a female egg.

Translocation: An error in chromosome structure in which one part of a chromosome is transferred to another chromosome.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Cystic Fibrosis: Prenatal Screening and Diagnosis

What is cystic fibrosis (CF)?

Cystic fibrosis (CF) is a disease that affects a person’s long-term health and lifespan. It often causes problems with digestion and breathing. In some cases, CF can be a mild disease. But in most people with CF, it poses a serious risk to a person’s health. The average lifespan of a person with CF is 37 years. Those with a milder form can live into their 50s.

What causes CF?

Cystic fibrosis is a genetic disorder caused by a gene that is passed from parent to child. It takes two genes—one from the mother and one from the father—for a person to have CF. If a person has only one copy of a gene for CF, he or she is known as a carrier. Carriers often do not know that they have a gene for CF. They usually do not have symptoms or may have only mild symptoms. If both parents are carriers, each of their children has a 25% chance of having the disorder. Put another way, this couple has a 1-in-4 chance of having a child with CF.

What are the symptoms of CF?

The symptoms of CF can vary in type and severity. Many people with CF produce a thick, sticky mucus in their bodies. This mucus builds up and clogs the lungs, which makes it hard to breathe and can lead to infection. Mucus buildup also can affect the digestive organs, making it hard for the body to break down food and absorb nutrients. Most males with CF are sterile and cannot have children.

Is treatment available for CF?

New drugs and treatments have improved the outlook for people with CF, but there is no cure. The disease gets worse the longer a person has it. To treat lung problems, children with CF need to have physical therapy for about a half hour every day. This therapy helps clear mucus from the lungs. The therapy can be done by parents or other family members.

What are risk factors for CF?

The risk of being a CF carrier is increased in families with a history of CF. The risk also is higher in certain races and ethnic groups. It occurs more often in non-Hispanic white people than in other racial groups. But as our population has become more diverse, it is harder to assign a person to just one ethnicity. For this reason, the American College of Obstetricians and Gynecologists recommends offering carrier screening to all women who are thinking about becoming pregnant or are currently pregnant.

What is carrier screening?

Carrier screening uses a sample of blood, saliva, or tissue from the inside of the cheek. Carrier testing is voluntary. You can choose to have carrier screening or not to have it. Currently, there are several approaches to carrier screening:

  • Testing based on your ethnicity if your ethnic group is known to be at higher risk (ethnic-based screening)
  • Testing for many disorders at once (expanded carrier screening)
  • Testing for just a few specific disorders

When should I have carrier screening?

Carrier screening can be done before pregnancy or during pregnancy. If you have carrier screening before you become pregnant and both you and your partner are carriers, you have more options. If you have carrier screening while you are pregnant, you have fewer options. Prenatal diagnostic tests are available to test whether the fetus has CF or is a CF carrier. This type of testing can be done as early as 10 weeks of pregnancy.

How is carrier screening for CF done?

You are usually tested first. If results show that you are a carrier, your partner is tested. If you already are pregnant, you and your partner can be tested together. If your partner has a family history of CF, he may be tested first.

What does it mean if the test result for one partner is negative?

If your test result is negative, the chance that you are a CF carrier is small, but no screening test checks for every known CF mutation. For this reason, if your test result is negative, there still is a very small chance that you could be a carrier of a mutated gene that was not detected by the test.

What does it mean if the test result for one partner is positive?

If your test result is positive, it means that you are a CF carrier. The next step is to test your partner. Both parents must be CF carriers for the baby to have CF. If one parent has a negative test result, the chance that the baby will have CF is small. If only one partner is a carrier and the other has a negative result, no further testing is recommended.

What does it mean if the test results for both partners are positive?

If two people who are both CF carriers have a baby, there is a 25% (1-in-4) chance that the baby will have CF. However, it is more likely that the baby will be a carrier and not have the disease. There also is a 1-in-4 chance that the baby will not have CF and will not be a CF carrier.

If both partners are positive, what are the follow-up tests and what can they show?

If you are pregnant and you and your partner are CF carriers, prenatal diagnostic testing can be done to detect whether the fetus has CF. The results of these prenatal tests can tell you with a high degree of certainty whether the fetus has CF or is a CF carrier. They cannot tell you exactly how severe or mild the disease will be if the fetus has the disorder.

Prenatal diagnostic tests include chorionic villus sampling (CVS) and amniocentesis. CVS can be performed between 10 weeks and 13 weeks of pregnancy. Amniocentesis usually is done between 15 weeks and 20 weeks of pregnancy, but it also can be done up until you have the baby.

Diagnostic testing is voluntary. Some parents want to know this information before the birth of the baby. Other parents do not want to know. There is no right or wrong answer.

 

What are my options if diagnostic test results show that the fetus has CF?

Two options are available:

  1. Continue the pregnancy and prepare for a child with CF. Couples can use this time to learn as much as possible about the disease, current treatment options, and the experiences of other families who have a child with CF.
  2. End the pregnancy. Each state has its own laws on pregnancy termination. Your health care professional can answer any questions you may have. You also may want to talk with your partner, counselors, and close friends.

What about future pregnancies?

If a test result shows that you are a CF carrier, the result is definite and will not change. If both partners are carriers, it means that in each pregnancy the fetus will have a 25% (1-in-4) chance of having CF. In this case, you have several options for future pregnancies:

  • You can accept the level of risk and become pregnant. You may choose to have prenatal diagnostic testing in each pregnancy, or you may not. If you want to know whether your baby will have CF, you will need to have amniocentesis or CVS in each pregnancy.
  • You can adopt.
  • You can use in vitro fertilization (IVF) with donor sperm or donor eggs (but the donor should be tested for CF carrier status).
  • You can use IVF with your own sperm and eggs, and then use preimplantation genetic diagnosis to see if the fertilized egg has CF or is a CF carrier.

Cystic Fibrosis Glossary of Terms

Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells from the sac surrounding the fetus.

Carrier: A person who shows no signs of a particular disorder but could pass the gene on to his or her children.

Carrier Screening: A test done on a person without signs or symptoms to find out whether he or she carries a gene for a genetic disorder.

Chorionic Villus Sampling (CVS): A procedure in which a small sample of cells is taken from the placenta and tested.

Cystic Fibrosis (CF): An inherited disorder that causes problems in digestion and breathing.

Diagnostic Tests: Tests that look for a disease or cause of a disease.

Ethnic-Based Screening: Carrier screening recommended for people who belong to an ethnic group or race that has a high rate of carriers of a specific genetic disorder.

Expanded Carrier Screening: A carrier screening technology that allows a large number of disorders to be screened for simultaneously using a sample of a person’s blood and without regard to the person’s race or ethnicity.

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Gene: A segment of DNA that contains instructions for the development of a person’s physical traits and control of the processes in the body. It is the basic unit of heredity and can be passed down from parent to child.

Genetic Disorder: A disorder caused by a change in genes or chromosomes.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Mutation: A permanent change in a gene that can be passed from parent to child.

Preimplantation Genetic Diagnosis: A type of genetic testing that can be done during in vitro fertilization. Tests are performed on the fertilized egg before it is transferred to the uterus.

Preeclampsia and High Blood Pressure During Pregnancy

What is high blood pressure?

Blood pressure is the pressure of the blood against the blood vessel walls each time the heart contracts (squeezes) to pump the blood through your body. High blood pressure also is called hypertension. Hypertension can lead to health problems. During pregnancy, severe or uncontrolled hypertension can cause complications for you and your fetus.

What is gestational hypertension?

Gestational hypertension is high blood pressure that first occurs in the second half (after 20 weeks) of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future.

What is chronic hypertension?

Chronic hypertension is high blood pressure that was present before you became pregnant or that occurs in the first half (before 20 weeks) of your pregnancy. The guidelines for blood pressure are the following:

  • Normal: Less than 120/80 mm Hg
  • Elevated: Systolic between 120–129 and diastolic less than 80 mm Hg
  • Stage 1 hypertension: Systolic between 130–139 or diastolic between 80–89 mm Hg
  • Stage 2 hypertension: Systolic at least 140 or diastolic at least 90 mm Hg

What kinds of problems can hypertension cause during pregnancy?

High blood pressure during pregnancy can place extra stress on your heart and kidneys and can increase your risk of heart disease, kidney disease, and stroke. Other possible complications include the following:

  • Fetal growth restriction—High blood pressure can decrease the flow of nutrients to the baby through the placenta. The baby may have growth problems as a result.
  • Preeclampsia—This condition is more likely to occur in women with chronic high blood pressure than in women with normal blood pressure.
  • Preterm delivery—If the placenta is not providing enough nutrients and oxygen to your baby, it may be decided that early delivery is better for your baby than allowing the pregnancy to continue.
  • Placental abruption—This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment.
  • Cesarean delivery—Women with hypertension are more likely to have a cesarean delivery than women with normal blood pressure. A cesarean delivery carries risks of infection, injury to internal organs, and bleeding.

How is chronic hypertension during pregnancy managed?

Your blood pressure will be monitored closely throughout pregnancy. You may need to monitor your blood pressure at home. Ultrasound exams may be done throughout pregnancy to track the growth of your fetus. If growth problems are suspected, you may have additional tests that monitor the fetus’s health. This testing usually begins in the third trimester of pregnancy. If your hypertension is mild, your blood pressure may stay that way or even return to normal during pregnancy, and your medication may be stopped or your dosage decreased. If you have severe hypertension or have health problems related to your hypertension, you may need to start or continue taking blood pressure medication during pregnancy.

What is preeclampsia?

Preeclampsia is a serious blood pressure disorder that can affect all of the organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is proteinuria (an abnormal amount of protein in the urine). A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of platelets in the blood, abnormal kidney or liver function, pain over the upper abdomen, changes in vision, fluid in the lungs, or a severe headache. A very high blood pressure reading also is considered a severe feature.

When does preeclampsia occur?

It usually occurs after 20 weeks of pregnancy, typically in the third trimester. When it occurs before 32 weeks of pregnancy, it is called early-onset preeclampsia. It also can occur in the postpartum period.

What causes preeclampsia?

It is not clear why some women develop preeclampsia, but the risk of developing preeclampsia is increased in women who

  • are pregnant for the first time
  • have had preeclampsia in a previous pregnancy or have a family history of preeclampsia
  • have a history of chronic hypertension, kidney disease, or both
  • are 40 years or older
  • are carrying more than one fetus
  • have certain medical conditions such as diabetes mellitus, thrombophilia, or lupus
  • are obese
  • had in vitro fertilization

What are the risks for my baby if preeclampsia occurs?

If preeclampsia occurs during pregnancy, your baby may need to be delivered right away, even if he or she is not fully grown. Preterm babies have an increased risk of serious complications. Some preterm complications last a lifetime and require ongoing medical care. Babies born very early also may die.

What are the risks for me if preeclampsia occurs?

Women who have had preeclampsia—especially those whose babies were born preterm—have an increased risk later in life of cardiovascular disease and kidney disease, including heart attack, stroke, and high blood pressure. Having preeclampsia once increases the risk of having it again in a future pregnancy. Preeclampsia also can lead to seizures, a condition called eclampsia. It also can lead to HELLP syndrome.

What is HELLP syndrome?

HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. In this condition, red blood cells are damaged or destroyed, blood clotting is impaired, and the liver can bleed internally, causing chest or abdominal pain. HELLP syndrome is a medical emergency. Women can die from HELLP syndrome or have lifelong health problems as a result.

What are the signs and symptoms of preeclampsia?

  • Swelling of face or hands
  • A headache that will not go away
  • Seeing spots or changes in eyesight
  • Pain in the upper abdomen or shoulder
  • Nausea and vomiting (in the second half of pregnancy)
  • Sudden weight gain
  • Difficulty breathing

How is mild gestational hypertension or preeclampsia without severe features managed?

Management of mild gestational hypertension or preeclampsia without severe features may take place either in a hospital or on an outpatient basis (you can stay at home with close monitoring by your health care professional). You may be asked to keep track of your baby’s movements by doing a daily kick count and to measure your blood pressure at home. You will need to see your health care professional at least weekly and sometimes twice weekly. Once you reach 37 weeks of pregnancy, it may be recommended that you have your baby. If test results show that the baby is not doing well, you may need to have the baby earlier.

How is preeclampsia with severe features managed?

Preeclampsia with severe features usually is treated in the hospital. If you are at least 34 weeks pregnant, it often is recommended that you have your baby as soon as your condition is stable. If you are less than 34 weeks pregnant and your condition is stable, it may be possible to wait to deliver your baby. Corticosteroids may be given to help the baby’s lungs mature, and you most likely will be given medications to help reduce your blood pressure and to help prevent seizures. If your condition or the baby’s condition worsens, prompt delivery will be needed.

What steps can I take to help prevent preeclampsia?

Prevention involves identifying whether you have risk factors for preeclampsia and taking steps to address these factors. If you have hypertension and are planning a pregnancy, see your health care professional for a prepregnancy check-up to find out whether your hypertension is under control and whether it has affected your health. If you are overweight, weight loss usually is advised before pregnancy. If you have a medical condition, such as diabetes, it usually is recommended that your condition be well controlled before you become pregnant.

Preeclampsia and High Blood Pressure Glossary of Terms

Cardiovascular Disease: Disease of the heart and blood vessels.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Chronic Hypertension: High blood pressure that was diagnosed before the current pregnancy.

Corticosteroids: Hormones given to help fetal lungs mature, for arthritis, or for other medical conditions.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Eclampsia: Seizures occurring in pregnancy and linked to high blood pressure.

Fetal Growth Restriction: A condition in which a fetus has an estimated weight that is less than that of 9 out of 10 other fetuses of the same gestational age.

Gestational Hypertension: New-onset high blood pressure that occurs after 20 weeks of pregnancy.

HELLP Syndrome: A severe type of preeclampsia; HELLP stands for hemolysis, elevated liver enzymes, and low platelet count.

Hemolysis: Destruction of red blood cells.

Hypertension: High blood pressure.

In Vitro Fertilization: A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Kick Count: A record kept during late pregnancy of the number of times a fetus moves over a certain period.

Liver Enzymes: Chemicals made by liver cells; elevated levels may indicate liver damage.

Lupus: An autoimmune disorder that causes changes in the joints, skin, kidneys, lungs, heart, or brain.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Oxygen: A gas that is necessary to sustain life.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Placental Abruption: A condition in which the placenta has begun to separate from the inner wall of the uterus before the baby is born.

Platelets: Small, disc-shaped structures found in the blood that help the blood to clot.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, a severe headache, or changes in vision.

Preterm: Born before 37 weeks of pregnancy.

Proteinuria: The presence of an abnormal amount of protein in the urine.

Thrombophilia: A condition in which the blood does not clot correctly.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Skin Conditions During Pregnancy

What are some of the common skin changes that occur during pregnancy?

Many women notice changes to their skin, nails, and hair during pregnancy. Some of the most common changes include
the following:

  • Dark spots on the breasts, nipples, or inner thighs
  • Melasma—brown patches on the face around the cheeks, nose, and forehead
  • Linea nigra—a dark line that runs from the navel to the pubic hair
  • Stretch marks
  • Acne
  • Spider veins
  • Varicose veins
  • Changes in nail and hair growth

Can I prevent varicose veins?

Although you cannot prevent them, there are some things you can do to ease the swelling and soreness and prevent varicose veins from getting worse:

  • Be sure to move around from time to time if you must sit or stand for long periods.
  • Do not sit with your legs crossed for long periods.
  • Prop your legs up on a couch, chair, or footstool as often as you can.
  • Exercise regularly—walk, swim, or ride an exercise bike.
  • Wear support hose.
  • Avoid constipation by eating foods high in fiber and drinking plenty of liquids.

What causes varicose veins?

The weight and pressure of your uterus can decrease blood flow from your lower body and cause the veins in your legs to become swollen, sore, and blue. These are called varicose veins. Varicose veins also can appear on your vulva and in your vagina and rectum (usually called hemorrhoids). In most cases, varicose veins are a cosmetic problem that will go away after delivery.

What causes spider veins?

Hormonal changes and the higher amounts of blood in your body during pregnancy can cause tiny red veins, known as spider veins, to appear on your face, neck, and arms. The redness should fade after the baby is born.

Can prescription medications be used during pregnancy to treat acne?

Some prescription acne medications should not be used while you are pregnant:

  • Hormonal therapy—Several medications that block specific hormones can be used to treat acne. Their use during pregnancy is not recommended due to the risk of birth defects.
  • Isotretinoin—This drug is a form of vitamin A. It may cause severe birth defects in fetuses, including intellectual disabilities, life-threatening heart and brain defects, and other physical deformities.
  • Oral tetracyclines—This antibiotic can cause discoloration of the fetus’s teeth if it is taken after the fourth month of pregnancy and also can affect the growth of the fetus’s bones as long as the medication is taken.
  • Topical retinoids—These medications are a form of vitamin A and are in the same drug family as isotretinoin. Unlike isotretinoin, topical retinoids are applied to the skin, and the amount of medication absorbed by the body is low. However, it is generally recommended that use of these medications be avoided during pregnancy. Some retinoids are available by prescription. But other retinoids can be found in some OTC products. Read labels carefully.

Can over-the-counter medications be used during pregnancy to treat acne?

Over-the-counter (OTC) products containing the following ingredients can be used during pregnancy:

  • Topical benzoyl peroxide
  • Azelaic acid
  • Topical salicylic acid
  • Glycolic acid

If you want to use an OTC product that contains an ingredient not on this list, contact your health care professional.

How can I treat my skin if I get acne during pregnancy?

If you get acne during pregnancy, take these steps to treat your skin:

  • Wash your face twice a day with a mild cleanser and lukewarm water.
  • If you have oily hair, shampoo every day and try to keep your hair off your face.
  • Avoid picking or squeezing acne sores to lessen possible scarring.
  • Choose oil-free cosmetics.

Is acne common during pregnancy?

Many women have acne during pregnancy. Some already have acne and notice that it gets worse during pregnancy. Other women who may always have had clear skin will develop acne while they are pregnant.

What are stretch marks?

As your belly grows during pregnancy, your skin may become marked with reddish lines called stretch marks. By the third trimester, many pregnant women commonly have stretch marks on the abdomen, buttocks, breasts, or thighs. Using a heavy moisturizer may help keep your skin soft, but it will not help get rid of stretch marks. Most stretch marks fade after the baby is born, but they may never disappear completely.

Why do dark spots and patches appear on the skin during pregnancy?

Dark spots and patches are caused by an increase in the body’s melanin—a natural substance that gives color to the skin and hair. Dark spots and melasma usually fade on their own after you give birth. Some women, however, may have dark patches that last for years. To help prevent melasma from getting worse, wear sunscreen and a wide-brimmed hat every day when you are outside.

What causes these skin changes during pregnancy?

Some are due to changes in hormone levels that occur during pregnancy. For most skin changes, however, health care professionals are not sure of the exact cause.

What changes to my hair may occur during pregnancy?

The hormone changes in pregnancy may cause the hair on your head and body to grow or become thicker. Sometimes women grow hair in areas where they do not normally have hair, such as the face, chest, abdomen, and arms. Your hair should return to normal within 6 months after giving birth.

What hair changes may I experience after childbirth?

About 3 months after childbirth, most women begin to notice hair loss from the scalp. This happens because hormones are returning to normal levels, which allows the hair to return to its normal cycle of growing and falling out. In most cases, your hair should grow back completely within 3–6 months.

What nail changes can I expect during pregnancy?

Some women find that their nails grow faster during pregnancy. Others notice that their nails split and break more easily. Like the changes to your hair, those that affect your nails will ease after birth.

What are some uncommon skin changes that can occur during pregnancy?

Certain uncommon skin conditions can arise during pregnancy. They can cause signs and symptoms, including bumps and itchy skin.

What is pruritic urticarial papules and plaques of pregnancy?

In pruritic urticarial papules and plaques of pregnancy (PUPPP), small, red bumps and hives appear on the skin later in pregnancy. The bumps can form large patches that can be very itchy. These bumps usually first appear on the abdomen and can spread to the thighs, buttocks, and breasts. It is not clear what causes PUPPP. It usually goes away after you give birth.

What is prurigo of pregnancy?

With prurigo of pregnancy, tiny, itchy bumps that look like insect bites can appear almost anywhere on the skin. This condition can occur anytime during pregnancy and usually starts with a few bumps that increase in number each day. It is thought to be caused by changes in the immune system that occur during pregnancy. Prurigo can last for several months and may even continue for some time after the baby is born.

What is pemphigoid gestationis?

Pemphigoid gestationis is a rare skin condition that usually starts during the second and third trimesters of pregnancy or sometimes right after childbirth. With this condition, blisters appear on the abdomen, and in severe cases, the blisters can cover a wide area of the body. It is thought to be an autoimmune disorder. There is a slightly increased risk of pregnancy problems with this condition, including preterm birth and a smaller-than-average baby.

What is intrahepatic cholestasis of pregnancy?

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver condition that occurs during pregnancy. The main symptom of ICP is severe itching in the absence of a rash. Itching commonly occurs on the palms of the hands and soles of the feet, but it also can spread to the trunk of the body. Symptoms usually start during the third trimester of pregnancy but often go away a few days after childbirth. ICP may increase the risk of preterm birth and other problems, including, in rare cases, fetal death.

Skin Conditions Glossary of Terms

Antibiotic: A drug that treats certain types of infections.

Autoimmune Disorder: A condition in which the body attacks its own tissues.

Hormone: A substance made in the body that controls the function of cells or organs.

Immune System: The body’s natural defense system against viruses and bacteria that cause disease.

Linea Nigra: A line running from the belly button to pubic hair that darkens during pregnancy.

Melasma: A common skin problem that causes brown to gray-brown patches on the face. Also known as the “mask of pregnancy.”

Rectum: The last part of the digestive tract.

Trimester: A 3-month time in pregnancy. It can be first, second, or third.

Uterus: A muscular organ in the female pelvis. During pregnancy this organ holds and nourishes the fetus.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Vulva: The external female genital area.

Obesity and Pregnancy

What is obesity?

Being overweight is defined as having a body mass index (BMI) of 25–29.9. Obesity is defined as having a BMI of 30 or greater. Within the general category of obesity, there are three levels that reflect the increasing health risks that go along with increasing BMI:

  • Lowest risk is a BMI of 30–34.9.
  • Medium risk is a BMI of 35.0–39.9.
  • Highest risk is a BMI of 40 or greater.

You can find out your BMI by using an online BMI calculator on a web site such as http://www.nhlbi.nih.gov/health/
educational/lose_wt/BMI/bmicalc.htm
.

Does being obese during pregnancy put me at risk of any health problems?

Obesity during pregnancy puts you at risk of several serious health problems:

  • Gestational diabetes is diabetes that is first diagnosed during pregnancy. This condition can increase the risk of having a cesarean delivery. Women who have had gestational diabetes also have a higher risk of having diabetes in the future, as do their children. Obese women are screened for gestational diabetes early in pregnancy and also may be screened later in pregnancy as well.
  • Preeclampsia is a high blood pressure disorder that can occur during pregnancy or after pregnancy. It is a serious illness that affects a woman’s entire body. The kidneys and liver may fail. Preeclampsia can lead to seizures, a condition called eclampsia. In rare cases, stroke can occur. Severe cases need emergency treatment to avoid these complications. The baby may need to be delivered early.
  • Sleep apnea is a condition in which a person stops breathing for short periods during sleep. Sleep apnea is associated with obesity. During pregnancy, sleep apnea not only can cause fatigue but also increases the risk of high blood pressure, preeclampsia, eclampsia, and heart and lung disorders.

Does being obese during pregnancy put my baby at risk of any problems?

Obesity increases the risk of the following problems during pregnancy:

  • Pregnancy loss—Obese women have an increased risk of pregnancy loss (miscarriage) compared with women of normal weight.
  • Birth defects—Babies born to obese women have an increased risk of having birth defects, such as heart defects and neural tube defects.
  • Problems with diagnostic tests—Having too much body fat can make it difficult to see certain problems with the baby’s anatomy on an ultrasound exam. Checking the baby’s heart rate during labor also may be more difficult if you are obese.
  • Macrosomia—In this condition, the baby is larger than normal. This can increase the risk of the baby being injured during birth. For example, the baby’s shoulder can become stuck during delivery. Macrosomia also increases the risk of cesarean delivery. Infants born with too much body fat have a greater chance of being obese later in life.
  • Preterm birth—Problems associated with a woman’s obesity, such as preeclampsia, may lead to a medically indicated preterm birth. This means that the baby is delivered early for a medical reason. Preterm babies are not as fully developed as babies who are born after 39 weeks of pregnancy. As a result, they have an increased risk of short-term and long-term health problems.
  • Stillbirth—The higher the woman’s BMI, the greater the risk of stillbirth.

If I am overweight or obese, should I plan to lose weight before getting pregnant?

Losing weight before you become pregnant is the best way to decrease the risk of problems caused by obesity. Losing even a small amount of weight (5–7% of your current weight, or about 10–20 pounds) can improve your overall health and pave the way for a healthier pregnancy.

How can I lose weight safely?

To lose weight, you need to use up more calories than you take in. You can do this by getting regular exercise and eating healthy foods. Your obstetrician may refer you to a nutritionist to help you plan a healthy diet. You also can use the Choose My Plate web site at www.choosemyplate.gov. Increasing your physical activity is important if you want to lose weight. Aim to be moderately active (for example, biking, brisk walking, and general gardening) for 60 minutes or vigorously active (jogging, swimming laps, or doing heavy yard work) for 30 minutes on most days of the week. You do not have to do this amount all at once. For instance, you can exercise for 20 minutes three times a day.

Are there medications to help me lose weight before getting pregnant?

If you have tried to lose weight through diet changes and exercise and you still have a BMI of 30 or greater or a BMI of at least 27 with certain medical conditions, such as diabetes or heart disease, weight-loss medications may be suggested. These medications should not be taken if you are trying to become pregnant or are already pregnant.

Is there surgery to help me lose weight before getting pregnant?

Bariatric surgery may be an option for people who are very obese or who have major health problems caused by obesity. If you have weight loss surgery, you should delay getting pregnant for 12–24 months after surgery, when you will have the most rapid weight loss. If you have had fertility problems, they may resolve on their own as you rapidly lose the excess weight. It is important to be aware of this because the increase in fertility can lead to an unplanned pregnancy. Some types of bariatric surgery may affect how the body absorbs medications taken by mouth, including birth control pills. You may need to switch to another form of birth control.

Can I still have a healthy pregnancy if I am obese?

Despite the risks, you can have a healthy pregnancy if you are obese. It takes careful management of your weight, attention to diet and exercise, regular prenatal care to monitor for complications, and special considerations for your labor and delivery.

How do I plan healthy meals during pregnancy?

Finding a balance between eating healthy foods and staying at a healthy weight is important for your health as well as your baby’s health. In the second and third trimesters, a pregnant woman needs an average of 300 extra calories a day—about the amount of calories in a glass of skim milk and half of a sandwich. You can get help with planning a healthy diet by talking to a nutrition counselor. Help also can be found at the Choose My Plate web site, which has a special section for women who are pregnant or breastfeeding (www.choosemyplate.gov/moms-pregnancy-breastfeeding).

How much should I exercise during pregnancy?

If you have never exercised before, pregnancy is a great time to start. Discuss your exercise plan with your obstetrician to make sure it is safe. Begin with as little as 5 minutes of exercise a day and add 5 minutes each week. Your goal is to stay active for 30 minutes on most—preferably all—days of the week. Walking is a good choice if you are new to exercise. Swimming is another good exercise for pregnant women. The water supports your weight so you can avoid injury and muscle strain. It also helps you stay cool.

How will my weight be monitored during pregnancy?

Your weight will be tracked at each prenatal visit. The growth of your baby also will be checked. If you are gaining less than the recommended guidelines, and if your baby is growing well, you do not have to increase your weight gain to catch up to the guidelines. If your baby is not growing well, changes may need to be made to your diet and exercise plan.

How does obesity affect labor and delivery?

Overweight and obese women have longer labors than women of normal weight. It can be harder to monitor the baby during labor. For these reasons, obesity during pregnancy increases the likelihood of having a cesarean delivery. If a cesarean delivery is needed, the risks of infection, bleeding, and other complications are greater for an obese woman than for a woman of normal weight.

How can I manage my weight after my baby is born?

Once you are home with your new baby, stick to your healthy eating and exercise habits to reach a normal weight. Breastfeeding is recommended for the first year of a baby’s life. Not only is breastfeeding the best way to feed your baby, it also may help with postpartum weight loss. Overall, women who breastfeed their babies for at least a few months tend to lose pregnancy weight faster than women who do not breastfeed.

Obesity Glossary of Terms

Bariatric Surgery: Surgical procedures that cause weight loss for the treatment of obesity.

Body Mass Index (BMI): A number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese.

Calories: Units of heat used to express the fuel or energy value of food.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the woman’s abdomen and uterus.

Eclampsia: Seizures occurring in pregnancy or after pregnancy and linked to high blood pressure.

Gestational Diabetes: Diabetes that arises during pregnancy.

Macrosomia: A condition in which a fetus has an estimated weight of 4,500 grams (9 pounds 15 ounces) or greater.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Obesity: A condition characterized by excessive body fat.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Preterm: Born before 37 weeks of pregnancy.

Sleep Apnea: A disorder characterized by interruptions of breathing during sleep that can lead to other health problems.

Stillbirth: Delivery of a dead baby.

Stroke: A sudden interruption of blood flow to all or part of the brain, caused by blockage or bursting of a blood vessel in the brain and often resulting in loss of consciousness and temporary or permanent paralysis.

Trimesters: The three 3-month periods into which pregnancy is divided.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

The Flu Vaccine and Pregnancy

What is influenza (the flu)?

Influenza (the flu) is more than a bad cold. It usually comes on suddenly. Signs and symptoms may include fever, headache, fatigue, muscle aches, coughing, and sore throat. It can lead to complications, such as pneumonia. Some complications can be life-threatening.

Who is at risk of developing complications from the flu?

Certain people have an increased risk of developing flu complications. These include the following groups:

  • Adults 65 years and older
  • Children younger than 5 years
  • People who have illnesses or conditions like asthma, heart disease, or cancer
  • Pregnant women

How does being pregnant increase my risk of complications from the flu?

Normal changes in the immune system that occur during pregnancy may increase your risk of flu complications. You also have a higher risk of pregnancy complications, such as preterm labor and preterm birth, if you get the flu. You are more likely to be hospitalized if you get the flu while you are pregnant than when you are not pregnant. Your risk of dying from the flu is increased as well.

Who should get vaccinated against the flu?

The Centers for Disease Control and Prevention (CDC) recommend that everyone 6 months of age and older—including pregnant women and women who are breastfeeding—get the flu vaccine each year. If you are pregnant, it is best to get the vaccine early in the flu season (October through May), as soon as the vaccine is available. You can get the shot at any time during your pregnancy. If you are not vaccinated early in the flu season, you still can get the vaccine later in the flu season. If you have a medical condition that further increases the risk of flu complications, such as asthma or heart disease, you should think about getting the vaccine before the flu season starts.

Which type of flu vaccine should I get?

There are two types of flu vaccines: 1) a shot and 2) a nasal mist. The flu shot contains a form of the flu virus that is inactivated. It cannot cause disease. The shot can be given to pregnant women at any time during pregnancy. A live, attenuated influenza vaccine is available as a nose spray. The nose spray vaccine is not recommended for pregnant women. However, it is safe for women after they have given birth, including those who are breastfeeding.

How does the flu vaccine work?

The flu vaccine triggers your immune system to make antibodies against the flu virus. Antibodies circulate in the bloodstream. If they encounter a flu virus, they “tag” it for destruction by other parts of the immune system. It takes about 2 weeks for the body to build up protective antibodies after you get the flu shot.

How often should I get the flu vaccine?

With some types of vaccines, the antibodies that are made remain active for many years. But the types of viruses that cause the flu can change every year. The antibodies made in response to one year’s flu vaccine may not work against the next year’s flu viruses. For this reason, the flu vaccine is updated each year. To be fully protected, you need to get the flu vaccine yearly.

How does getting the flu vaccine when I am pregnant help my baby?

The flu vaccine does “double duty” by protecting both you and your baby. Babies cannot get the flu vaccine until they are 6 months old. When you get a flu shot during pregnancy, the protective antibodies made in your body are transferred to your baby. These antibodies will protect your baby against the flu until he or she can get the vaccine at 6 months of age.

Are vaccines safe?

Vaccines are developed with the highest safety standards. The U.S. Food and Drug Administration approves all vaccines. The CDC continues to monitor all vaccines after they are approved. They have been used for many years in millions of pregnant women and are not known to cause pregnancy problems or birth defects.

Can vaccines made with thimerosal cause autism?

There is no scientific evidence that vaccines made with thimerosal, a mercury-containing preservative, can cause autism or other health problems in babies. Thimerosal-containing vaccines do not cause autism in children born to women who received these vaccines. There is a flu vaccine made without thimerosal, but experts have not said that the thimerosal-free version is better for any particular group—including children and pregnant women.

Do vaccines have any side effects?

Most side effects of vaccines are mild, such as a sore arm or a low fever, and go away within a day or two. Severe side effects and reactions are rare. The CDC keeps track of side effects and reactions to all vaccines given in the United States. When you receive a vaccine, you should receive a Vaccine Information Statement. This statement lists the possible side effects of and reactions to that vaccine. If you have concerns about vaccine side effects, talk to your obstetrician or other member of your health care team.

What should I do if I get the flu while I am pregnant?

If you think you have the flu and you are pregnant (or you have had a baby within the past 2 weeks), contact your obstetrician or other health care professional right away. Taking an antiviral medication as soon as possible is recommended. Flu symptoms may include the following:

  • Fever or feeling feverish
  • Chills
  • Body aches
  • Headache
  • Fatigue
  • Cough or sore throat
  • Runny or stuffy nose

Antiviral medication is available by prescription. It is most effective when taken within 48 hours of the onset of flu symptoms, but there still is some benefit to taking it up to 4–5 days after symptoms start. An antiviral drug does not cure the flu, but it can shorten how long it lasts and how severe it is. Even if you just think you have the flu, it is best to be on the safe side and contact your obstetrician or other member of your health care team.

What should I do if I come into close contact with someone who has the flu while I am pregnant?

You also should call your obstetrician or other health care professional if you are pregnant and come in close contact with someone who has the flu. This includes living with, caring for, or talking face-to-face with someone who may have the flu. You may be prescribed an antiviral drug to reduce the risk that you will get the flu.

Flu Vaccine Glossary of Terms

Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Autism: A group of developmental disorders that range from mild to severe and that result in communication problems, problems interacting with others, behavioral difficulties, and repetitive behaviors.

Complications: Diseases or conditions that occur as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Influenza: An infection with the influenza virus that most commonly affects the respiratory tract. Symptoms include fever, headache, muscle aches, cough, nasal congestion, and extreme fatigue. Complications can occur in severe cases, such as pneumonia and bronchitis. There are a number of different influenza virus types, including A, B, and C, and different strains, including 18 H types and 11 N types (eg, H1N1 or “swine flu”).

Live, Attenuated Influenza Vaccine: An influenza vaccine containing live viruses that have been altered to not cause disease. It is given as a nasal spray. It is not recommended for pregnant women.

Obstetrician: A physician who specializes in caring for women during pregnancy, labor, and the postpartum period.

Pneumonia: An infection of the lungs.

Preterm: Born before 37 weeks of pregnancy.

Thimerosal: A preservative used in some vaccines.

Virus: An agent that causes certain types of infections.

Group B Strep and Pregnancy

What is group B streptococcus?

Group B streptococcus (GBS) is one of the many bacteria that live in the body. It usually does not cause serious illness, and it is not a sexually transmitted infection (STI). Also, although the names are similar, GBS is different from group A streptococcus, the bacteria that causes “strep throat.”

Why is group B streptococcus a concern for pregnant women?

In women, GBS most often is found in the vagina and rectum. This means that GBS can pass from a pregnant woman to her fetus during labor. This is rare and happens to 1 or 2 babies out of 100 when the mother does not receive treatment with antibiotics during labor. The chance of a newborn getting sick is much lower when the mother receives treatment.

How can group B streptococcus affect a newborn?

Even though it is rare for a baby to get GBS, it can be very serious when it happens. Babies who get GBS may have early-onset or late-onset disease.

What is early-onset disease?

With early-onset disease, a baby typically gets sick within 12 to 48 hours after birth or up to the first 7 days. Early-onset disease can cause severe problems, such as

  • inflammation of the covering of the brain or spinal cord (meningitis)
  • infection of the lungs (pneumonia)
  • infection in the blood (sepsis)

A small number of babies with early-onset disease die even with immediate treatment.

What is late-onset disease?

With late-onset disease, a baby gets sick between a week to a few months after birth. The disease is usually caused by contact with the mother after delivery if she is infected. But it can come from other sources too, such as contact with other people who have GBS.

Late-onset disease also is serious and can cause meningitis. In newborns, the signs and symptoms of meningitis can be hard to spot. Contact your baby’s health care professional right away if your baby has any signs or symptoms of disease, including

  • lack of energy
  • irritability
  • poor feeding
  • high fever

Will I be tested for group B streptococcus?

Yes, pregnant women are screened for GBS as part of routine prenatal care. The test for GBS is called a culture. It is now done between 36 and 38 weeks of pregnancy. In this test, a swab is used to take a sample from the vagina and rectum.

What if the test result is positive?

If the results show that GBS is present, most women will receive antibiotics through an intravenous (IV) line once labor has started. This is done to help protect the fetus from being infected. The best time for treatment is during labor. Penicillin is the antibiotic that is most often given to prevent early-onset disease in newborns. While treatment with antibiotics during labor can help prevent early-onset GBS disease in a baby, this treatment does not prevent late-onset disease.

What if I am allergic to penicillin?

If you are allergic to penicillin, tell your health care professional before you are tested for GBS. You may have a skin test to determine the severity of your allergies. If needed, other antibiotics can be used.

Are there times when antibiotics are given without testing first?

In some cases, women are automatically given antibiotics during labor without testing for GBS. Antibiotics may be given without testing if

  • you had a previous child who had GBS disease
  • you have GBS bacteria in your urine at any point during your pregnancy
  • your GBS status is not known when you go into labor and you have a fever
  • your GBS status is not known and you go into labor before 37 weeks
  • your GBS status is not known and it has been 18 hours or more since your water broke
  • your GBS status for this pregnancy is not known but you tested positive for GBS in a past pregnancy

What if I plan to have a cesarean birth?

Women who have a cesarean birth do not need to be given antibiotics for GBS during delivery if their labor has not started and the amniotic sac has not ruptured (their water has not broken). But these women should still be tested for GBS because labor may happen before a cesarean birth. If the test result is positive, the baby may need to be monitored for GBS disease after birth.

Glossary of Terms for Group B Strep

Amniotic Sac: Fluid-filled sac in a woman’s uterus. The fetus develops in this sac.

Antibiotics: Drugs that treat certain types of infections.

Bacteria: One-celled organisms that can cause infections in the human body.

Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman’s abdomen.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Group B Streptococcus (GBS): A type of bacteria that many people carry normally and can be passed to the fetus at the time of delivery. GBS can cause serious infection in some newborns. Antibiotics are given to women who carry the bacteria during labor to prevent newborn infection.

Intravenous (IV) Line: A tube inserted into a vein and used to deliver medication or fluids.

Meningitis: Inflammation of the covering of the brain or spinal cord.

Pneumonia: An infection of the lungs.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Rectum: The last part of the digestive tract.

Sepsis: A condition in which infectious toxins (usually from bacteria) are in the blood. It is a serious condition that can be life threatening. Symptoms include fever, rapid heart rate, breathing difficulty, and mental confusion.

Sexually Transmitted Infection (STI): An infection that is spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Preeclampsia and High Blood Pressure During Pregnancy

What is high blood pressure?

Blood pressure is the pressure of the blood against the blood vessel walls each time the heart contracts (squeezes) to pump the blood through your body. High blood pressure also is called hypertension. Hypertension can lead to health problems. During pregnancy, severe or uncontrolled hypertension can cause complications for you and your fetus.

What is chronic hypertension?

Chronic hypertension is high blood pressure that was present before you became pregnant or that occurs in the first half (before 20 weeks) of your pregnancy. The guidelines for blood pressure are the following:

  • Normal: Less than 120/80 mm Hg
  • Elevated: Systolic between 120–129 and diastolic less than 80 mm Hg
  • Stage 1 hypertension: Systolic between 130–139 or diastolic between 80–89 mm Hg
  • Stage 2 hypertension: Systolic at least 140 or diastolic at least 90 mm Hg

When does preeclampsia occur?

It usually occurs after 20 weeks of pregnancy, typically in the third trimester. When it occurs before 32 weeks of pregnancy, it is called early-onset preeclampsia. It also can occur in the postpartum period.

What is preeclampsia?

Preeclampsia is a serious blood pressure disorder that can affect all of the organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is proteinuria (an abnormal amount of protein in the urine). A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of platelets in the blood, abnormal kidney or liver function, pain over the upper abdomen, changes in vision, fluid in the lungs, or a severe headache. A very high blood pressure reading also is considered a severe feature.

How is chronic hypertension during pregnancy managed?

Your blood pressure will be monitored closely throughout pregnancy. You may need to monitor your blood pressure at home. Ultrasound exams may be done throughout pregnancy to track the growth of your fetus. If growth problems are suspected, you may have additional tests that monitor the fetus’s health. This testing usually begins in the third trimester of pregnancy. If your hypertension is mild, your blood pressure may stay that way or even return to normal during pregnancy, and your medication may be stopped or your dosage decreased. If you have severe hypertension or have health problems related to your hypertension, you may need to start or continue taking blood pressure medication during pregnancy.

What kinds of problems can hypertension cause during pregnancy?

High blood pressure during pregnancy can place extra stress on your heart and kidneys and can increase your risk of heart disease, kidney disease, and stroke. Other possible complications include the following:

  • Fetal growth restriction—High blood pressure can decrease the flow of nutrients to the baby through the placenta. The baby may have growth problems as a result.
  • Preeclampsia—This condition is more likely to occur in women with chronic high blood pressure than in women with normal blood pressure.
  • Preterm delivery—If the placenta is not providing enough nutrients and oxygen to your baby, it may be decided that early delivery is better for your baby than allowing the pregnancy to continue.
  • Placental abruption—This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment.
  • Cesarean delivery—Women with hypertension are more likely to have a cesarean delivery than women with normal blood pressure. A cesarean delivery carries risks of infection, injury to internal organs, and bleeding.

What is gestational hypertension?

Gestational hypertension is high blood pressure that first occurs in the second half (after 20 weeks) of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future.

What causes preeclampsia?

It is not clear why some women develop preeclampsia, but the risk of developing preeclampsia is increased in women who

  • are pregnant for the first time
  • have had preeclampsia in a previous pregnancy or have a family history of preeclampsia
  • have a history of chronic hypertension, kidney disease, or both
  • are 40 years or older
  • are carrying more than one fetus
  • have certain medical conditions such as diabetes mellitus, thrombophilia, or lupus
  • are obese
  • had in vitro fertilization

What are the risks for my baby if preeclampsia occurs?

If preeclampsia occurs during pregnancy, your baby may need to be delivered right away, even if he or she is not fully grown. Preterm babies have an increased risk of serious complications. Some preterm complications last a lifetime and require ongoing medical care. Babies born very early also may die.

What are the risks for me if preeclampsia occurs?

Women who have had preeclampsia—especially those whose babies were born preterm—have an increased risk later in life of cardiovascular disease and kidney disease, including heart attack, stroke, and high blood pressure. Having preeclampsia once increases the risk of having it again in a future pregnancy. Preeclampsia also can lead to seizures, a condition called eclampsia. It also can lead to HELLP syndrome.

What is HELLP syndrome?

HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. In this condition, red blood cells are damaged or destroyed, blood clotting is impaired, and the liver can bleed internally, causing chest or abdominal pain. HELLP syndrome is a medical emergency. Women can die from HELLP syndrome or have lifelong health problems as a result.

What are the signs and symptoms of preeclampsia?

  • Swelling of face or hands
  • A headache that will not go away
  • Seeing spots or changes in eyesight
  • Pain in the upper abdomen or shoulder
  • Nausea and vomiting (in the second half of pregnancy)
  • Sudden weight gain
  • Difficulty breathing

How is mild gestational hypertension or preeclampsia without severe features managed?

Management of mild gestational hypertension or preeclampsia without severe features may take place either in a hospital or on an outpatient basis (you can stay at home with close monitoring by your health care professional). You may be asked to keep track of your baby’s movements by doing a daily kick count and to measure your blood pressure at home. You will need to see your health care professional at least weekly and sometimes twice weekly. Once you reach 37 weeks of pregnancy, it may be recommended that you have your baby. If test results show that the baby is not doing well, you may need to have the baby earlier.

How is preeclampsia with severe features managed?

Preeclampsia with severe features usually is treated in the hospital. If you are at least 34 weeks pregnant, it often is recommended that you have your baby as soon as your condition is stable. If you are less than 34 weeks pregnant and your condition is stable, it may be possible to wait to deliver your baby. Corticosteroids may be given to help the baby’s lungs mature, and you most likely will be given medications to help reduce your blood pressure and to help prevent seizures. If your condition or the baby’s condition worsens, prompt delivery will be needed.

What steps can I take to help prevent preeclampsia?

Prevention involves identifying whether you have risk factors for preeclampsia and taking steps to address these factors. If you have hypertension and are planning a pregnancy, see your health care professional for a prepregnancy check-up to find out whether your hypertension is under control and whether it has affected your health. If you are overweight, weight loss usually is advised before pregnancy. If you have a medical condition, such as diabetes, it usually is recommended that your condition be well controlled before you become pregnant.

Preeclampsia and High Blood Pressure Glossary of Terms

Cardiovascular Disease: Disease of the heart and blood vessels.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Chronic Hypertension: High blood pressure that was diagnosed before the current pregnancy.

Corticosteroids: Hormones given to help fetal lungs mature, for arthritis, or for other medical conditions.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Eclampsia: Seizures occurring in pregnancy and linked to high blood pressure.

Fetal Growth Restriction: A condition in which a fetus has an estimated weight that is less than that of 9 out of 10 other fetuses of the same gestational age.

Gestational Hypertension: New-onset high blood pressure that occurs after 20 weeks of pregnancy.

HELLP Syndrome: A severe type of preeclampsia; HELLP stands for hemolysis, elevated liver enzymes, and low platelet count.

Hemolysis: Destruction of red blood cells.

Hypertension: High blood pressure.

In Vitro Fertilization: A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Kick Count: A record kept during late pregnancy of the number of times a fetus moves over a certain period.

Liver Enzymes: Chemicals made by liver cells; elevated levels may indicate liver damage.

Lupus: An autoimmune disorder that causes changes in the joints, skin, kidneys, lungs, heart, or brain.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Oxygen: A gas that is necessary to sustain life.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Placental Abruption: A condition in which the placenta has begun to separate from the inner wall of the uterus before the baby is born.

Platelets: Small, disc-shaped structures found in the blood that help the blood to clot.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, a severe headache, or changes in vision.

Preterm: Born before 37 weeks of pregnancy.

Proteinuria: The presence of an abnormal amount of protein in the urine.

Thrombophilia: A condition in which the blood does not clot correctly.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Morning Sickness: Nausea and Vomiting of Pregnancy

How common is nausea and vomiting of pregnancy?

Nausea and vomiting of pregnancy is a very common condition. Although nausea and vomiting of pregnancy often is called “morning sickness,” it can occur at any time of the day. Nausea and vomiting of pregnancy usually is not harmful to the fetus, but it can have a serious effect on your life, including your ability to work or do your normal daily activities.

What is the difference between mild and severe nausea and vomiting of pregnancy?

Some women feel nauseated for a short time each day and may vomit once or twice. This usually is defined as mild nausea and vomiting of pregnancy. In more severe cases, nausea lasts several hours each day and vomiting occurs more frequently. Deciding to seek treatment depends on how much nausea and vomiting of pregnancy affects your life and causes you concern, not whether your condition is “mild” or “severe.”

When does nausea and vomiting of pregnancy start?

Nausea and vomiting of pregnancy usually starts before 9 weeks of pregnancy. For most women, it goes away by the second trimester (14 weeks of pregnancy). For some women, it lasts for several weeks or months. For a few women, it lasts throughout the entire pregnancy.

What is hyperemesis gravidarum?

Hyperemesis gravidarum is the most severe form of nausea and vomiting of pregnancy. It occurs in up to 3% of pregnancies. This condition may be diagnosed when a woman has lost 5% of her prepregnancy weight and has other problems related to dehydration (loss of body fluids). Women with hyperemesis gravidarum need treatment to stop their vomiting and restore body fluids. Sometimes treatment in a hospital is needed.

Am I at risk of severe nausea and vomiting of pregnancy?

If you have any of the following factors, your risk of severe nausea and vomiting of pregnancy may be increased:

  • Being pregnant with more than one fetus (multiple pregnancy)
  • Past pregnancy with nausea and vomiting (either mild or severe)
  • Your mother or sister had severe nausea and vomiting of pregnancy
  • History of motion sickness or migraines
  • Being pregnant with a female fetus

Could nausea and vomiting during pregnancy be caused by another medical condition?

Some medical conditions can cause nausea and vomiting during pregnancy. These include an ulcer, food-related illness, thyroid disease, or gallbladder disease. Your obstetrician or other health care professional may suspect that you have one of these conditions if you have signs or symptoms that do not usually occur with nausea and vomiting of pregnancy:

  • Nausea and vomiting that occurs for the first time after 9 weeks of pregnancy
  • Abdominal pain or tenderness
  • Fever
  • Headache
  • Enlarged thyroid gland (swelling in the front of the neck)

Can nausea and vomiting of pregnancy affect my fetus?

Having nausea and vomiting of pregnancy usually does not harm your health or your fetus’s health. It does not mean your fetus is sick. It can become more of a problem if you cannot keep down any food or fluids and begin to lose weight. When this happens, it sometimes can affect the fetus’s weight at birth. You also can develop problems with your thyroid, liver, and fluid balance.

When is the best time to treat nausea and vomiting of pregnancy?

Because severe nausea and vomiting of pregnancy is hard to treat and can cause health problems, many experts recommend early treatment so that it does not become severe.

What can I do to feel better if I have nausea and vomiting of pregnancy?

Diet and lifestyle changes may help you feel better. You may need to try more than one of these suggestions:

  • Take a multivitamin.
  • Try eating dry toast or crackers in the morning before you get out of bed to avoid moving around on an empty stomach.
  • Drink fluids often.
  • Avoid smells that bother you.
  • Eat small, frequent meals instead of three large meals.
  • Try bland foods. For example, the “BRATT” diet (bananas, rice, applesauce, toast, and tea) is low in fat and easy to digest.
  • Try ginger ale made with real ginger, ginger tea made from fresh grated ginger, ginger capsules, and ginger candies.

If you do vomit a lot, it can cause some of your tooth enamel to wear away. This happens because your stomach contains a lot of acid. Rinsing your mouth with a teaspoon of baking soda dissolved in a cup of water may help neutralize the acid and protect your teeth.

Is there medical treatment for nausea and vomiting of pregnancy?

If diet and lifestyle changes do not help your symptoms, or if you have severe nausea and vomiting of pregnancy, medical treatment may be needed. If other medical conditions are ruled out, certain medications can be given to treat nausea and vomiting of pregnancy:

  • Vitamin B6 and doxylamine—Vitamin B6 is a safe, over-the-counter treatment that may be tried first. Doxylamine, a medication found in over-the-counter sleep aids, may be added if vitamin B6 alone does not relieve symptoms. A prescription drug that combines vitamin B6 and doxylamine is available. Both drugs—taken alone or together—have been found to be safe to take during pregnancy and have no harmful effects on the fetus.
  • “Antiemetic” drugs—If vitamin B6 and doxylamine do not work, “antiemetic” drugs may be prescribed. These drugs prevent vomiting. Many antiemetic drugs have been shown to be safe to use during pregnancy. Others have conflicting or limited safety information. You and your obstetrician or other members of your health care team can discuss all of these factors to determine the best treatment for your personal situation.

What may happen if my nausea and vomiting are severe or I have hyperemesis gravidarum?

You may need to stay in the hospital until your symptoms are under control. Lab tests may be done to check how your liver is working. If you are dehydrated from loss of fluids, you may receive fluids and vitamins through an intravenous line. If your vomiting cannot be controlled, you may need additional medication. If you continue to lose weight, sometimes tube feeding is recommended to ensure that you and your fetus are getting enough nutrients.

Morning Sickness Glossary of Terms

Dehydration: A condition that happens when the body does not have as much water as it needs.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Hyperemesis Gravidarum: Severe nausea and vomiting during pregnancy that can lead to loss of weight and body fluids.

Nausea and Vomiting of Pregnancy: A condition that occurs in early pregnancy, usually starting before 9 weeks of pregnancy.

Nutrients: Nourishing substances found through food, such as vitamins and minerals.

Thyroid Gland: A butterfly-shaped gland located at the base of the neck in front of the windpipe. This gland makes, stores, and releases thyroid hormone that controls the body’s metabolism and regulates how parts of the body work.

Age and Pregnancy (Having a Baby After 35)

How does age affect fertility?

A woman’s peak reproductive years are between the late teens and late 20s. By age 30 years, fertility (the ability to get pregnant) starts to decline. This decline becomes more rapid once you reach your mid 30s. By age 45 years, fertility has declined so much that getting pregnant naturally is unlikely for most women.

Is there testing to find out the risk of having a baby with a birth defect?

Yes. Prenatal screening tests assess the risk that a baby will be born with a specific birth defect or genetic disorder. Prenatal diagnostic tests can detect if a fetus has a specific birth defect or genetic disorder. Every woman should review the available testing options with her obstetrician–gynecologist (ob-gyn) or other health care professional so that she can make an informed choice.

How does aging affect the risk of having a baby with a birth defect?

The overall risk of having a baby with a chromosome abnormality is small. But as a woman ages, the risk of having a baby with missing, damaged, or extra chromosomes increases. Down syndrome is the most common chromosome problem that occurs with later childbearing. The risk of having a baby with Down syndrome is

  • 1 in 1,480 at age 20 years
  • 1 in 940 at age 30 years
  • 1 in 353 at age 35 years
  • 1 in 85 at age 40 years
  • 1 in 35 at age 45 years

How can later childbearing affect a woman’s health?

Pregnant women older than 40 years have an increased risk of preeclampsia. Some of the increase in risk may be because older women tend to have more health problems before they get pregnant than younger women. For example, having high blood pressure, a condition that becomes more common with age, can increase the risk of preeclampsia. Studies also show that older women who do not have any health conditions still can have complicated pregnancies.

What are the risks of later childbearing?

Women who get pregnant in their late 30s or 40s have a higher risk of complications. Some of these problems may affect a woman’s health. Others can affect the health of the fetus.

Why do women become less fertile as they age?

Women become less fertile as they age because they begin life with a fixed number of eggs in their ovaries. The number of eggs decreases as women get older. Also, the remaining eggs in older women are more likely to have abnormal chromosomes. And as age increases, women are at higher risk of disorders that can affect fertility, such as uterine fibroids and endometriosis.

How likely is pregnancy as a woman ages?

For healthy couples in their 20s and early 30s, around 1 in 4 women will get pregnant in any single menstrual cycle. By age 40 years, around 1 in 10 women will get pregnant per menstrual cycle. A man’s fertility also declines with age, but not as predictably as a woman’s fertility.

What are other risks of later childbearing?

The risks of miscarriage and stillbirth are greater in women who are older than 35 years. Also, multiple pregnancy occurs more often in older women than in younger women. As the ovaries age, they are more likely to release more than one egg each month.

What is a reproductive life plan?

All women should think about whether they would like to have children and, if so, when to have them. This is called a reproductive life plan. If you would like to have children someday, your ob-gyn or other health care professional can help you develop your reproductive life plan.

How often should I talk about my reproductive life plan with my ob-gyn?

It is a good idea to talk about your plan once a year with your ob-gyn or other health care professional.

What should I do if I do not want to get pregnant now?

If you do not want to get pregnant now or have decided not to have children, use a birth control method to prevent pregnancy if you are having sexual intercourse. Make sure you are using a method that fits your reproductive goals, your lifestyle, and any health conditions that you have. You and your ob-gyn or other health care professional can review your birth control options.

What should I do if I do want to get pregnant soon?

If you want to get pregnant soon, you should try to be as healthy as possible before pregnancy. Steps toward better health include stopping alcohol, tobacco, and marijuana use. You also should start taking folic acid to help prevent neural tube defects.

What is a prepregnancy health care visit?

A prepregnancy health care visit is a time for your ob-gyn or other health care professional to review your medical and family history. He or she also will review any medications you take and your immunizations to be sure that you have all of the recommended vaccines. Your ob-gyn or other health care professional also may

  • ask about your diet and lifestyle
  • discuss how you can maintain a healthy weight before getting pregnant
  • recommend screening for sexually transmitted infections (STIs)
  • discuss the option of carrier screening for you and, if needed, your partner

Are there ways to preserve fertility?

Currently, there is no medical technique that can guarantee fertility will be preserved. If you know that you want to have children later in life, one option may be in vitro fertilization (IVF). With IVF, sperm is combined with a woman’s eggs in a laboratory. If the sperm fertilizes the eggs, embryos may grow. Embryos can be frozen and used many years later. When you are ready, an embryo can be transferred to your uterus to try to achieve a pregnancy.

What are the chances that in vitro fertilization will work for me?

The chance that IVF will work for you depends on many factors, including your health and your age when the embryos are frozen. Talking with a fertility expert will help you understand your chances of success with IVF.

What else should I know about in vitro fertilization?

Some IVF treatments are expensive and may not be covered by insurance.

I have heard about egg freezing. What is this procedure?

In a procedure called oocyte cryopreservation—“freezing your eggs”—several eggs are removed from the ovaries. The unfertilized eggs are then frozen for later use in IVF. Egg freezing is recommended mainly for women having cancer treatment that will affect their future fertility. There is not enough research to recommend routine egg freezing for the sole purpose of putting off childbearing. Egg freezing also is expensive and may not be covered by insurance.

I have not gotten pregnant. Should I have an evaluation?

If you are older than 35 years and have not gotten pregnant after 6 months of having regular sexual intercourse without using any form of birth control, talk with your ob-gyn or other health care professional about an infertility evaluation. If you are older than 40 years, an evaluation is recommended before trying to get pregnant. This advice is especially true if you have a problem that could affect fertility, such as endometriosis.

What happens during an infertility evaluation?

During an infertility evaluation, you have physical exams and tests to try to find the cause of infertility. If a cause is found, treatment may be possible. In many cases, infertility can be successfully treated even if no cause is found. But the chances of success with these treatments decrease with age.

Can a woman older than 35 years have a healthy pregnancy?

Yes. Despite the challenges, many women older than 35 years can have healthy pregnancies and babies. Seeing a health care professional before pregnancy and receiving good prenatal care during pregnancy are key.

Why is prenatal care important?

When you are pregnant, getting early and regular prenatal care may increase your chances of having a healthy baby. You should visit your ob-gyn or other health care professional regularly. At each visit, your health and your fetus’s health will be monitored. If you have a preexisting medical condition or if a medical condition develops during pregnancy, you may need to have special tests or more frequent prenatal care visits. You also may need special care during labor and delivery.

Aging, Fertility, and Pregnancy Glossary of Terms

Carrier Screening: A test done on a person without signs or symptoms to find out whether he or she carries a gene for a genetic disorder.

Chromosomes: Structures that are located inside each cell in the body and contain the genes that determine a person’s physical makeup.

Diagnostic Tests: Tests that look for a disease or cause of a disease.

Down Syndrome: A genetic disorder that causes abnormal features of the face and body, medical problems such as heart defects, and intellectual disability. Most cases of Down syndrome are caused by an extra chromosome 21 (trisomy 21). Many children with Down syndrome live to adulthood.

Embryos: The stage of prenatal development that starts at fertilization (joining of an egg and sperm) and lasts up to 8 weeks.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Fibroids: Growths, usually benign, that form in the muscle of the uterus.

Folic Acid: A vitamin that has been shown to reduce the risk of certain birth defects when taken in sufficient amounts before and during pregnancy.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Miscarriage: Loss of a pregnancy.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Oocyte Cryopreservation: A procedure in which eggs are removed from a woman’s ovaries and frozen for later use with in vitro fertilization.

Ovaries: The paired organs in the female reproductive system that contain the eggs released at ovulation and produce hormones.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Screening Tests: Tests that look for possible signs of disease in people who do not have signs or symptoms.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called “having sex” or “making love”).

Sexually Transmitted Infections (STIs): An infection that is spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Stillbirth: Birth of a dead fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Age and Pregnancy (Having a Baby In Your Teens)

What is prenatal care?

Prenatal care is the health care you get while you are pregnant. It includes medical care, education, and counseling. The earlier you get prenatal care, the better your chances are for a healthy pregnancy and baby.

How much weight should I gain during pregnancy?

How much weight you should gain during pregnancy depends on your weight before you were pregnant. If you were underweight, you need to gain as much as 40 pounds. If you were a normal weight, you should gain 25–35 pounds. If you were overweight or obese, you need to gain as little as 11 pounds.

Are there any foods that I should avoid?

While you are pregnant, there are some foods you should not eat or eat only in small amounts:

  • Certain types of cooked fish—While you are pregnant, avoid shark, tilefish, king mackerel, and swordfish. You should limit albacore tuna (but not “chunk light tuna”) to about one small can a week. These fish may have high levels of mercury, which can be harmful during pregnancy.
  • Caffeine—Caffeine is found in coffee, tea, chocolate, energy drinks, and soft drinks. It is a good idea to limit your daily intake of caffeine to less than 200 mg, which is the amount in two small cups of brewed coffee.
  • Sushi—Raw fish may be harmful during pregnancy.
  • Unpasteurized milk and cheese—These foods can cause a disease called listeriosis. Avoid cheeses that are made with raw milk (such as some feta, queso fresco, and bleu cheeses).

Why is it important to eat a healthy diet during pregnancy?

Eating the right food is good for your health and helps your fetus grow. This is the time to make healthy choices. An online program called MyPlate (www.choosemyplate.gov) can help you plan a balanced diet. MyPlate makes it easy to remember what to eat at each meal. One half of your plate should be fruits and vegetables. The other half should be grains and protein foods. You need a small amount of dairy foods at each meal as well.

What are things I can do to help ensure a healthy pregnancy?

It is important to eat healthy foods, exercise regularly, and get plenty of rest. You should avoid things that could harm your fetus, such as alcohol, tobacco, marijuana, and illegal drugs. You also need to talk to your health care professional about any prescription drugs you are taking as well as drugs you can buy without a prescription, like vitamins and pain relievers.

What are childbirth classes?

In childbirth classes, you can learn more about pregnancy, giving birth, breastfeeding, and being a parent. There may be special classes for pregnant teens. There also are classes that can teach you how to take care of your baby. This includes how to feed, diaper, and bathe your baby and how to keep your baby healthy and safe. You can ask other mothers, family members, or health care staff to teach you, too.

What may happen at my first prenatal care visit?

At your first prenatal care visit, your health care professional will ask you many questions. You will be asked the date of the first day of your last menstrual period. Your health care professional uses this date to figure out how many weeks pregnant you are and estimate when your baby will be born (your due date). You will have a complete physical exam, which may include a pelvic exam. You also may have a urine test and some blood tests. You may be tested for certain sexually transmitted infections (STIs).

What vitamins are necessary during pregnancy?

An important vitamin for pregnant women is a B vitamin called folic acid. Getting enough folic acid before and during pregnancy may help prevent major birth defects of the fetus’s brain and spine. During pregnancy, you should get 600 micrograms of folic acid daily. Iron also is important. More iron is needed during pregnancy to make extra blood that carries oxygen to your fetus.

How can I be sure I am getting all of the necessary vitamins during pregnancy?

One way to get the all the vitamins and minerals you need during pregnancy is to take a multivitamin pill. There are special ones for pregnant women. At your first prenatal care visit, tell your health care professional about any other vitamins you have been taking. You may want to bring the bottles with you. Excess amounts of some vitamins can be harmful. Your health care professional will help you decide which vitamin pills to take.

Why is exercise important during pregnancy?

Exercise can help give you more energy, ease some of the discomforts of pregnancy, and make you stronger for labor and delivery. Most teens should exercise 30 minutes or more on most, if not all, days of the week. The 30 minutes do not have to be all at one time. For example, you can do three 10-minute periods of exercise.

Should I expect to feel tired during pregnancy?

During early and late pregnancy, it is common to feel very tired. It is important to get plenty of rest while you are pregnant— your body needs 8.5–9.5 hours of sleep each night. Listen to your body. During the day, take breaks and rest when you feel tired. Exercise and a healthy diet may help boost your energy.

Should I be taking medications during pregnancy?

Some teens need to take medicine during pregnancy for their health or for the health of the fetus. Tell your health care professional about any prescription medicines you are taking or bring the bottles with you to your first prenatal visit. Be sure to talk to your health care professional before taking any over-the-counter medicines, herbal remedies, vitamins, or minerals.

Can using alcohol, tobacco, marijuana, or other illegal drugs cause harm during pregnancy?

Alcohol, tobacco, marijuana, and other drugs can harm you and your baby. If you use any of these substances, now is a good time to quit. If you want to stop, but cannot, ask your health care professional. He or she can help you find ways to quit.

Do teens have any special pregnancy risks?

Pregnant teens are at higher risk of certain health problems (such as high blood pressure or anemia) than pregnant women who are older. Pregnant teens are more likely to go into labor too early. This is called preterm birth. These risks are even greater for teens who are younger than 15 years or for those who do not get prenatal care.

Teens also are likely to have STIs. You may have an STI and not know it. If you have sex during pregnancy, you could get an STI. Using a latex condom can help prevent getting or spreading some STIs

What should I know about breastfeeding?

Breastfeeding is the best way to feed your baby. Breast milk helps the baby resist diseases and allergies. Breastfeeding also is cheaper than bottle-feeding and may help you return to your prepregnancy weight more quickly. Breastfeeding is recommended for the first 6 months of the baby’s life, but breastfeeding only for a few weeks or months has health benefits for the baby.

When you go back to school or to work, you can still feed your baby breast milk. You will need to get a breast pump to collect and store milk. Your workplace or school should have a place where you can do this.

When should I see my health care professional after I have the baby?

Plan to see your health care professional within the first 3 weeks after your baby is born (the postpartum period). During this visit, your health care professional will make sure you are healthy and talk about your future health needs. You also should plan for a full postpartum checkup no later than 12 weeks after birth.

Teenage Pregnancy Glossary of Terms

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Listeriosis: A type of illness you can get from bacteria found in unpasteurized milk, hot dogs, luncheon meats, and smoked seafood.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Preterm: Less than 37 weeks of pregnancy.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact.

How to Tell When Labor Begins

What happens when labor begins?

As labor begins, the cervix opens (dilates). The uterus, which contains muscle, contracts at regular intervals. When it contracts, the abdomen becomes hard. Between the contractions, the uterus relaxes and becomes soft. Up to the start of labor and during early labor, the baby will continue to move.

Certain changes also may signal that labor is beginning. You may or may not notice some of them before labor begins:

Signs That You Are Approaching Labor
Sign What It is When It Happens
Feeling as if the baby has dropped lower Lightening. This is known as the “baby dropping.” The baby’s head has settled deep into your pelvis. From a few weeks to a few hours before labor begins
Increase in vaginal discharge (clear, pink, or slightly bloody) Show. A thick mucus plug has accumulated at the cervix during pregnancy. When the cervix begins to dilate, the plug is pushed into the vagina. Several days before labor begins or at the onset of labor

What is false labor?

Your uterus may contract off and on before “true” labor begins. These irregular contractions are called false labor or Braxton Hicks contractions. They are normal but can be painful at times. You might notice them more at the end of the day.

How can I tell the difference between true labor and false labor?

Usually, false labor contractions are less regular and not as strong as true labor. Sometimes the only way to tell the difference is by having a vaginal exam to look for changes in your cervix that signal the onset of labor.

One good way to tell the difference is to time the contractions. Note how long it is from the start of one contraction to the start of the next one. Keep a record for an hour. It may be hard to time labor pains accurately if the contractions are slight. Listed as follows are some differences between true labor and false labor:

Differences Between False Labor and True Labor
Type of Change False Labor True Labor
Timing of contractions Often are irregular and do not get closer together (called Braxton Hicks contractions) Come at regular intervals and, as time goes on, get closer together. Each lasts about 30–70 seconds.
Change with movement Contractions may stop when you walk or rest, or may even stop with a change of position Contractions continue, despite movement
Strength of contractions Usually weak and do not get much stronger (may be strong and then weak) Increase in strength steadily
Pain of contractions Usually felt only in the front Usually starts in the back and moves to the front

Fetal Heart Rate Monitoring During Labor

What is fetal heart rate monitoring?

Fetal heart rate monitoring is the process of checking the condition of your fetus during labor and delivery by monitoring your fetus’s heart rate with special equipment.

Why is fetal heart rate monitoring done during labor and delivery?

Fetal heart rate monitoring may help detect changes in the normal heart rate pattern during labor. If certain changes are detected, steps can be taken to help treat the underlying problem. Fetal heart rate monitoring also can help prevent treatments that are not needed. A normal fetal heart rate can reassure both you and your obstetrician–gynecologist
(ob-gyn)
or other health care professional that it is safe to continue labor if no other problems are present.

What are the types of monitoring?

There are two methods of fetal heart rate monitoring in labor. Auscultation is a method of periodically listening to the fetal heartbeat. Electronic fetal monitoring is a procedure in which instruments are used to continuously record the heartbeat of the fetus and the contractions of the woman’s uterus during labor. The method that is used depends on the policy of your ob-gyn or hospital, your risk of problems, and how your labor is going. If you do not have any complications or risk factors for problems during labor, either method is acceptable.

How is auscultation performed?

Auscultation is done with either a special stethoscope or a device called a Doppler transducer. When the transducer is pressed against your abdomen, you can hear your fetus’s heartbeat.

When auscultation is used, your ob-gyn or other health care professional will check the heart rate of the fetus at set times during labor. If you have risk factors for problems during labor or if problems appear during labor, the fetal heart rate will be checked and recorded more frequently.

How is electronic fetal monitoring performed?

Electronic fetal monitoring uses special equipment to measure the response of the fetus’s heart rate to contractions of the uterus. It provides an ongoing record that can be read. Your ob-gyn or other health care professional will review the electronic recording of the fetus’s heartbeat (called the fetal heart rate tracing) at set times. The tracing may be reviewed more frequently if problems arise.

Electronic fetal monitoring can be external, internal, or both. You may need to stay in bed during both types of electronic monitoring, but you can move around and find a comfortable position.

How is external monitoring performed?

With this method, a pair of belts is wrapped around your abdomen. One belt uses Doppler to detect the fetal heart rate. The other belt measures the length of contractions and the time between them.

How is internal monitoring performed?

With this method, a wire called an electrode is used. It is placed on the part of the fetus closest to the cervix, usually the scalp. This device records the heart rate. Uterine contractions also may be monitored with a special tube called an intrauterine pressure catheter that is inserted through the vagina into your uterus. Internal monitoring can be used only after the membranes of the amniotic sac have ruptured (after “your water breaks” or is broken).

What happens if the fetal heart rate pattern is abnormal?

Abnormal fetal heart rate patterns do not always mean there is a problem. Other tests may be done to get a better idea of what is going on with your fetus.

If there is an abnormal fetal heart rate pattern, your ob-gyn or other health care professional will first try to find the cause. Steps can be taken to help the fetus get more oxygen, such as having you change position. If these procedures do not work, or if further test results suggest your fetus has a problem, your ob-gyn or other health care professional may decide to deliver right away. In this case, the delivery is more likely to be by cesarean birth or with forceps or vacuum-assisted delivery.

Fetal Heart Rate Monitoring Glossary of Terms

Amniotic Sac: Fluid-filled sac in the mother’s uterus in which the fetus develops.

Auscultation: A method of listening to internal organs, such as the fetal heart during labor.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Cesarean Birth: Birth of a baby through incisions made in the mother’s abdomen and uterus.

Doppler Transducer: A device that uses sound waves to reflect motion—such as the fetal heartbeat—in the form of signals that can be heard.

Electrode: A small wire that is attached to the scalp of the fetus to monitor the heart rate.

Electronic Fetal Monitoring (EFM): A method in which electronic instruments are used to record the heartbeat of the fetus and contractions of the mother’s uterus.

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Forceps: Special instruments placed around the baby’s head to help guide it out of the birth canal during delivery.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Vacuum-Assisted Delivery: The use of a special instrument attached to the baby’s head to help guide it out of the birth canal during delivery.

Multiple Pregnancy

How does multiple pregnancy occur?

A pregnancy with more than one fetus is called multiple pregnancy. If more than one egg is released during the menstrual cycle and each is fertilized by a sperm, more than one embryo may implant and grow in your uterus. This type of pregnancy results in fraternal twins (or more). When a single fertilized egg splits, it results in multiple identical embryos. This type of pregnancy results in identical twins (or more). Identical twins are less common than fraternal twins.

Do I need to gain extra weight if I am pregnant with multiples?

It generally is recommended that women who are pregnant with multiples gain more weight than women who are pregnant with one fetus. An extra 300 calories a day is needed for each fetus. For instance, if you are pregnant with twins, you need an extra 600 calories a day. For triplets and more, weight gain should be individualized.

What are some symptoms of multiple pregnancy?

Women who are pregnant with multiples may have more severe morning sickness or breast tenderness than women who are pregnant with a single fetus. They also may gain weight more quickly. Most multiple pregnancies are discovered during an ultrasound exam.

What are some causes of multiple pregnancy?

The use of fertility drugs to induce ovulation often causes more than one egg to be released from the ovaries and can result in twins, triplets, or more. In vitro fertilization (IVF) can lead to a multiple pregnancy if more than one embryo is transferred to the uterus. Identical multiples also may result if the fertilized egg splits after transfer. Women older than 35 years are more likely to release two or more eggs during a single menstrual cycle than younger women. Therefore, they are more likely than younger women to become pregnant with multiples.

Should I exercise if I am pregnant with multiples?

Staying active during multiple pregnancy is important for your health, but you may need to avoid strenuous exercise. Try low-impact exercise, such as swimming, prenatal yoga, and walking. You should aim for 30 minutes of exercise a day. If problems arise during your pregnancy, it may be recommended that you avoid exercise.

Is the risk of complications higher if I am pregnant with multiples?

The risk of certain complications is higher if you are pregnant with multiples. You most likely will have more frequent prenatal care visits with your obstetrician–gynecologist (ob-gyn) or other health care professional. Starting in your second trimester, you may have ultrasound exams every 4–6 weeks. If a problem is suspected, you may have special tests, such as a nonstress test or biophysical profile, and more frequent ultrasound exams.

What is the most common complication of multiple pregnancy?

The most common complication of multiple pregnancy is preterm birth. More than one half of all twins are born preterm. Triplets and more are almost always born preterm.

Babies born before 37 weeks of pregnancy may have an increased risk of short-term and long-term health problems, including problems with breathing, eating, and staying warm. Other problems, such as learning and behavioral disabilities, may appear later in childhood or even in adulthood. Very preterm babies (those who are born before 32 weeks of pregnancy) can die or have severe health problems, even with the best of care.

Preterm multiples also have a greater risk than single preterm babies of the same gestational age for serious complications that can lead to cerebral palsy. Children born with problems related to being preterm may need lifelong medical care.

What are chorionicity and amnionicity?

Early in a multiple pregnancy, an ultrasound exam is done to find out whether each baby has its own chorion (chorionicity) and amniotic sac (amnionicity). There are three types of twins:

  1. Dichorionic–diamniotic—Twins who have their own chorions and amniotic sacs. They typically do not share a placenta and can be fraternal or identical.
  2. Monochorionic–diamniotic—Twins who share a chorion but have separate amniotic sacs. They share a placenta and are identical.
  3. Monochorionic–monoamniotic—Twins who share one chorion and one amniotic sac. They share a placenta and are identical.

What are the risks associated with monochorionic babies?

Monochorionic babies have a higher risk of complications than those with separate placentas. One problem that can occur in monochorionic–diamniotic babies is twin–twin transfusion syndrome (TTTS). In TTTS, the blood flow between the twins becomes unbalanced. One twin donates blood to the other twin. The donor twin has too little blood, and the recipient twin has too much blood. The earlier TTTS occurs in the pregnancy, the more serious the outcomes for one or both babies.

Although monochorionic–monoamniotic babies are rare, this type of pregnancy is very risky. The most common problem is an umbilical cord complication. Women with this type of pregnancy are monitored more frequently and are likely to have a cesarean birth.

How can multiple pregnancy affect my risk of preeclampsia?

Preeclampsia is a blood pressure disorder that usually starts after 20 weeks of pregnancy or after childbirth. It occurs more often in multiple pregnancies than in singleton pregnancies. It also tends to occur earlier and is more severe in multiple pregnancies.

Preeclampsia can damage many organs in your body, most commonly your kidneys, liver, brain, and eyes. Preeclampsia that worsens and causes seizures is called eclampsia. When preeclampsia occurs during pregnancy, the babies may need to be delivered right away, even if they are not fully grown.

How can multiple pregnancy affect my risk of gestational diabetes?

Women carrying multiples have a high risk of gestational diabetes. This condition can increase the risk of preeclampsia and of developing diabetes mellitus later in life. Newborns may have breathing problems or low blood sugar levels. Diet, exercise, and sometimes medication can reduce the risk of these complications.

How can multiple pregnancy affect fetal growth?

Multiples are more likely to have growth problems than single babies. Multiples are called discordant if one fetus is much smaller than the others. Discordant growth is common with multiples. It does not always signal a problem. Sometimes, though, a fetus’s restricted growth may be caused by an infection, TTTS, or a problem with the placenta or umbilical cord. If growth restriction is suspected in one or both fetuses, frequent ultrasound exams may be done to track how the fetuses are growing.

Are tests for genetic disorders as accurate in multiple pregnancies?

Screening tests for genetic disorders that use a sample of the mother’s blood (serum screening tests) are not as sensitive in multiple pregnancy. It is possible to have a positive screening test result when no problem is present in either fetus.

Diagnostic tests for birth defects include chorionic villus sampling (CVS) and amniocentesis. These tests are harder to perform in multiples because each fetus must be tested. There also is a small risk of loss of one or all of the fetuses. Results of these tests may show that one fetus has a disorder, while the others do not.

How can multiple pregnancy affect delivery?

The chance of cesarean birth is higher with multiples. In some cases, twins can be delivered by vaginal birth. How your babies are born depends on the following:

  • Number of babies and the position, weight, and health of each baby
  • Your health and how your labor is going
  • The experience of your ob-gyn or other health care professional

Can multiple pregnancy affect my risk of postpartum depression?

Having multiples might increase your risk of postpartum depression. If you have intense feelings of sadness, anxiety, or despair that prevent you from being able to do your daily tasks, let your ob-gyn or other member of your health care team know.

Multiple Pregnancy Glossary of Terms

Amniocentesis: A procedure in which amniotic fluid and cells are taken from the uterus for testing. The procedure uses a needle to withdraw fluid and cells from the sac that holds the fetus.

Amnionicity: The number of amniotic (inner) membranes that surround fetuses in a multiple pregnancy. When multiple fetuses have only one amnion, they share an amniotic sac.

Amniotic Sac: Fluid-filled sac in a woman’s uterus. The fetus develops in this sac.

Biophysical Profile: A test that uses ultrasound to measure a fetus’s breathing, movement, muscle tone, and heart rate. The test also measures the amount of fluid in the amniotic sac.

Birth Defects: Physical problems that are present at birth.

Cerebral Palsy: A disorder of the nervous system that affects movement, posture, and coordination. This disorder is present at birth.

Cesarean Birth: Birth of a fetus from the uterus through an incision made in the woman’s abdomen.

Chorion: The outer membrane that surrounds the fetus.

Chorionic Villus Sampling (CVS): A procedure in which a small sample of cells is taken from the placenta and tested.

Chorionicity: The number of chorionic (outer) membranes that surround the fetuses in a multiple pregnancy.

Diagnostic Tests: Tests that look for a disease or cause of a disease.

Discordant: A large difference in the size of fetuses in a multiple pregnancy.

Eclampsia: Seizures occurring in pregnancy or after pregnancy that are linked to high blood pressure.

Embryo: The stage of development that starts at fertilization (joining of an egg and sperm) and lasts up to 8 weeks.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Fraternal Twins: Twins that have developed from two different fertilized eggs.

Gestational Age: How far along a woman is in her pregnancy, usually reported in weeks and days.

Gestational Diabetes: Diabetes that starts during pregnancy.

Identical Twins: Twins that have developed from a single fertilized egg that are usually genetically identical.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Multiple Pregnancy: A pregnancy where there are two or more fetuses.

Nonstress Test: A test in which changes in the fetal heart rate are recorded using an electronic fetal monitor.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Ovulation: The time when an ovary releases an egg.

Placenta: An organ that provides nutrients to and takes waste away from the fetus.

Postpartum Depression: A type of depressive mood disorder that develops in the first year after the birth of a child. This type of depression can affect a woman’s ability to take care of her child.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Preterm: Less than 37 weeks of pregnancy.

Screening Tests: Tests that look for possible signs of disease in people who do not have signs or symptoms.

Twin–Twin Transfusion (TTS): A condition of identical twins in which one twin gets more blood than the other during pregnancy.

Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

Umbilical Cord: A cord-like structure containing blood vessels. It connects the fetus to the placenta.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

Can I breastfeed if I have multiples?

Yes, but it may take some practice. Your milk supply will increase to the right amount. You will need to eat healthy foods and drink plenty of liquids. Lactation specialists are available at many hospitals and in your community to help you work out any problems you may have.

Cesarean Birth (C-Section)

What is cesarean birth?

Cesarean birth is the delivery of a baby through incisions made in the mother’s abdomen and uterus.

What are the reasons for cesarean birth?

The following situations are some of the reasons why a cesarean birth is performed:

  • Failure of labor to progress—Contractions may not open the cervix enough for the baby to move into the vagina.
  • Concern for the baby—For instance, the umbilical cord may become pinched or compressed or fetal monitoring may detect an abnormal heart rate.
  • Multiple pregnancy—If a woman is pregnant with twins, a cesarean birth may be necessary if the babies are being born too early, are not in good positions in the uterus, or if there are other problems. The likelihood of having a cesarean birth increases with the number of babies a woman is carrying.
  • Problems with the placenta
  • A very large baby
  • Breech presentation
  • Maternal infections, such as human immunodeficiency virus or herpes
  • Maternal medical conditions, such as diabetes mellitus or high blood pressure

Is a cesarean birth necessary if I have had a previous cesarean birth?

Women who have had a cesarean birth before may be able to give birth vaginally. The decision depends on the type of incision used in the previous cesarean delivery, the number of previous cesarean deliveries, whether you have any conditions that make a vaginal delivery risky, and the type of hospital in which you have your baby, as well as other factors. Talk to your obstetrician–gynecologist (ob-gyn) or other health care professional about your options.

Can I request cesarean birth?

Some women may request a cesarean birth even if a vaginal delivery is an option. This decision should be weighed carefully and discussed with your doctor. As with any surgery, there are risks and complications to consider. Your hospital stay may be longer than with vaginal birth. Also, the more cesarean births a woman has, the greater her risk for some medical problems and problems with future pregnancies. This may not be a good option for women who want to have more children.

What are the preparations for cesarean birth?

Before you have a cesarean delivery, a nurse will prepare you for the operation. An intravenous line will be put in a vein in your arm or hand. This allows you to get fluids and medications during the surgery. Your abdomen will be washed, and your pubic hair may be clipped or trimmed. You will be given medication to prevent infection.

A catheter (tube) is then placed in your urethra to drain your bladder. Keeping the bladder empty decreases the chance of injuring it during surgery.

What type of anesthesia will be used during the procedure?

You will be given either general anesthesia, an epidural block, or a spinal block. If general anesthesia is used, you will not be awake during the delivery. An epidural block numbs the lower half of the body. An injection is made into a space in your spine in your lower back. A small tube may be inserted into this space so that more of the drug can be given through the tube later, if needed. A spinal block also numbs the lower half of your body. You receive it the same way as an epidural block, but the drug is injected directly into the spinal fluid.

How is the procedure performed?

A cut (incision) is made through your skin and the wall of the abdomen. The skin incision may be transverse (horizontal or “bikini”) or vertical. The muscles in your abdomen are separated and may not need to be cut. Another incision will be made in the wall of the uterus. The incision in the wall of the uterus also will be either transverse or vertical.

The baby will be delivered through the incisions, the umbilical cord will be cut, and then the placenta will be removed. The uterus will be closed with stitches that will dissolve in the body. Stitches or staples are used to close your abdominal skin.

What are the complications?

Some complications occur in a small number of women and usually are easily treated:

  • Infection
  • Blood loss
  • Blood clots in the legs, pelvic organs, or lungs
  • Injury to the bowel or bladder
  • Reaction to medications or to the anesthesia that is used

What should I expect after the procedure?

If you are awake for the surgery, you can probably hold your baby right away. You will be taken to a recovery room or directly to your room. Your blood pressure, pulse rate, breathing rate, amount of bleeding, and abdomen will be checked regularly. If you are planning on breastfeeding, be sure to let your doctor know. Having a cesarean delivery does not mean you will not be able to breastfeed your baby. You should be able to begin breastfeeding right away.

You may need to stay in bed for a while. The first few times you get out of bed, a nurse or other adult should help you.

Soon after surgery, the catheter is removed from the bladder. The abdominal incision will be sore for the first few days. Your doctor can prescribe pain medication for you to take after the anesthesia wears off. A heating pad may be helpful. There are many different ways to control pain. Talk with your ob-gyn or other health care professional about your options.

A hospital stay after a cesarean birth usually is 2–4 days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover. When you go home, you may need to take special care of yourself and limit your activities.

What should I expect during recovery?

While you recover, the following things may happen:

  • Mild cramping, especially if you are breastfeeding
  • Bleeding or discharge for about 4–6 weeks
  • Bleeding with clots and cramps
  • Pain in the incision

To prevent infection, for a few weeks after the cesarean birth you should not place anything in your vagina or have sex. Allow time to heal before doing any strenuous activity. Call your ob-gyn or other health care professional if you have a fever, heavy bleeding, or the pain gets worse.

Cesarean Birth Glossary of Terms

Breech Presentation: A situation in which a fetus’s buttocks or feet would be born first.

Cervix: The opening of the uterus at the top of the vagina.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Epidural Block: A type of regional anesthesia or analgesia in which pain medications are given through a tube placed in the space at the base of the spine.

Fetal Monitoring: Procedures used to evaluate the well-being of the fetus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Placenta: Tissue that provides nourishment to and takes away waste from the fetus.

Umbilical Cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Urethra: A tube-like structure through which urine flows from the bladder to the outside of the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Assisted Vaginal Delivery

What is assisted vaginal delivery?

Assisted vaginal delivery is vaginal delivery of a baby performed with the help of forceps or a vacuum device. It sometimes is called operative vaginal delivery.

What are the types of assisted vaginal delivery?

There are two types of assisted vaginal delivery: 1) forceps-assisted delivery and 2) vacuum-assisted delivery. The type of delivery that is done depends on many factors, including your obstetrician’s experience and your individual situation.

How common is assisted vaginal delivery?

Today, assisted vaginal delivery is done in about 3% of vaginal deliveries in the United States.

How is forceps-assisted delivery performed?

Forceps look like two large spoons. They are inserted into the vagina and placed around the baby’s head. The forceps are used to apply gentle traction to help guide the baby’s head out of the birth canal while you keep pushing.

How is vacuum-assisted delivery performed?

A vacuum device is a suction cup with a handle attached. The suction cup is placed in the vagina and applied to the top of the baby’s head. Gentle, well-controlled traction is used to help guide the baby out of the birth canal while you keep pushing.

Why might assisted vaginal delivery be done?

Some of the reasons why an assisted vaginal delivery may be done include the following:

  • There are concerns about the baby’s heart rate pattern during labor.
  • You have pushed for a long time, but the baby’s head has stopped moving down the birth canal.
  • You are very tired from a long labor.
  • A medical condition (such as heart disease) limits your ability to push safely and effectively.

What factors will be considered before choosing assisted vaginal delivery?

Before choosing this option, your obstetrician assesses a number of factors to ensure that the highest levels of safety are met. These factors include your baby’s estimated weight, where your baby is in the birth canal, and whether the size of your pelvis appears adequate for a vaginal delivery. Your cervix should be fully dilated, and the baby’s head should be engaged (this means that the baby’s head has dropped down into your pelvis).

What are the benefits of assisted vaginal delivery?

One of the main advantages of assisted vaginal delivery is that it avoids a cesarean delivery. Cesarean delivery is major surgery and has risks, such as heavy bleeding and infection. If you are planning to have more children, avoiding a cesarean delivery may help prevent some of the possible future complications of multiple cesarean deliveries. Recovery from a vaginal delivery generally is shorter than recovery from a cesarean delivery. Often, assisted vaginal delivery can be done more quickly than a cesarean delivery.

What are the risks for me if I have assisted vaginal delivery?

Both forceps-assisted delivery and vacuum-assisted delivery are associated with a small increased risk of injury to the tissues of the vagina, perineum, and anus. A very small number of women may have urinary or fecal incontinence as a result of these injuries. Incontinence may go away on its own, or treatment may be needed.

What are the risks for my baby if I have assisted vaginal delivery?

Although the overall rate of injury to the baby as a result of assisted vaginal delivery is low, there still is a risk of certain complications for the baby. These include injuries to the baby’s scalp, head, and eyes; bleeding inside the skull; and problems with the nerves located in the arm and face. There is no evidence that assisted vaginal delivery has any effect on a child’s development.

What are the chances of having a repeat assisted vaginal delivery in a future pregnancy?

If you have had one assisted vaginal delivery, you have an increased risk of having one in a subsequent pregnancy. However, chances are good that you will have a spontaneous vaginal delivery. Some of the factors that increase the risk of another assisted delivery include a long (more than 3 years) interval between pregnancies or a fetus that is estimated to be larger than average.

What can I expect after having an assisted vaginal delivery?

After an assisted vaginal delivery, you may have perineal pain and bruising. It may be hard to walk or sit for a time. If you have had a perineal tear, it may require repair with stitches. Minor tears may heal on their own without stitches. You likely will have a few weeks of swelling and pain as the perineum heals.

What can I do to help relieve pain and swelling after an assisted vaginal delivery?

To help ease pain and swelling after delivery, try the following tips:

  • Take an over-the-counter pain reliever. Ibuprofen is preferred if you are breastfeeding. Acetaminophen also is a good choice.
  • Apply an ice pack, cold pack, or cold gel pads to the area.
  • Sit in cool water that is just deep enough to cover your buttocks and hips (called a sitz bath).
  • Try putting a witch hazel pad on a sanitary napkin. Witch hazel, which has a cooling effect, is a liquid made from certain plants that are distilled in water. It is available over the counter.
  • Use a “peri-bottle” while using the bathroom and afterward. This is a squeeze bottle that sends a spray of warm water over your perineum. It can help you urinate with less pain and is a great alternative to using toilet paper for clean-up.
  • Ask your obstetrician or other member of your health care team about using a numbing spray or cream to ease pain. Some of these sprays are available over the counter without a prescription.
  • If sitting is uncomfortable, sit on a pillow. There also are special cushions that may be helpful.

Assisted Vaginal Delivery Glossary of Terms

Anus: The opening of the digestive tract through which bowel movements leave the body.

Assisted Vaginal Delivery: Vaginal delivery of a baby performed with the help of forceps or a vacuum device.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Forceps: Special instruments placed around the baby’s head to help guide it out of the birth canal during delivery.

Incontinence: Involuntary leakage of urine, feces, or gas.

Obstetrician: A physician who specializes in caring for women during pregnancy, labor, and the postpartum period.

Perineal Tear: A tear that occurs in the female perineum, usually as a result of childbirth. Perineal tears differ in severity.

Perineum: The area between the vagina and the anus.

Spontaneous Vaginal Delivery: A vaginal birth that occurs without assistance from forceps or a vacuum device.

Vacuum Device: A metal or plastic cup that is applied to the fetus’ head with suction to assist delivery.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vaginal Birth After Cesarean Delivery

What is a vaginal birth after cesarean delivery (VBAC)?

If you have had a previous cesarean delivery, you have two choices about how to give birth again:

  1. You can have a scheduled cesarean delivery
  2. You can give birth vaginally. This is called a VBAC.

What is a trial of labor after cesarean delivery (TOLAC)?

A TOLAC is the attempt to have a VBAC. If it is successful, TOLAC results in a vaginal birth. If it is not successful, you will need another cesarean delivery.

What are some of the benefits of a VBAC?

A successful VBAC has the following benefits:

  • No abdominal surgery
  • Shorter recovery period
  • Lower risk of infection
  • Less blood loss

Many women would like to have the experience of vaginal birth, and when successful, VBAC allows this to happen. For women planning to have more children, VBAC may help them avoid certain health problems linked to multiple cesarean deliveries. These problems can include bowel or bladder injury, hysterectomy, and problems with the placenta in future pregnancies. If you know that you want more children, this may figure into your decision.

What are the risks of a VBAC?

Some risks of a VBAC are infection, blood loss, and other complications. One rare but serious risk with VBAC is that the cesarean scar on the uterus may rupture (break open). Although a rupture of the uterus is rare, it is very serious and may harm both you and your fetus. If you are at high risk of rupture of the uterus, VBAC should not be tried.

Why is the type of uterine incision used in my previous cesarean delivery important?

After cesarean delivery, you will have a scar on your skin and a scar on your uterus. Some uterine scars are more likely than others to cause a rupture during VBAC. The type of scar depends on the type of cut in the uterus:

  1. Low transverse—A side-to-side cut made across the lower, thinner part of the uterus. This is the most common type of incision and carries the least chance of future rupture.
  2. Low vertical—An up-and-down cut made in the lower, thinner part of the uterus. This type of incision carries a higher risk of rupture than a low transverse incision.
  3. High vertical (also called “classical”)—An up-and-down cut made in the upper part of the uterus. This is sometimes done for very preterm cesarean deliveries. It has the highest risk of rupture.

How do I know what type of uterine incision I had with a past cesarean delivery?

You cannot tell what kind of cut was made in the uterus by looking at the scar on the skin. Medical records from the previous delivery should include this information. It is a good idea to get your medical records of your prior cesarean delivery so your obstetrician–gynecologist (ob-gyn) or other health care professional can review them.

Where can I have a VBAC?

VBAC should take place in a hospital that can manage situations that threaten the life of the woman or her fetus. Some hospitals may not offer VBAC because hospital staff do not feel they can provide this type of emergency care. You and your ob-gyn or other health care professional should consider the resources available at the hospital you have chosen.

Are there things that can happen during labor that may change my delivery plan?

If you have chosen to try a VBAC, things can happen that alter the balance of risks and benefits. For example, you may need to have your labor induced (started with drugs or other methods). This can reduce the chances of a successful vaginal delivery. Labor induction also may increase the chance of complications during labor. If circumstances change, you and your ob-gyn or other health care professional may want to reconsider your decision.

The reverse also may be true. For example, if you have planned a cesarean delivery but go into labor before your scheduled surgery, it may be best to consider VBAC if you are far enough along in your labor and your fetus is healthy.

Glossary of Terms for this Section

Cesarean Delivery: Delivery of a baby through surgical incisions made in the woman’s abdomen and uterus.

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Hysterectomy: Removal of the uterus.

Obstetrician–Gynecologist (Ob-Gyn): A physician who specializes in caring for women during pregnancy, labor, and the postpartum period.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Endometrial Ablation

What is endometrial ablation?

Endometrial ablation destroys a thin layer of the lining of the uterus. Menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be needed.

Why is endometrial ablation done?

Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used.

Who should not have endometrial ablation?

Endometrial ablation should not be done in women past menopause. It is not recommended for women with certain medical conditions, including the following:

  • Disorders of the uterus or endometrium
  • Endometrial hyperplasia
  • Cancer of the uterus
  • Recent pregnancy
  • Current or recent infection of the uterus

Can I still get pregnant after having endometrial ablation?

Pregnancy is not likely after ablation, but it can happen. If it does, the risks of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should use birth control until after menopause. Sterilization may be a good option to prevent pregnancy after ablation.

A woman who has had ablation still has all her reproductive organs. Routine cervical cancer screening and pelvic exams are still needed.

What techniques are used to perform endometrial ablation?

The following methods are those most commonly used to perform endometrial ablation:

  • Radiofrequency—A probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue, while suction is applied to remove it.
  • Freezing—A thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the procedure.
  • Heated fluid—Fluid is inserted into the uterus through a hysteroscope, a slender, light-transmitting device. The fluid is heated and stays in the uterus for about 10 minutes. The heat destroys the lining.
  • Heated balloon—A balloon is placed in the uterus with a hysteroscope.
  • Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium.
  • Microwave energy—A special probe is inserted into the uterus through the cervix. The probe applies microwave energy to the uterine lining, which destroys it.
  • Electrosurgery—Electrosurgery is done with a resectoscope. A resectoscope is a slender telescopic device that is inserted into the uterus. It has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia. It is not as frequently used as the other methods.

What should I expect after the procedure?

Some minor side effects are common after endometrial ablation:

  • Cramping, like menstrual cramps, for 1–2 days
  • Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2–3 days after the procedure.
  • Frequent urination for 24 hours
  • Nausea

What are the risks associated with endometrial ablation?

Endometrial ablation has certain risks. There is a small risk of infection and bleeding. The device used may pass through the uterine wall or bowel. With some methods, there is a risk of burns to the vagina, vulva, and bowel. Rarely, the fluid used to expand your uterus during electrosurgery may be absorbed into your bloodstream. This condition can be serious. To prevent this problem, the amount of fluid used is carefully checked throughout the procedure.

Endometrial Ablation Glossary of Terms

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick. A specific type of endometrial hyperplasia may lead to cancer.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for
12 months.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Sterilization: A permanent method of birth control.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vulva: The external female genital area.

Exercise During Pregnancy

Is it safe to exercise during pregnancy?

If you are healthy and your pregnancy is normal, it is safe to continue or start regular physical activity. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with your obstetrician or other member of your health care team during your early prenatal visits. If your health care professional gives you the OK to exercise, you can discuss what activities you can do safely

Are there certain conditions that make exercise during pregnancy unsafe?

Women with the following conditions or pregnancy complications should not exercise during pregnancy:

  • Certain types of heart and lung diseases
  • Cervical insufficiency or cerclage
  • Being pregnant with twins or triplets (or more) with risk factors for preterm labor
  • Placenta previa after 26 weeks of pregnancy
  • Preterm labor or ruptured membranes (your water has broken) during this pregnancy regular physical activity
  • Preeclampsia or pregnancy-induced high blood pressure
  • Severe anemia

What are the benefits of exercise during pregnancy?

Regular exercise during pregnancy benefits you and your fetus in these key ways:

  • Reduces back pain
  • Eases constipation
  • May decrease your risk of gestational diabetes, preeclampsia, and cesarean delivery
  • Promotes healthy weight gain during pregnancy
  • Improves your overall general fitness and strengthens your heart and blood vessels
  • Helps you to lose the baby weight after your baby is born

How much should I exercise during pregnancy?

Ideally, pregnant women should get at least 150 minutes of moderate-intensity aerobic activity every week. An aerobic activity is one in which you move large muscles of the body (like those in the legs and arms) in a rhythmic way. Moderate intensity means you are moving enough to raise your heart rate and start sweating. You still can talk normally, but you cannot sing.

Examples of moderate-intensity aerobic activity include brisk walking and general gardening (raking, weeding, or digging). You can divide the 150 minutes into 30-minute workouts on 5 days of the week or into smaller 10-minute workouts throughout each day.

If you are new to exercise, start out slowly and gradually increase your activity. Begin with as little as 5 minutes a day. Add 5 minutes each week until you can stay active for 30 minutes a day.

If you were very active before pregnancy, you can keep doing the same workouts with your obstetrician’s approval. However, if you start to lose weight, you may need to increase the number of calories that you eat.

What changes occur in the body during pregnancy that can affect my exercise routine?

Your body goes through many changes during pregnancy. It is important to choose exercises that take these changes into account:

  • Joints—The hormones made during pregnancy cause the ligaments that support your joints to become relaxed. This makes the joints more mobile and at risk of injury. Avoid jerky, bouncy, or high-impact motions that can increase your risk of being hurt.
  • Balance—The extra weight in the front of your body shifts your center of gravity. This places stress on joints and muscles, especially those in your pelvis and lower back. Because you are less stable and more likely to lose your balance, you are at greater risk of falling.
  • Breathing—When you exercise, oxygen and blood flow are directed to your muscles and away from other areas of your body. While you are pregnant, your need for oxygen increases. This may affect your ability to do strenuous exercise, especially if you are overweight or obese.

What precautions should I take when exercising during pregnancy?

There are a few precautions that pregnant women should keep in mind during exercise:

  • Drink plenty of water before, during, and after your workout. Signs of dehydration include dizziness, a racing or pounding heart, and urinating only small amounts or having urine that is dark yellow.
  • Wear a sports bra that gives lots of support to help protect your breasts. Later in pregnancy, a belly support belt may reduce discomfort while walking or running.
  • Avoid becoming overheated, especially in the first trimester. Drink plenty of water, wear loose-fitting clothing, and exercise in a temperature-controlled room. Do not exercise outside when it is very hot or humid.
  • Avoid standing still or lying flat on your back as much as possible. When you lie on your back, your uterus presses on a large vein that returns blood to the heart. Standing motionless can cause blood to pool in your legs and feet. These positions may cause your blood pressure to decrease for a short time.

What are some safe exercises I can do during pregnancy?

Experts agree these exercises are safest for pregnant women:

  • Walking—Brisk walking gives a total body workout and is easy on the joints and muscles.
  • Swimming and water workouts—Water workouts use many of the body’s muscles. The water supports your weight so you avoid injury and muscle strain.
  • Stationary bicycling—Because your growing belly can affect your balance and make you more prone to falls, riding a standard bicycle during pregnancy can be risky. Cycling on a stationary bike is a better choice.
  • Modified yoga and modified Pilates—Yoga reduces stress, improves flexibility, and encourages stretching and focused breathing. There are prenatal yoga and Pilates classes designed for pregnant women. These classes often teach modified poses that accommodate a pregnant woman’s shifting balance. You also should avoid poses that require you to be still or lie on your back for long periods.

If you are an experienced runner, jogger, or racquet-sports player, you may be able to keep doing these activities during pregnancy. Discuss these activities with your obstetrician or other member of your health care team.

What exercises should I avoid during pregnancy?

While pregnant, avoid activities that put you at increased risk of injury, such as the following:

  • Contact sports and sports that put you at risk of getting hit in the abdomen, including ice hockey, boxing, soccer, and basketball
  • Skydiving
  • Activities that may result in a fall, such as downhill snow skiing, water skiing, surfing, off-road cycling, gymnastics, and horseback riding
  • Hot yoga” or “hot Pilates,” which may cause you to become overheated
  • Scuba diving
  • Activities performed above 6,000 feet (if you do not already live at a high altitude)

What are warning signs that I should stop exercising?

Whether you’re a seasoned athlete or a beginner, watch for the following warning signs when you exercise. If you have any of them, stop and call your obstetrician:

  • Bleeding from the vagina
  • Feeling dizzy or faint
  • Shortness of breath before starting exercise
  • Chest pain
  • Headache
  • Muscle weakness
  • Calf pain or swelling
  • Regular, painful contractions of the uterus
  • Fluid gushing or leaking from the vagina

Why is it important to keep exercising after my baby is born?

Exercising after your baby is born may help improve mood and decreases the risk of deep vein thrombosis (DVT), a condition that can occur more frequently in women in the weeks after childbirth. In addition to these health benefits, exercise after pregnancy can help you lose the extra pounds that you may have gained during pregnancy

Exercise Glossary of Terms

Anemia: Abnormally low levels of red blood cells in the bloodstream. Most cases are caused by iron deficiency (lack of iron).

Cerclage: A procedure in which the cervical opening is closed with stitches to prevent or delay preterm birth.

Cervical Insufficiency: A condition in which the cervix is unable to hold a pregnancy in the second trimester.

Cesarean Delivery: Delivery of a fetus from the uterus through an incision made in the woman’s abdomen.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Dehydration: A condition that happens when the body does not have as much water as it needs.

Gestational Diabetes: Diabetes that starts during pregnancy.

Hormones: Substances made in the body that control the function of cells or organs.

Obstetrician: A doctor who cares for women during pregnancy and their labor.

Oxygen: An element that we breathe in to sustain life.

Placenta Previa: A condition in which the placenta covers the opening of the uterus.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Preterm: Less than 37 weeks of pregnancy.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

Medications for Pain Relief During Labor and Delivery

What types of medications for pain relief are used during labor and delivery?

In general, there are two types of drugs for pain relief: 1) analgesics and 2) anesthetics. Analgesics lessen pain without loss of feeling or muscle movement. Anesthetics relieve pain by blocking most feeling, including pain. Pain relief medications can be either systemic, regional, or local. Systemic medications affect the entire body. Local medications affect only a small area of the body. Regional medications affect a region of the body, like the region below the waist.

What is nitrous oxide?

Nitrous oxide is a tasteless and odorless gas used as a labor analgesic by some hospitals. It reduces anxiety and increases a feeling of well-being so that pain is easier to deal with. Nitrous oxide is mixed with oxygen and inhaled through a mask. A woman holds the mask herself and decides when she will inhale. It works best when a woman begins inhaling 30 seconds before the start of a contraction.

What are the side effects and risks of systemic analgesics?

Side effects are minor and include itching, nausea, vomiting, feeling drowsy, or having trouble concentrating. Opioids can affect your baby’s breathing and heart rate for a short time. Your baby may be drowsy, which can make it harder for your baby to breastfeed in the first few hours after birth. You may not be able to get systemic analgesics within the hour before delivery.

What are systemic analgesics?

Systemic analgesics reduce your awareness of pain and have a calming effect. The medications used are known as opioids. These drugs will not cause you to lose consciousness. Systemic analgesics usually are given as a shot or through an intravenous (IV) line. This is a small tube that is placed into a vein through which medications or fluids are given.

What are the side effects and risks of nitrous oxide?

Nitrous oxide is safe for the mother and the baby. Some women feel dizzy or nauseated while inhaling nitrous oxide, but these sensations go away within a few minutes

What is local anesthesia?

Local anesthesia is the use of drugs to prevent pain in a small area of the body. The anesthetic drug is injected into the area around the nerves that carry feeling to the vagina, vulva, and perineum. Local anesthetics provide relief from pain in these areas. The drug also is used when an episiotomy needs to be done or when tissues need to be repaired after childbirth. When used to relieve pain during childbirth, the drug is given just before delivery.

What are the side effects and risks of local anesthesia?

Rarely, a woman may have an allergic reaction to a local anesthetic or may have nerve or heart problems if the dose given is too high. Local anesthesia rarely affects the baby.

What are regional analgesia and regional anesthesia?

Regional analgesia and regional anesthesia are used to lessen or block pain below the waist. They include the epidural block, spinal block, and combined spinal–epidural (CSE) block. The medication includes an anesthetic that may be mixed with an opioid analgesic. The medication may be given as a single shot or through a thin tube placed in the lower back.

What is an epidural block?

An epidural block (sometimes referred to as “an epidural”) is the most common type of pain relief used for childbirth in the United States. In an epidural block, medication is given through a tube placed in the lower back. For labor and vaginal delivery, a combination of analgesics and anesthetics may be used. You will have some loss of feeling in the lower areas of your body, but you remain awake and alert. You should be able to bear down and push your baby through the birth canal. For a cesarean delivery, the dose of anesthetic may be increased. This causes loss of sensation in the lower half of your body. An epidural also can be used for postpartum sterilization.

Will I be able to move or feel anything after receiving an epidural?

You can move with an epidural, but you may not be able to walk. Although an epidural block will make you more comfortable, you still may be aware of your contractions. You also may feel vaginal exams as labor progresses.

What are the side effects of an epidural?

When opioids are used, itching is common. This itching can be treated with another medication. Other less common side effects related to opioids include nausea, vomiting, and breathing problems.

What are the risks of an epidural?

As with systemic analgesia, use of opioids in an epidural block increases the risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects are short term.

Less common side effects include the following:

  • Decrease in your blood pressure
  • Fever
  • Headache
  • Soreness

Serious complications with epidurals are very rare and include the following:

  • Injury to your spinal cord or nerves
  • Breathing problems if the anesthetic affects your breathing muscles
  • Numbness, tingling, or rapid heartbeat if the anesthetic is injected into a vein instead of a nerve

What is a spinal block?

A spinal block—like an epidural block—is a form of regional anesthesia. Medication is given as a single shot into the fluid around the spinal cord. It starts to relieve pain quickly, but it lasts for only an hour or two. A spinal block is commonly used for cesarean delivery. It has the same side effects and risks as an epidural block.

What is a combined spinal–epidural block?

A CSE block is another form of regional anesthesia. It has the benefits of a spinal block and an epidural block. The spinal part acts quickly to relieve pain. The epidural part provides continuous pain relief. Lower doses of medication can be used with a CSE block than with an epidural block for the same level of pain relief. It has the same side effects and risks as an epidural block.

Pregnancy Pain Medication Glossary of Terms

Analgesics: Drugs that relieve pain without loss of muscle function.

Anesthetics: Drugs that relieve pain by loss of sensation.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Combined Spinal–Epidural (CSE) Block: A form of regional anesthesia or analgesia in which pain medications are administered into the spinal fluid (spinal block) as well as through a thin tube into the epidural space (epidural block).

Epidural Block: A type of regional anesthesia or analgesia in which pain medications are given through a tube placed in the space at the base of the spine.

Episiotomy: A surgical incision made into the perineum (the region between the vagina and the anus) to widen the vaginal opening for delivery.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Nitrous Oxide: A gas with no odor that is commonly known as “laughing gas.” When people inhale this gas, they feel relaxed and calm.

Opioids: Medications that blunt how you perceive pain and your emotional response to it.

Perineum: The area between the vagina and the anus.

Postpartum Sterilization: A permanent procedure that prevents a woman from becoming pregnant, performed soon after the birth of a child.

Regional Analgesia: The use of drugs to relieve pain in a region of the body.

Regional Anesthesia: The use of drugs to block sensation in a region of the body.

Spinal Block: A type of regional anesthesia or analgesia in which pain medications are administered into the spinal fluid.

Systemic Analgesics: Drugs that provide pain relief over the entire body without causing loss of consciousness.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vulva: The external female genital area.

What are the risks of general anesthesia?

A rare but major risk is aspiration of food or liquids from a woman’s stomach into the lungs. If you have undigested food in your stomach, it can come back into the mouth and be inhaled while you are unconscious. This can cause a lung infection (pneumonia) that can be serious. General anesthesia usually requires the placement of a breathing tube into the lungs to help you breathe while you are unconscious. Difficulty placing this tube is another risk. General anesthesia can cause the newborn baby’s breathing rate to decrease. It also can make the baby less alert. In rare cases, the baby may need help breathing after birth.

What is general anesthesia?

With general anesthesia, you are not awake and you do not feel pain. It can be started quickly and usually is used only for emergency situations during childbirth. It is given through an IV line or through a mask. After you are asleep, your anesthesiologist will place a breathing tube into your mouth and windpipe.

Polycystic Ovary Syndrome (PCOS)

What are common signs and symptoms of polycystic ovary syndrome (PCOS)?

Common PCOS signs and symptoms include the following:

  • Irregular menstrual periods—Menstrual disorders can include absent periods, periods that occur infrequently or too frequently, heavy periods, or unpredictable periods.
  • Infertility—PCOS is one of the most common causes of female infertility.
  • Obesity—Up to 80% of women with PCOS are obese.
  • Excess hair growth on the face, chest, abdomen, or upper thighs—This condition, called hirsutism, affects more than 70% of women with PCOS.
  • Severe acne or acne that occurs after adolescence and does not respond to usual treatments
  • Oily skin
  • Patches of thickened, velvety, darkened skin called acanthosis nigricans
  • Multiple small fluid-filled sacs in the ovaries

What causes PCOS?

Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together. These factors include insulin resistance, increased levels of hormones called androgens, and an irregular menstrual cycle.

What is insulin resistance?

Insulin resistance is a condition in which the body’s cells do not respond to the effects of insulin. When the body does not respond to insulin, the level of glucose in the blood increases. This may cause more insulin to be produced as the body tries to move glucose into cells. Insulin resistance can lead to diabetes mellitus. It also is associated with acanthosis nigricans.

What can high levels of androgens lead to?

When higher than normal levels of androgens are produced, the ovaries may be prevented from releasing an egg each month (a process called ovulation). High androgen levels also cause the unwanted hair growth and acne seen in many women with PCOS.

What can irregular menstrual periods lead to?

Irregular menstrual periods can lead to infertility and, in some women, the development of numerous small fluid-filled sacs in the ovaries.

What are the health risks for women with PCOS?

PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.

Insulin resistance increases the risk of type 2 diabetes and cardiovascular disease. Another condition that is associated with PCOS is metabolic syndrome. This syndrome contributes to both diabetes and heart disease.

Women with PCOS also tend to have a condition called endometrial hyperplasia, in which the lining of the uterus becomes too thick. This condition increases the risk of endometrial cancer.

Are treatments available for women with PCOS?

A variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to become pregnant.

How can combined hormonal birth control pills be used to treat women with PCOS?

Combined hormonal birth control pills can be used for long-term treatment in women with PCOS who do not wish to become pregnant. Combined hormonal pills contain both estrogen and progestin. These birth control pills regulate the menstrual cycle and reduce hirsutism and acne by decreasing androgen levels. They also decrease the risk of endometrial cancer.

What effect can weight loss have on women with PCOS?

For overweight women, weight loss alone often regulates the menstrual cycle. Even a loss of 10–15 pounds can be helpful in making menstrual periods more regular. Weight loss also has been found to improve cholesterol and insulin levels and relieve symptoms such as excess hair growth and acne.

How can insulin-sensitizing drugs help treat women with PCOS?

Insulin-sensitizing drugs used to treat diabetes frequently are used in the treatment of PCOS. These drugs help the body respond to insulin. In women with PCOS, they can help decrease androgen levels and improve ovulation. Restoring ovulation helps make menstrual periods regular and more predictable.

What can be done to increase the chances of pregnancy for women with PCOS?

Successful ovulation is the first step toward pregnancy. For overweight women, weight loss often accomplishes this goal. Medications also may be used to cause ovulation. Surgery on the ovaries has been used when other treatments do not work. However, the long-term effects of these procedures are not clear.

PCOS Glossary of Terms

Acanthosis Nigricans: Patches of thickened, velvety, darkened skin associated with insulin resistance.

Androgens: Steroid hormones, produced by the adrenal glands or by the ovaries, that promote male characteristics, such as a beard and deepening voice.

Cardiovascular Disease: Disease of the heart and blood vessels.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cholesterol: A natural substance that serves as a building block for cells and hormones and helps to carry fat through the blood vessels for use or storage in other parts of the body.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick. A specific type of endometrial hyperplasia may lead to cancer.

Estrogen: A female hormone produced in the ovaries.

Glucose: A sugar that is present in the blood and is the body’s main source of fuel.

Hirsutism: Excessive hair on the face, abdomen, and chest.

Hormones: Substances made in the body by cells or organs that control the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Infertility: A condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control.

Insulin: A hormone that lowers the levels of glucose (sugar) in the blood.

Metabolic Syndrome: A combination of factors, including elevated blood pressure, waist circumference of 35 inches or greater (in women), higher-than-normal blood glucose level, lower-than- normal levels of “good” cholesterol, and high levels of fats in the blood (triglycerides), that contribute to diabetes and heart disease.

Ovaries: The paired organs in the female reproductive system that contain the eggs released at ovulation and produce hormones.

Ovulation: The release of an egg from one of the ovaries.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Heavy Menstrual Bleeding

How common is heavy menstrual bleeding?

Heavy menstrual bleeding is very common. About one third of women seek treatment for it. Heavy menstrual bleeding is not normal. It can disrupt your life and may be a sign of a more serious health problem. If you are worried that your menstrual bleeding is too heavy, tell your obstetrician–gynecologist (ob-gyn).

When is menstrual bleeding considered “heavy”?

Any of the following is considered to be heavy menstrual bleeding:

  • Bleeding that lasts more than 7 days.
  • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.
  • Needing to wear more than one pad at a time to control menstrual flow.
  • Needing to change pads or tampons during the night.
  • Menstrual flow with blood clots that are as big as a quarter or larger.

How can heavy menstrual bleeding affect my health?

Heavy menstrual bleeding may be a sign of an underlying health problem that needs treatment. Blood loss from heavy periods also can lead to a condition called iron-deficiency anemia. Severe anemia can cause shortness of breath and increase the risk of heart problems.

What causes heavy menstrual bleeding?

Many things can cause heavy menstrual bleeding. Some of the causes include the following:

  • Fibroids and polyps
  • Adenomyosis
  • Irregular ovulation—If you do not ovulate regularly, areas of the endometrium (the lining of the uterus) can become too thick. This condition is common during puberty and perimenopause. It also can occur in women with certain medical conditions, such as polycystic ovary syndrome and hypothyroidism.
  • Bleeding disorders—When the blood does not clot properly, it can cause heavy bleeding.
  • Medications—Blood thinners and aspirin can cause heavy menstrual bleeding. The copper intrauterine device (IUD) can cause heavier menstrual bleeding, especially during the first year of use.
  • Cancer—Heavy menstrual bleeding can be an early sign of endometrial cancer. Most cases of endometrial cancer are diagnosed in women in their mid 60s who are past menopause. It often is diagnosed at an early stage when treatment is the most effective.
  • Other causes—Endometriosis can cause heavy menstrual bleeding. Other causes include those related to pregnancy, such as ectopic pregnancy and miscarriage. Pelvic inflammatory disease also can cause heavy menstrual bleeding. Sometimes, the cause is not known.

How is heavy menstrual bleeding evaluated?

When you see your ob-gyn about heavy menstrual bleeding, you may be asked about the following things:

  • Past and present illnesses and surgical procedures
  • Pregnancy history
  • Medications, including those you buy over the counter
  • Your birth control method
  • Your menstrual cycle—If you can, use a calendar or period-tracking smartphone app to keep track of your menstrual cycle before your visit. Your ob-gyn will want to know detailed information about several menstrual cycles, including the dates that your period started, how long bleeding lasted, and the amount of flow (light, medium, heavy, or spotting).

What tests and exams may be used to evaluate heavy menstrual bleeding?

You will have a physical exam, including a pelvic exam. Several laboratory tests may be done. You may have a pregnancy test and tests for some sexually transmitted infections. Based on your symptoms and your age, additional tests may be needed:

  • Ultrasound exam—Sound waves are used to make a picture of the pelvic organs.
  • Hysteroscopy—A thin, lighted scope is inserted into the uterus through the opening of the cervix. It allows your ob-gyn to see the inside of the uterus.
  • Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope. Sometimes hysteroscopy is used to guide this test. A surgical procedure called dilation and curettage (D&C) is another way this test can be done.
  • Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the uterus.
  • Magnetic resonance imaging—This imaging test uses powerful magnets to create images of the internal organs.

Which medications can be used to treat heavy menstrual bleeding?

Medications often are tried first to treat heavy menstrual bleeding:

  • Heavy bleeding caused by problems with ovulation, endometriosis, polycystic ovary syndrome, and fibroids often can be managed with certain hormonal birth control methods. Depending on the type, these methods can lighten menstrual flow, help make periods more regular, or even stop bleeding completely.
  • Hormone therapy can be helpful for heavy menstrual bleeding that occurs during perimenopause. Before deciding to use hormone therapy, it is important to weigh the benefits and risks (increased risk of heart attack, stroke, and cancer).
  • Gonadotropin-releasing hormone (GnRH) agonists stop the menstrual cycle and reduce the size of fibroids. They are used only for short periods (less than 6 months). Their effect on fibroids is temporary. Once you stop taking the drug, fibroids usually return to their original size.
  • Tranexamic acid is a prescription medication that treats heavy menstrual bleeding. It comes in a tablet and is taken each month at the start of the menstrual period.
  • Nonsteroidal antiinflammatory drugs, such as ibuprofen, also may help control heavy bleeding and relieve menstrual cramps.
  • If you have a bleeding disorder, your treatment may include special medications to help your blood clot.

Which procedures can be used to treat heavy menstrual bleeding?

If medication does not reduce your bleeding, a surgical procedure may be needed:

  • Endometrial ablation destroys the lining of the uterus. It stops or reduces menstrual bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications is greatly increased. You will need to use a birth control method until after menopause following endometrial ablation. Sterilization (permanent birth control) may be a good option to prevent pregnancy for women having ablation. Endometrial ablation should be considered only after medication or other therapies have not worked.
  • Uterine artery embolization (UAE) is used to treat fibroids. In UAE, the blood vessels to the uterus are blocked, which stops the blood flow that allows fibroids to grow.
  • Myomectomy is surgery to remove fibroids without removing the uterus.
  • Hysteroscopy can be used to remove fibroids or stop bleeding caused by fibroids in some cases.
  • Hysterectomy is surgical removal of the uterus. Hysterectomy is used to treat fibroids and adenomyosis when other types of treatment have failed or are not an option. It also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.

Menstrual Bleeding Glossary of Terms

Adenomyosis: A condition in which the tissue that normally lines the uterus begins to grow in the muscle wall of the uterus.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Dilation and Curettage (D&C): A procedure in which the cervix is opened (dilated) and tissue is gently scraped (curettage) or suctioned from the inside of the uterus.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Endometrial Ablation: A minor surgical procedure in which the lining of the uterus is destroyed to stop or reduce menstrual bleeding.

Endometrial Cancer: Cancer of the lining of the uterus.

Endometrial Biopsy: A procedure in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Endometrium: The lining of the uterus.

Fibroids: Growths, usually benign, that form in the muscle of the uterus.

Gonadotropin-releasing Hormone (GnRH) Agonists: Medical therapy used to block the effects of certain hormones.

Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve some of the symptoms caused by low levels of these hormones.

Hypothyroidism: A condition in which the thyroid gland makes too little thyroid hormone.

Hysterectomy: Removal of the uterus.

Hysteroscopy: A procedure in which a device called a hysteroscope is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Iron-Deficiency Anemia: Abnormally low levels of iron, which is the part of the red blood cells that carries oxygen to the cells and tissues of the body.

Magnetic Resonance Imaging: A method of viewing internal organs and structures by using a strong magnetic field and sound waves.

Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for 1 year.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined from the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Miscarriage: Loss of a pregnancy that occurs in the first 13 weeks of pregnancy.

Myomectomy: Surgical removal of uterine fibroids only, leaving the uterus in place.

Nonsteroidal Antiinflammatory Drugs: A type of pain reliever that relieves pain by reducing inflammation. Many types are available over the counter.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Ovulation: The release of an egg from one of the ovaries.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Pelvic Inflammatory Disease: An infection of the uterus, fallopian tubes, and nearby pelvic structures.

Perimenopause: The period before menopause that usually extends from age 45 years to 55 years.

Polycystic Ovary Syndrome: A condition characterized by two of the following three features: the presence of growths called cysts on the ovaries, irregular menstrual periods, and an increase in the levels of certain hormones.

Polyps: Benign (noncancerous) growths that develop from tissue lining an organ, such as that lining the inside of the uterus.

Puberty: The stage of life when the reproductive organs become functional and secondary sex characteristics develop.

Sexually Transmitted Infections: Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus, herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Sonohysterography: A procedure in which sterile fluid is injected into the uterus through the cervix while ultrasound images are taken of the inside of the uterus.

Sterilization: A permanent method of birth control.

Tranexamic Acid: A medication prescribed to treat or prevent heavy bleeding.

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterine Artery Embolization (UAE): A procedure in which the blood vessels to the uterus are blocked. It is used to treat postpartum hemorrhage and other problems that cause uterine bleeding.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Breastfeeding

How long should I breastfeed my baby?

Exclusive breastfeeding is recommended for the first 6 months of a baby’s life. Breastfeeding should continue up to the baby’s first birthday as new foods are introduced. You can keep breastfeeding after the baby’s first birthday for as long as you and your baby would like.

How soon should I start breastfeeding after childbirth?

Most healthy newborns are ready to breastfeed within the first hour after birth. Holding your baby directly against your bare skin (called “skin-to-skin” contact) right after birth helps encourage him or her to start breastfeeding.

You also should ask about “rooming in,” which means having your baby stay in your room with you instead of in the hospital nursery. Having your baby nearby makes it easier to breastfeed while you are still in the hospital.

How does breastfeeding benefit me?

Breastfeeding is good for you for the following reasons:

  • Breastfeeding triggers the release of a hormone called oxytocin that causes the uterus to contract. This helps the uterus return to its normal size more quickly and may decrease the amount of bleeding you have after giving birth.
  • Breastfeeding may make it easier to lose the weight you gained during pregnancy.
  • Breastfeeding may reduce the risk of breast cancer and ovarian cancer.

How does breastfeeding benefit my baby?

Breastfeeding is best for your baby for the following reasons:

  • Breast milk has the right amount of fat, sugar, water, protein, and minerals needed for a baby’s growth and development. As your baby grows, your breast milk changes to adapt to the baby’s changing nutritional needs.
  • Breast milk is easier to digest than formula.
  • Breast milk contains antibodies that protect infants from certain illnesses, such as ear infections, diarrhea, respiratory illnesses, and allergies. The longer your baby breastfeeds, the greater the health benefits.
  • Breastfed infants have a lower risk of sudden infant death syndrome (SIDS).
  • Breast milk can help reduce the risk of many of the short-term and long-term health problems that preterm babies face.

How do I get my baby to latch on to my breast?

Holding your baby directly against your bare skin right after birth triggers reflexes that help the baby to attach or “latch on” to your breast. Cup your breast in your hand and stroke your baby’s lower lip with your nipple. The baby will open his or her mouth wide, like a yawn. Pull the baby close to you, aiming the nipple toward the roof of the baby’s mouth. Remember to bring your baby to your breast—not your breast to your baby.

How can I tell if my baby is hungry?

When babies are hungry, they look alert, bend their arms, close their fists, and bring their fingers to their mouths. Offer your baby your breast when he or she first starts bringing fingers to his or her mouth. Crying is a late sign of hunger, and an unhappy baby will find it harder to latch. When full, babies relax their arms and legs and close their eyes.

How often should I breastfeed my baby?

Let your baby set his or her own schedule. During the first weeks of life, most babies feed at least 8–12 times in 24 hours, or at least every 2–3 hours (timed from the start time of one feeding to the start time of the next feeding). Many newborns breastfeed for 10–15 minutes on each breast. But they also can nurse for much longer periods (sometimes 60–120 minutes at a time) or feed very frequently (every 30 minutes, which is called “cluster feeding”). Some babies feed from one breast per feeding, while others feed from both breasts. When your baby releases one breast, offer the other. If your baby is not interested, plan to start on the other side for the next feeding.

What should I do if I am having trouble breastfeeding?

Breastfeeding is a natural process, but it can take some time for you and your baby to learn. Most women are able to breastfeed. A few women cannot breastfeed because of medical conditions or other problems.

Lots of breastfeeding help is available. Peer counselors, nurses, doctors, and certified lactation consultants can teach you what you need to know to get started. They also can give advice if you run into challenges.

What kinds of foods should I eat while breastfeeding?

The following tips will help you meet the nutritional goals needed for breastfeeding:

  • Your body needs about 450–500 extra calories a day to make breast milk for your baby. If your weight is in the normal range, you need about 2,500 total calories per day.
  • Eat fish and seafood 2–3 times a week, but avoid eating fish with high mercury levels. Do not eat shark, swordfish, king mackerel, or tilefish, and limit albacore tuna to 6 ounces a week. If you eat fish caught in local waters, check for advisories about mercury or other pollutants. If no information is available, limit your intake of such fish to 6 ounces a week, and do not eat any other fish that week.
  • Your health care professional may recommend that you continue to take your prenatal multivitamin supplement while you are breastfeeding.
  • Drink plenty of fluids, and drink more if your urine is dark yellow.

Can I drink caffeine while breastfeeding?

Drinking caffeine in moderate amounts (200 mg a day) most likely will not affect your baby. Newborns and preterm infants are more sensitive to caffeine’s effects. You may want to consume a lower amount of caffeine in the first few days after your baby is born or if your infant is preterm.

Can I drink alcohol while breastfeeding?

If you want to have an occasional alcoholic drink, wait at least 2 hours after a single drink to breastfeed. The alcohol will leave your milk as it leaves your bloodstream—there is no need to express and discard your milk. Drinking more than two drinks per day on a regular basis may be harmful to your baby and may cause drowsiness, weakness, and abnormal weight gain.

How do I know if a medication is safe to take while breastfeeding?

Most medications are safe to take while breastfeeding. Although medications can be passed to your baby in breast milk, levels are usually much lower than the level in your bloodstream. The latest information about medications and their effects on breastfed babies can be found at LactMed, a database of scientific information, at www.toxnet.nlm.nih.gov/newtoxnet/lactmed.htm. If you are breastfeeding and need to take a prescription medication to manage a health condition, discuss this with your health care team and the health care professional caring for your baby.

Why is it important to avoid smoking and drug use while breastfeeding?

Secondhand smoke from cigarettes is harmful to infants and children. It increases the risk of allergies, asthma, and SIDS. Smoking can decrease your milk supply and can make it harder for the baby to gain weight. Be sure not to smoke around the baby.

Using illegal drugs, such as cocaine, heroin, and methamphetamines, and taking prescription drugs for nonmedical reasons can harm your baby if you use them while breastfeeding. And although marijuana is now legal in several states, its use is discouraged during breastfeeding. If you need help stopping drug use, talk with your obstetrician, lactation consultant, or other health care professional.

What birth control methods can I use while breastfeeding?

Many birth control methods are available that can be used while breastfeeding, including nonhormonal methods (copper intrauterine device (IUD), condoms, and diaphragms) and hormonal methods. There are some concerns that hormonal methods of birth control can affect milk supply, especially when you first start breastfeeding. If you start using a hormonal method and your milk supply decreases, talk with your obstetrician or other member of your health care team about other options for preventing pregnancy.

Breastfeeding Glossary of Terms

Antibodies: Proteins in the blood that the body makes in reaction to foreign substances, such as bacteria and viruses.

Exclusive Breastfeeding: Feeding a baby only breast milk and no other foods or liquids, unless advised by the baby’s doctor.

Hormone: A substance made in the body that controls the function of cells or organs.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Oxytocin: A hormone made in the body that can cause contractions of the uterus and release of milk from the breast.

Preterm: Less than 37 weeks of pregnancy.

Sudden Infant Death Syndrome (SIDS): The unexpected death of an infant in which the cause is unknown.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

Newborn Male Circumcision

What is male circumcision?

Male circumcision is the surgical removal of the foreskin, which is the layer of skin that covers the head of the penis.

Who performs circumcisions?

The procedure may be done by your obstetrician–gynecologist (ob-gyn) or by a pediatrician, a physician who takes care of the health of children. In some cases, a circumcision may be done in a nonmedical setting for religious or cultural reasons. If this is the case, the person doing the circumcision should be well trained in how to do the procedure, how to relieve pain, and how to prevent infection.

What pain medication is used for circumcision?

Analgesia is safe and effective in reducing the pain associated with newborn circumcision. Before the procedure, you should ask what type of pain relief will be used.

How is circumcision performed?

Circumcision takes only a few minutes. During the procedure, the baby is placed on a special table. Various surgical techniques are used, but they follow the same steps:

  • The penis and foreskin are cleaned.
  • A special clamp is attached to the penis and the foreskin is cut and removed.
  • After the procedure, gauze with petroleum jelly is placed over the wound to protect it from rubbing against the diaper.

When is circumcision performed?

Circumcision may be performed before or after the mother and baby leave the hospital. It is performed only if the baby is healthy. If the baby has a medical condition, circumcision may be postponed.

Is circumcision a required procedure?

It is your choice whether to have your son circumcised. It is not required by law or by hospital policy. Because circumcision is an elective procedure, it may not be covered by your health insurance policy. To find out if your policy covers the procedure, call your health insurance provider.

Why do some parents choose to have their infant sons circumcised?

One reason why parents circumcise their newborn sons is for health benefits, such as decreased risk of urinary tract infection during the first year of life and decreased risk of sexually transmitted infections (STIs) later in life. Others may choose circumcision so that the child does not look different from his father or other boys. For some people, circumcision is a part of cultural or religious practices. Muslims and Jews, for example, have circumcised their male newborns for centuries.

Why do some parents choose not to have their infant sons circumcised?

Some parents choose not to circumcise their sons because they are worried about the pain the baby feels or the risks involved. Others believe it is a decision a boy should make himself when he is older. However, recovery may take longer when circumcision is done on an older child or adult. The risk of complications also is increased when circumcision is done later.

What are the health benefits associated with circumcision?

Circumcision reduces the bacteria that can live under the foreskin. This includes bacteria that can cause urinary tract infections or, in adults, STIs. Circumcised infants appear to have less risk of urinary tract infections than uncircumcised infants during the first year of life. Some research shows that circumcision may decrease the risk of a man getting human immunodeficiency virus (HIV) from an infected female partner. More research is needed in this area.

After studying scientific evidence, the American Academy of Pediatrics (AAP) found that the health benefits of circumcision in newborn boys outweigh the risks of the procedure. But the AAP also found the benefits are not great enough to recommend that all newborn boys be circumcised.

Are there risks associated with circumcision?

All surgical procedures carry some risk. Complications from a circumcision are rare, but they can occur. When they do occur, they usually are minor. Possible complications include bleeding, infection, or scarring. In rare cases, too much of the foreskin or not enough foreskin is removed. Complications generally are less likely if the circumcision is done by someone well trained in the procedure. It also is less likely for complications to arise if the circumcision is done in a medical setting.

Some parents also may worry that circumcision harms a man’s sexual function, sensitivity, or satisfaction. However, current evidence shows that it does not.

When should circumcision not be done?

Circumcision should only be done when the newborn is stable and healthy. Reasons to delay circumcision include the following:

  • The baby is born very early
  • The baby has certain problems with his blood or a family history of bleeding disorders
  • The baby has certain congenital abnormalities

How should I care for my circumcised son?

If you choose to have your baby boy circumcised, you will need to care for his penis as it heals. With each diaper change, the penis should be cleaned and petroleum jelly placed over the wound. The jelly can be placed on a gauze pad and applied directly on the penis or placed on the diaper in the area the penis touches. In most cases, the skin will heal in 7–10 days. You may notice that the tip of the penis is red and there may be a small amount of yellow fluid. This usually is a normal sign of healing.

How do I keep the circumcised area clean?

Use a mild soap to gently wash the penis. Remove any stool with soap and water during diaper changes. Change diapers often so that urine and stool do not cause infection. Signs of infection include redness that does not go away, swelling, or fluid that looks cloudy and forms a crust. Call your health care professional right away if you notice any of these signs.

How should I care for my uncircumcised son?

If your baby boy is not circumcised, wash the outside of the penis with a mild soap and water. Do not attempt to pull back the infant’s foreskin. The foreskin may not be able to pull back completely until he is older. This is normal. Your child’s pediatrician will tell you when it is ready to be pulled back and cleaned.

As your child gets older, teach your son how to wash his penis. When he is old enough, he should gently pull back the foreskin and clean the area with soap and water. The foreskin then should be pushed back into place.

What should I consider when making a decision about circumcision?

It is important to have all of the information about the possible benefits and risks of the procedure before making a decision. You may think about future health benefits, religious or cultural beliefs, and personal preferences or social concerns. Remember, circumcision is elective—it is your choice whether to have it done. If you have any questions or concerns, talk with your ob-gyn or other health care professional during your pregnancy so you have enough time to make an informed decision.

Cicumcision Glossary of Terms

Analgesia: Relief of pain without loss of muscle function.

Bacteria: One-celled organisms that can cause infections in the human body.

Circumcision: The surgical removal of a fold of skin called the foreskin that covers the glans (head) of the penis.

Complications: Diseases or conditions that occur as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Elective Procedure: A planned, nonemergency procedure that is chosen by a patient or health care professional. The procedure is seen as positive for the patient but not absolutely necessary.

Foreskin: A layer of skin covering the end of the penis.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Penis: An external male sex organ.

Sexually Transmitted Infection (STI): An infection that is spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Postpartum Sterilization

What is sterilization?

Sterilization is a permanent method of birth control. Sterilization for women is called tubal sterilization. In tubal sterilization, the fallopian tubes are closed off or removed. Tubal sterilization prevents the egg from moving down the fallopian tube to the uterus and keeps the sperm from reaching the egg

What is postpartum sterilization?

Postpartum sterilization is sterilization performed after the birth of a baby. After a woman gives birth, the fallopian tubes and the still-enlarged uterus are located just under the abdominal wall below the navel. Postpartum sterilization ideally is done before the uterus returns to its normal location, usually within a few hours or days following delivery. For women who have had a cesarean delivery, it is done right after the baby is born.

How is postpartum sterilization performed?

For women who have had a vaginal delivery, a small incision is made in the abdomen (a procedure called minilaparotomy). For women who have had a cesarean delivery, postpartum sterilization can be done through the same abdominal incision that was made for delivery of the baby. The fallopian tubes are brought up through the incision. The tubes are cut and closed with special thread or removed completely. The incision below the navel is closed with stitches and a bandage.

What kind of anesthesia is used for postpartum sterilization?

Often, the type of anesthesia used for the delivery can be used for postpartum sterilization. Types of anesthesia used include regional anesthesia, general anesthesia, or local anesthesia.

How long does postpartum sterilization take?

The operation takes about 30 minutes. Having it done soon after childbirth usually does not make your hospital stay any longer.

Are there risks associated with postpartum sterilization?

In general, sterilization is a safe form of birth control. It has a low risk of death and complications. The most common complications are those that are related to general anesthesia. Other risks include bleeding and infection.

What are the side effects of postpartum sterilization?

Side effects after surgery vary and may depend on the type of anesthesia used and the way the surgery is performed. You likely will have some pain in your abdomen and feel tired. The following side effects also can occur but are not as common:

  • Dizziness
  • Nausea
  • Shoulder pain
  • Abdominal cramps
  • Gassy or bloated feeling
  • Sore throat (from the breathing tube if general anesthesia was used)

If you have abdominal pain that does not go away after a few days, if pain is severe, or if you have a fever, contact your health care provider right away.

When should sterilization be avoided?

You should avoid making this choice during times of stress (such as during a divorce). You also should not make this choice under pressure from a partner or others. Research shows that women younger than 30 years are more likely than older women to regret having the procedure. If there are serious problems or complications with the baby, you may want to think about postponing postpartum sterilization.

What if I decide I want to become pregnant after sterilization?

If you choose to have sterilization and you change your mind after the operation, attempts to reverse it may not work. After tubal sterilization is reversed, many women still are not able to get pregnant. Also, the risk of problems, such as ectopic pregnancy, is increased.

What are some alternatives to postpartum sterilization?

Long-acting reversible contraception, such as the intrauterine device or implant, last for several years. They are about as effective at preventing pregnancy as sterilization. They can be removed at any time if you want to become pregnant.

Sterilization Glossary of Terms

Anesthesia: Relief of pain by loss of sensation.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Minilaparotomy: A small abdominal incision used for a sterilization procedure, in which the fallopian tubes are closed off.

Postpartum Sterilization: A permanent procedure that prevents a woman from becoming pregnant, performed soon after the birth of a child.

Regional Anesthesia: The use of drugs to block sensation in certain areas of the body.

Postpartum Birth Control

Why is postpartum birth control recommended?

If you are not using a birth control method, it is possible to become pregnant very soon after having a baby. Using a birth control method in the weeks after you have a baby (the postpartum period) helps you avoid an unintended pregnancy.

What is the progestin-only pill?

Progestin-only birth control pills contain just progestin. They work mainly by preventing fertilization of the egg by the sperm. They must be taken at the exact same time each day. If you miss a pill by more than 3 hours, you will need to use a back-up method for the next 48 hours.

What are the possible risks and side effects of combined hormonal methods?

  • During the postpartum period, women have a higher risk of developing blood clots in veins located deep in the body. This condition is called deep vein thrombosis (DVT). Combined hormonal methods increase the risk of DVT even further. If you have no additional risk factors for DVT, you can start using these methods 3 weeks after childbirth.
  • There is a very small risk that the estrogen in these methods can affect your milk supply if you are breastfeeding. You should avoid these methods for the first 4–6 weeks after childbirth, until breastfeeding is established.
  • Combined hormonal methods have been linked to a small risk of stroke and heart attacks. They are not recommended if you are older than 35 years and smoke; have high blood pressure or a history of stroke, heart attack, or DVT; have a history of migraine headaches with aura; have certain medical conditions; or have breast cancer or a history of breast cancer.
  • Side effects may include breakthrough bleeding, headaches, breast tenderness, and nausea.

What are the benefits of combined hormonal methods?

These methods do not interfere with sex. They may make your period more regular, lighter, and shorter. These methods may also reduce cramps, improve acne, reduce menstrual migraine frequency, and reduce unwanted hair growth.

What are combined hormonal methods?

Birth control pills, the vaginal ring, and the patch are birth control methods that contain estrogen and progestin. They work mainly by preventing ovulation. Depending on the method, you need to remember to do one of the following: take a pill each day, insert a vaginal ring every 21 days, or apply a skin patch every week for 3 weeks.

What are the possible risks and side effects of an injection?

  • Bone loss may occur with use of the injection. When injections are stopped, some, if not all, of the bone that was lost is gained back.
  • An injection should not be used if you have multiple risk factors for cardiovascular disease.
  • An injection may cause irregular bleeding, headaches, or slight weight gain.

What are the benefits of an injection?

An injection does not interfere with sex. Almost all women are able to use the injection.

What is a birth control injection?

The birth control injection contains a type of progestin called depot medroxyprogesterone acetate (DMPA). It works by preventing ovulation. Your ob-gyn or other health care professional will give you a shot of DMPA in your arm or buttock every 3 months. You can get your first shot right after a vaginal or cesarean delivery.

What are the possible risks and side effects of an implant?

The implant may cause unpredictable bleeding. Your periods may be heavier, lighter, or longer. Some users experience infrequent periods or bleeding in between periods. Other common side effects include mood changes, headaches, acne, and depression.

What are the benefits of an implant?

The implant does not interfere with sex or daily activities. Once it is inserted, you do not have to do anything else to prevent pregnancy. Almost all women are able to use the implant.

What is a birth control implant?

The birth control implant is a single flexible rod about the size of a matchstick that your ob-gyn or other health care professional inserts under the skin in your upper arm. You can have the implant inserted immediately after a vaginal or cesarean delivery. It releases progestin into the body and is approved for up to 3 years of use.

What are the possible risks and side effects of an intrauterine device?

  • The IUD may come out of the uterus. This happens in about 5% of users in the first year of using the IUD. Serious complications from using an IUD, such as infection or injury, are rare.
  • The hormonal IUD may cause spotting and irregular bleeding in the first 3–6 months of use. Other side effects include headaches, nausea, depression, and breast tenderness.
  • The copper IUD may increase menstrual pain and bleeding or cause bleeding between periods, mainly in the first few months of use. This usually decreases within 1 year of use.

What are the benefits of an intrauterine device?

IUDs do not interfere with sex or daily activities. Once inserted, you do not have to do anything else to prevent pregnancy. The hormonal IUD may decrease menstrual pain and heavy menstrual bleeding.

What is an intrauterine device?

The intrauterine device (IUD) is a small, T-shaped device that your obstetrician–gynecologist (ob-gyn) or other health care professional inserts into your uterus. IUDs usually can be inserted right after a vaginal or cesarean delivery or at your first postpartum health care visit. The hormonal IUD releases a small amount of progestin into the uterus and is approved for up to 3-5 years of use, depending on the kind you get. The copper IUD releases a small amount of copper into the uterus and is approved for up to 10 years of use. Both work mainly by stopping the egg and sperm from joining (fertilization).

How do I choose a postpartum birth control method?

When choosing a birth control method to use after you have a baby, think about the following:

  • Timing—Some birth control methods can be started right after childbirth. With other methods, you need to wait a few weeks to start.
  • Breastfeeding—All methods are safe to use while breastfeeding. However, there are a few methods that are not recom-mended during the first weeks of breastfeeding because there is a very small risk that they can affect your milk supply.
  • Effectiveness—The method you used before pregnancy may not be the best choice to use after pregnancy. For example, the sponge and cervical cap are much less effective in women who have given birth.

What are the benefits of the progestin-only pill?

Progestin-only pills do not interfere with sex. They may reduce menstrual bleeding or stop your period altogether.

What are the possible risks and side effects of the progestin-only pill?

Side effects include headaches, nausea, and breast tenderness. Progestin-only pills should not be used if you have breast cancer or a history of breast cancer. They are not recommended if you have certain medical conditions.

What is the barrier method?

Barrier methods include spermicide, male and female condoms, the diaphragm, the cervical cap, and the sponge. Barrier methods work by preventing the man’s sperm from reaching the woman’s egg. The cervical cap, diaphragm, and sponge can be used starting 6 weeks after childbirth, when the uterus and cervix have returned to normal size. If you used a diaphragm or cervical cap before childbirth, you should be refitted after childbirth.

What are the benefits of the barrier method?

Condoms are the only birth control method that protect against sexually transmitted infections (STIs). Condoms, spermicide, and the sponge can be bought over the counter. Barrier methods have no effect on a woman’s natural hormones.

What are the possible risks and side effects of the barrier method?

Spermicides can cause vaginal burning and irritation. Some people are allergic to spermicide and may have a reaction. Frequent use of spermicides (such as every day) can increase the risk of getting human immunodeficiency virus (HIV) from an infected partner.

What is the lactational amenorrhea method?

Lactational amenorrhea method (LAM) is a temporary method of birth control based on the natural way the body prevents ovulation when a woman is breastfeeding. It requires exclusive, frequent breastfeeding. The time between feedings should not be longer than 4 hours during the day or 6 hours at night. LAM may not be practical for many women.

What are the benefits of the lactational amenorrhea method?

It is a natural form of birth control. It does not cost anything.

What are the possible risks and side effects of the lactational amenorrhea method?

There are no health risks or side effects to using LAM. This method can be used for only 6 months after childbirth or until your period returns. It is unclear whether pumping breast milk decreases the effectiveness of LAM.

What is sterilization?

Sterilization is permanent birth control. In women, sterilization is performed by closing off or removing the fallopian tubes. It can be performed soon after delivery while you are still in the hospital, several weeks after you have your baby, or several months after childbirth. For men, vasectomy is an option. It takes about 2–4 months for the semen to become totally free of sperm after a vasectomy. A couple must use another method of birth control or avoid sexual intercourse until a sperm count confirms that no sperm are present.

What are the benefits of sterilization?

Sterilization is permanent. Once you have it done, you do not need to use any other birth control method.

Postpartum Birth Control Glossary of Terms

Aura: A sensation or feeling, such as flashing lights, a particular smell, dizziness, or seeing spots, experienced just before the onset of certain disorders like migraine attacks or epileptic seizures.

Bone Loss: The gradual loss of calcium and protein from bone, making it brittle and more likely to fracture.

Breakthrough Bleeding: Vaginal bleeding at a time other than the menstrual period.

Cardiovascular Disease: Disease of the heart and blood vessels.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the woman’s abdomen and uterus.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Estrogen: A female hormone produced in the ovaries.

Fertilization: Joining of the egg and sperm.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Lactational Amenorrhea Method (LAM): A temporary method of birth control that is based on the natural way the body prevents ovulation when a woman is breastfeeding.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Ovulation: The release of an egg from one of the ovaries.

Postpartum: A term that generally refers to the first weeks or months after pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Sexually Transmitted Infection (STI): An infection that is spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Semen: The fluid made by male sex glands that contains sperm.

Vasectomy: A method of male sterilization in which a portion of the vas deferens is removed.

What are the possible risks and side effects of sterilization?

There is a small risk of infection and bleeding with female and male sterilization. You should be sure that you no longer want to become pregnant again in the future. If you change your mind later, attempts to reverse it are not guaranteed to work.

Postpartum Depression

What are the postpartum blues?

About 2–3 days after childbirth, some women begin to feel depressed, anxious, and upset. They may feel angry with the new baby, their partners, or their other children. They also may

  • cry for no clear reason
  • have trouble sleeping, eating, and making choices
  • question whether they can handle caring for a baby

These feelings, often called the postpartum blues, may come and go in the first few days after childbirth.

When does postpartum depression occur?

Postpartum depression can occur up to 1 year after having a baby, but it most commonly starts about 1–3 weeks after childbirth.

What is postpartum depression?

Women with postpartum depression have intense feelings of sadness, anxiety, or despair that prevent them from being able to do their daily tasks.

How long do the postpartum blues usually last?

The postpartum blues usually get better within a few days or 1–2 weeks without any treatment.

What causes postpartum depression?

Postpartum depression probably is caused by a combination of factors. These factors include the following:

  • Changes in hormone levels—Levels of estrogen and progesterone decrease sharply in the hours after childbirth. These changes may trigger depression in the same way that smaller changes in hormone levels trigger mood swings and tension before menstrual periods.
  • History of depression—Women who have had depression at any time—before, during, or after pregnancy—or who currently are being treated for depression have an increased risk of developing postpartum depression.
  • Emotional factors—Feelings of doubt about pregnancy are common. If the pregnancy is not planned or is not wanted, this can affect the way a woman feels about her pregnancy and her unborn baby. Even when a pregnancy is planned, it can take a long time to adjust to the idea of having a new baby. Parents of babies who are sick or who need to stay in the hospital may feel sad, angry, or guilty. These emotions can affect a woman’s self-esteem and how she deals with stress.
  • Fatigue—Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength and energy. For women who have had their babies by cesarean birth, it may take even longer.
  • Lifestyle factors—Lack of support from others and stressful life events, such as a recent death of a loved one, a family illness, or moving to a new city, can greatly increase the risk of postpartum depression.

If I think I have postpartum depression, when should I see my health care provider?

If you think you may have postpartum depression, or if your partner or family members are concerned that you do, it is important to see your health care provider as soon as possible. Do not wait until your postpartum checkup.

How is postpartum depression treated?

Postpartum depression can be treated with medications called antidepressants. Talk therapy also is used to treat depression, often in combination with medications.

What are antidepressants?

Antidepressants are medications that work to balance the chemicals in the brain that control moods. There are many types of antidepressants. Drugs sometimes are combined when needed to get the best results. It may take 3–4 weeks of taking the medication before you start to feel better.

Can antidepressants cause side effects?

Antidepressants can cause side effects, but most are temporary and go away after a short time. If you have severe or unusual side effects that get in the way of your normal daily habits, notify your health care provider. You may need to try another type of antidepressant. If your depression worsens soon after starting medication or if you have thoughts of hurting yourself or others, contact your health care provider or emergency medical services right away.

Can antidepressants be passed to my baby through my breast milk?

If a woman takes antidepressants, they can be transferred to her baby during breastfeeding. The levels found in breast milk generally are very low. Breastfeeding has many benefits for both you and your baby. Deciding to take an antidepressant while breastfeeding involves weighing these benefits against the potential risks of your baby being exposed to the medication in your breast milk. It is best to discuss this decision with your health care provider.

What happens in talk therapy?

In talk therapy (also called psychotherapy), you and a mental health professional talk about your feelings and discuss how to manage them. Sometimes, therapy is needed for only a few weeks, but it may be needed for a few months or longer.

What are the types of talk therapy?

You may have one-on-one therapy with just you and the therapist or group therapy where you meet with a therapist and other people with problems similar to yours. Another option is family or couples therapy, in which you and your family members or your partner may work with a therapist.

What can be done to help prevent postpartum depression in women with a history of depression?

If you have a history of depression at any time in your life or if you are taking an antidepressant, tell your health care provider early in your prenatal care. Ideally, you should tell your health care provider before you become pregnant. Your health care provider may suggest that you begin treatment right after you give birth to prevent postpartum depression. If you were taking antidepressants before pregnancy, your health care provider can assess your situation and help you decide whether to continue taking medication during your pregnancy.

What support is available to help me cope with postpartum depression?

Support groups can be found at local hospitals, family planning clinics, or community centers. The hospital where you gave birth or your health care provider may be able to assist you in finding a support group. Useful information about postpartum depression can be found on the following web sites:

Postpartum Depression Glossary of Terms

Antidepressants: Medications that are used to treat depression.

Cesarean Birth: Birth of a baby through surgical incisions made in the mother’s abdomen and uterus.

Estrogen: A female hormone produced in the ovaries.

Hormone: A substance made in the body by cells or organs that controls the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Postpartum Blues: Feelings of sadness, fear, anger, or anxiety occurring about 3 days after childbirth and usually ending within 1–2 weeks.

Postpartum Depression: Intense feelings of sadness, anxiety, or despair after childbirth that interfere with a new mother’s ability to function and that do not go away after 2 weeks.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Menopause

What is menopause?

Menopause is the time in your life when you naturally stop having menstrual periods. Menopause happens when the ovaries stop making estrogen. Estrogen is a hormone that helps control the menstrual cycle. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years.

Besides menstrual cycle changes, what other signs and symptoms can occur during perimenopause?

Some women do not have any symptoms of perimenopause or have only a few mild symptoms. Others have many symptoms that can be severe. Common signs and symptoms include the following:

  • Hot flashes—A hot flash is a sudden feeling of heat that rushes to the upper body and face. A hot flash may last from a few seconds to several minutes or longer. Some women have hot flashes a few times a month. Others have them several times a day. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day.
  • Sleep problems—You may have insomnia (trouble falling asleep), or you may wake up long before your usual time. Night sweats may disrupt your sleep.
  • Vaginal and urinary tract changes—As estrogen levels decrease, the lining of the vagina may become thinner, dryer, and less elastic. Vaginal dryness may cause pain during sex. Vaginal infections also may occur more often. The urethra can become dry, inflamed, or irritated. This can cause more frequent urination and increase the risk of urinary tract infections.

What is perimenopause?

The years leading up to menopause are called perimenopause. Beginning in your 30s and 40s, the amount of estrogen produced by the ovaries begins to fluctuate. A common sign of perimenopause is a change in your menstrual cycle. Cycles may become longer than usual for you or become shorter. You may begin to skip periods. The amount of flow may become lighter or heavier. Although changes in menstrual bleeding are normal during perimenopause, you still should report them to your health care professional. Abnormal bleeding may be a sign of a problem.

What types of bone changes can occur after menopause?

A small amount of bone loss after age 35 years is normal for both men and women. But during the first 4–8 years after menopause, women lose bone more rapidly. This rapid loss occurs because of the decreased levels of estrogen. If too much bone is lost, it can increase the risk of osteoporosis. Osteoporosis increases the risk of bone fracture. The bones of the hip, wrist, and spine are affected most often.

What other health risks increase during perimenopause and menopause?

The estrogen produced by women’s ovaries before menopause protects against heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. Midlife also is the time when risk factors for heart disease, such as high cholesterol levels, high blood pressure, and being physically inactive, are more common. All of these combined factors increase the risk of heart attack and stroke in menopausal women.

What is hormone therapy?

Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, a hormone called progestin. Estrogen plus progestin sometimes is called “combined hormone therapy” or simply “hormone therapy.” Taking progestin helps reduce the risk of cancer of the uterus that occurs when estrogen is used alone. If you do not have a uterus, estrogen is given without progestin. Estrogen-only therapy sometimes is called “estrogen therapy.”

How is hormone therapy given?

Estrogen can be given in several forms. Systemic forms include pills, skin patches, and gels and sprays that are applied to the skin. If progestin is prescribed, it can be given separately or combined with estrogen in the same pill or in a patch. With systemic therapy, estrogen is released into the bloodstream and travels to the organs and tissues where it is needed. Women who only have vaginal dryness may be prescribed “local” estrogen therapy in the form of a vaginal ring, tablet, or cream. These forms release small doses of estrogen into the vaginal tissue.

What are the benefits of hormone therapy?

Systemic estrogen therapy (with or without progestin) has been shown to be the best treatment for the relief of hot flashes and night sweats. Both systemic and local types of estrogen therapy relieve vaginal dryness. Systemic estrogen protects against the bone loss that occurs early in menopause and helps prevent hip and spine fractures. Combined estrogen and progestin therapy may reduce the risk of colon cancer.

What are the risks of hormone therapy?

Hormone therapy may increase the risk of certain types of cancer and other conditions:

  • Estrogen-only therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer.
  • Combined hormone therapy is associated with a small increased risk of heart attack. This risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy.
  • Combined hormone therapy and estrogen-only therapy are associated with a small increased risk of stroke and deep vein thrombosis (DVT). Forms of therapy not taken by mouth (patches, sprays, rings, and others) may have less risk of causing deep vein thrombosis than those taken by mouth.
  • Combined hormone therapy is associated with a small increased risk of breast cancer.
  • There is a small increased risk of gallbladder disease associated with estrogen therapy with or without progestin. The risk is greatest with oral forms of therapy.

Can other medications help with menopause symptoms?

Several antidepressants are available for the treatment of hot flashes. Gabapentin, an antiseizure medication, and clonidine, a blood pressure medication, are prescription drugs that can be prescribed to reduce hot flashes and ease sleep problems associated with menopause. Selective estrogen receptor modulators (SERMs) are drugs that act on tissues that respond to estrogen. SERMs are available for the relief of hot flashes and pain during intercourse caused by vaginal dryness.

Can plant and herbal supplements help with menopause symptoms?

Plants and herbs that have been used for relief of menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness. Also, the way that these products are made is not regulated. There is no guarantee that the product contains safe ingredients or effective doses of the substance. If you do take one of these products, be sure to let your health care professional know.

Can bioidentical hormones help with menopause symptoms?

Bioidentical hormones come from plant sources. They include commercially available products and compounded preparations. Compounded bioidentical hormones are made by a compounding pharmacist from a health care professional’s prescription. Compounded drugs are not regulated by the U.S. Food and Drug Administration (FDA). Compounding pharmacies must be licensed, but they do not have to show the safety, effectiveness, and quality control that the FDA requires of drug makers. The American College of Obstetricians and Gynecologists recommends FDA-approved hormone therapy over compounded hormone therapy.

Can vaginal moisturizers and lubricants help with menopause symptoms?

These over-the-counter products can be used to help with vaginal dryness and painful sexual intercourse that may occur during menopause. They do not contain hormones, so they do not have an effect on the vagina’s thickness or elasticity. Vaginal moisturizers can be used every 2–3 days as needed. Lubricants can be used each time you have sexual intercourse.

What can I do to stay healthy after menopause?

A healthy lifestyle can help you make the best of the years after menopause. The following are some ways to stay healthy during midlife:

  • Nutrition—Eating a balanced diet will help you stay healthy before, during, and after menopause. Be sure to include enough calcium and vitamin D in your diet to help maintain strong bones.
  • Exercise—Regular exercise slows down bone loss and improves your overall health. Weight-bearing exercise, such as walking, can help keep bones strong. Strength training strengthens your muscles and bones by resisting against weight, such as your own body, an exercise band, or handheld weights. Balance training, such as yoga and tai chi, may help you avoid falls, which could lead to broken bones.
  • Routine health care—Visit your health care professional once a year to have regular exams and tests. Dental checkups and eye exams are important, too. Routine health care visits, even if you are not sick, can help detect problems early.

Menopause Glossary of Terms

Antidepressants: Drugs that are used to treat depression.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Estrogen: A female hormone produced in the ovaries.

Hormone: Substances made in the body that control the function of cells or organs.

Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve symptoms that may happen around the time of menopause.

Hysterectomy: Surgery to remove the uterus.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined as the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Osteoporosis: A condition of thin bones that could allow them to break more easily.

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Perimenopause: The time period leading up to menopause.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Urethra: A tube-like structure. Urine flows through this tube when it leaves the body.

Uterus: A muscular organ in the female pelvis. During pregnancy this organ holds and nourishes the fetus.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Abnormal Uterine Bleeding

What is a normal menstrual cycle?

The normal length of the menstrual cycle is typically between 24 days and 38 days. A normal menstrual period generally lasts up to 8 days.

When is bleeding abnormal?

Bleeding in any of the following situations is considered abnormal uterine bleeding:

  • Bleeding or spotting between periods
  • Bleeding or spotting after sex
  • Heavy bleeding during your period
  • Menstrual cycles that are longer than 38 days or shorter than 24 days
  • “Irregular” periods in which cycle length varies by more than 7–9 days
  • Bleeding after menopause

At what ages is abnormal bleeding more common?

Abnormal bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having them (around age 9–14 years). During perimenopause (beginning in the mid–40s), the number of days between periods may change. It also is normal to skip periods or for bleeding to get lighter or heavier during perimenopause.

What causes abnormal bleeding?

Some of the causes of abnormal bleeding include the following:

  • Problems with ovulation
  • Fibroids and polyps
  • A condition in which the endometrium grows into the wall of the uterus
  • Bleeding disorders
  • Problems linked to some birth control methods, such as an intrauterine device (IUD) or birth control pills
  • Miscarriage
  • Ectopic pregnancy
  • Certain types of cancer, such as cancer of the uterus

Your obstetrician–gynecologist (ob-gyn) or other health care professional may start by checking for problems most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. All should be checked.

How is abnormal bleeding diagnosed?

Your ob-gyn or other health care professional will ask about your health history and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. You also can use a smartphone app designed to track menstrual cycles.

You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a pregnancy test and tests for sexually transmitted
infections (STIs)
.

What tests may be needed to diagnose abnormal bleeding?

Based on your symptoms and your age, other tests may be needed. Some of these tests can be done in your ob-gyn’s office. Others may be done at a hospital or surgical center:

  • Ultrasound exam—Sound waves are used to make a picture of the pelvic organs.
  • Hysteroscopy—A thin, lighted scope is inserted through the vagina and the opening of the cervix. It allows your ob-gyn or other health care professional to see the inside of the uterus.
  • Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope.
  • Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the inside of the uterus.
  • Magnetic resonance imaging (MRI)—An MRI exam uses a strong magnetic field and sound waves to create images of the internal organs.
  • Computed tomography (CT)—This X-ray procedure shows internal organs and structures in cross section.

What medications are used to help control abnormal bleeding?

Medications often are tried first to treat irregular or heavy menstrual bleeding. The medications that may be used include the following:

  • Hormonal birth control methods—Birth control pills, the skin patch, and the vaginal ring contain hormones. These hormones can lighten menstrual flow. They also help make periods more regular.
  • Gonadotropin-releasing hormone (GnRH) agonists—These drugs can stop the menstrual cycle and reduce the size of fibroids.
  • Tranexamic acid—This medication treats heavy menstrual bleeding.
  • Nonsteroidal anti-inflammatory drugs—These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps.
  • Antibiotics—If you have an infection, you may be given an antibiotic.
  • Special medications—If you have a bleeding disorder, your treatment may include medication to help your blood clot.

What types of surgery are performed to treat abnormal bleeding?

If medication does not reduce your bleeding, a surgical procedure may be needed. There are different types of surgery depending on your condition, your age, and whether you want to have more children.

Endometrial ablation destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications, including life-threatening bleeding, is greatly increased. If you have this procedure, you will need to use birth control until after menopause.

Uterine artery embolization is a procedure used to treat fibroids. This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow. Another treatment, myomectomy, removes the fibroids but not the uterus.

Hysterectomy, the surgical removal of the uterus, is used to treat some conditions or when other treatments have failed. Hysterectomy also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.

Abnormal Uterine Bleeding Glossary of Terms

Abnormal Uterine Bleeding: Bleeding from the uterus that differs in frequency, regularity, duration, or amount from normal uterine bleeding in the absence of pregnancy.

Cervix: The opening of the uterus at the top of the vagina.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in the fallopian tubes.

Endometrium: The lining of the uterus.

Fibroids: Benign (noncancerous) growths that form on the inside of the uterus, on its outer surface, or within the uterine wall itself.

Gonadotropin-releasing Hormone (GnRH) Agonists: Medical therapy used to block the effects of certain hormones.

Intrauterine device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined as the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Miscarriage: The spontaneous loss of a pregnancy before the fetus can survive outside the uterus.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Ovulation: The release of an egg from one of the ovaries.

Perimenopause: The period before menopause that usually extends from age 45 years to 55 years.

Polyps: Growths that develop from membrane tissue, such as that lining the inside of the uterus.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Tranexamic Acid: A medication prescribed to treat or prevent heavy bleeding.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Ovarian Cysts

What is an ovarian cyst?

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms in or on an ovary. Ovarian cysts are very common. They can occur during the childbearing years or after menopause. Most ovarian cysts are benign (not cancer) and go away on their own without treatment. Rarely, a cyst may be malignant (cancer)

What are the different types of cysts?

Types of cysts include the following:

  • Functional cyst—This is the most common type of ovarian cyst. It usually causes no symptoms. Functional cysts often go away without treatment within 6–8 weeks.
  • Teratoma—This type of cyst contains different kinds of tissues that make up the body, such as skin and hair. These cysts may be present from birth but can grow during a woman’s reproductive years. In very rare cases, some teratomas can become cancer.
  • Cystadenoma—These cysts form on the outer surface of the ovary. They can grow very large but usually are benign.
  • Endometrioma—This cyst forms as a result of endometriosis.

What are the symptoms of ovarian cysts?

In most cases, cysts do not cause symptoms. Many are found during a routine pelvic exam or imaging test done for another reason. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause twisting of the ovary. This twisting usually causes pain on one side that comes and goes or can start suddenly. Cysts that bleed or burst also may cause sudden, severe pain.

How are ovarian cysts diagnosed?

If your obstetrician–gynecologist (ob-gyn) or other health care professional thinks that you may have a cyst, the following tests may be recommended to find out more information:

  • Ultrasound exam—This test uses sound waves to create pictures of the internal organs. An instrument called a transducer is placed in the vagina or on the abdomen. The views created by the sound waves show the shape, size, and location of the cyst. The views also show whether the cyst is solid or filled with fluid.
  • Blood tests—You may have a blood test that measures the level of a substance called CA 125. An increased level of
    CA 125, along with certain findings from ultrasound and physical exams, may raise concern for ovarian cancer, especially in a woman who is past menopause. Several other blood tests also can be used to help identify whether a mass on the ovary is concerning for ovarian cancer.

How are ovarian cysts treated?

There are several treatment options for cysts. Choosing an option depends on the type of cyst and other factors. Treatment options include watchful waiting and, if the cyst is large or causing symptoms, surgery.

What is watchful waiting?

Watchful waiting is a way of monitoring a cyst with repeat ultrasound exams to see if the cyst has changed in size or appearance. Your ob-gyn or other health care professional will decide when to repeat the ultrasound exam and how long this follow-up should last. Many cysts go away on their own after one or two menstrual cycles.

When is surgery recommended?

Surgery may be recommended if your cyst is very large or causing symptoms or if cancer is suspected. The type of surgery depends on several factors, including how large the cyst is, your age, your desire to have children, and whether you have a family history of ovarian or breast cancer. A cystectomy is the removal of a cyst from the ovary. In some cases, an ovary may need to be removed. This is called an oophorectomy.

How is surgery performed?

If your cyst is thought to be benign, minimally invasive surgery is recommended. Minimally invasive surgery is done using small incisions and a special instrument called a laparoscope. This type of surgery is called a laparoscopy. Another type of surgery is called open surgery. In open surgery, an incision is made horizontally or vertically in the lower abdomen. Open surgery may be done if cancer is suspected or if the cyst is too large to be removed by laparoscopy.

Ovarian Cysts Glossary of Terms

Benign: Not cancer.

CA 125: A substance in the blood that may increase in the presence of some cancerous tumors.

Cyst: A sac or pouch filled with fluid.

Cystectomy: Surgical removal of a cyst.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Laparoscope: An instrument that is inserted through a small incision to view internal organs or to perform surgery.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Malignant: A term used to describe cells or tumors that are able to invade tissue and spread to other parts of the body.

Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for 1 year.

Minimally Invasive Surgery: Surgery done through a very small incision.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Oophorectomy: Removal of one or both of the ovaries.

Ovary: One of the paired organs in the female reproductive system that contain the eggs released at ovulation and produce hormones.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Transducer: A device that emits sound waves and translates the echoes into electrical signals.

Ultrasound Exam: A test in which sound waves are used to examine internal structures.

Ovarian Cancer

What is cancer?

Normal cells in the body grow, divide, and are replaced on a routine basis. Sometimes, cells divide abnormally and begin to grow out of control. These cells may form growths or tumors. Tumors can be benign (not cancer) or malignant (cancer). Benign tumors do not spread to other body tissues. Cancer tumors can invade and destroy nearby healthy tissues, bones, and organs. Cancer cells also can spread to other parts of the body and form new cancerous areas.

What causes cancer?

Cancer is caused by several different factors. A few types of cancer run in families. These types are called “hereditary” or “familial” cancer. They are caused by changes in genes that can be passed from parent to child. Changes in genes are called mutations.

What causes cancer?

Cancer is caused by several different factors. A few types of cancer run in families. These types are called “hereditary” or “familial” cancer. They are caused by changes in genes that can be passed from parent to child. Changes in genes are called mutations.

What are the types of ovarian cancer?

Ovarian cancer can develop on the surface of the ovary or from tissues inside the ovary. There are three main types. The type that develops on the surface of the ovary, epithelial ovarian cancer, is the most common type. About 90% of cases of ovarian cancer involve epithelial tumors. This FAQ discusses epithelial ovarian cancer.

Researchers now believe that some high-grade tumors may develop in a fallopian tube and travel to an ovary. More research is needed in this area.

What are the risk factors for ovarian cancer?

Certain risk factors are associated with epithelial ovarian cancer. The following factors have been shown to increase a woman’s risk of getting this type of cancer:

  • Age older than 55 years
  • Family history of breast cancer, ovarian cancer, color cancer, or endometrial cancer (cancer of the lining of the uterus)
  • Personal history of breast cancer
  • Mutations in BRCA1 and BRCA2 genes
  • Never having had children
  • Infertility
  • Endometriosis
  • Lynch Syndrome

What screening tests are available for ovarian cancer?

A screening test is a test that is done when no symptoms are present. Examples of screening tests are colonoscopy for colorectal cancer and the Pap test for cervical cancer. Currently, there is no screening test for ovarian cancer. You should be alert to any changes in your body and discuss them with your obstetrician–gynecologist (ob-gyn) or health care professional. The earlier that ovarian cancer is diagnosed, the more likely that treatment will be successful.

What are the symptoms of ovarian cancer?

If you have any of the following symptoms, especially if you have them for more than 12 days per month, contact your ob-gyn or other health care professional:

  • Bloating or an increase in abdominal size
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (frequency and urgency)

Others symptoms can include vaginal bleeding, especially after menopause, and a change in bowel habits. Having these symptoms does not mean that you have ovarian cancer, but it is a good idea to find out what is causing them.

How is ovarian cancer diagnosed?

If you have frequent or persistent symptoms of ovarian cancer, you may have a physical exam, including a pelvic exam. An imaging test of the ovaries, such as a transvaginal ultrasound exam, may be done. If a growth is found on an ovary, your ob-gyn may order a blood test to measure your CA 125 level. CA 125 sometimes is increased in women with ovarian cancer. Results of these tests are used to assess the likelihood that the growth is cancer. Test results also will guide the next steps in evaluation.

How is ovarian cancer treated?

If a woman is thought to have ovarian cancer, surgery usually is recommended to remove the uterus, ovaries, and fallopian tubes. Lymph nodes and tissues in the pelvis and abdomen are checked for cancer and may be removed as well. In some cases, only the ovary with cancer may be removed.

Chemotherapy after surgery is recommended for most cases of ovarian cancer. Chemotherapy is the use of drugs that kill cancer cells. In some cases, chemotherapy may be recommended before surgery.

What type of follow-up is needed after treatment?

Women treated for ovarian cancer need to have regular checkups to make certain that the cancer has not come back. A checkup after cancer treatment usually includes a review of symptoms and a physical exam. The checkup also may include a CA 125 test. Imaging tests are not routinely done but may be recommended. These may include ultrasound, chest X-ray, magnetic resonance imaging (MRI), or computed tomography (CT).

How can I reduce my risk of ovarian cancer?

Combined hormonal birth control pills (those that contain estrogen and progestin) may reduce the risk of ovarian cancer. The longer a woman takes the pill, the more the risk is reduced—for every 5 years on the pill, a woman reduces her risk by about 20%. This benefit needs to be balanced against the risks of using the pill. The pill is safe for most women, but it is associated with a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke.

Current theories suggest that some types of ovarian cancer may start in the fallopian tubes. If you need to have your uterus removed or you have chosen sterilization as a permanent method of birth control, you may want to ask your ob-gyn or other health care professional about having your fallopian tubes removed. This operation is called a salpingectomy. In this procedure, only the fallopian tubes are removed. The ovaries are left in place. A salpingectomy may help reduce the risk of future ovarian cancer.

What should I know if I am at high risk of ovarian cancer?

For women at high risk of ovarian cancer, such as women with BRCA1 or BRCA2 mutations, periodic tests to check for ovarian cancer may be recommended. These tests may include transvaginal ultrasound exam to look for changes in the ovaries and a CA 125 test.

Risk-reducing salpingo-oophorectomy also is an option. This is the removal of the fallopian tubes and the ovaries in a woman who does not have cancer. It is recommended for women with BRCA1 or BRCA2 mutations by age 40 years or when childbearing is complete. It also may be recommended for women with Lynch syndrome. This operation reduces the risk of ovarian cancer.

Ovarian Cancer Glossary of Terms

BRCA1 and BRCA2: Genes that keep cells from growing too rapidly. Changes in these genes have been linked to an increased risk of breast cancer and ovarian cancer.

CA 125: A substance in the blood that may increase when a person has cancerous tumors.

Chemotherapy: Treatment of cancer with drugs.

Colonoscopy: An exam of the large intestine using a small, lighted instrument.

Computed Tomography (CT): A type of X-ray that shows internal organs and structures in cross section.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fallopian Tube: A tube through which an egg travels from the ovary to the uterus.

Genes: Segments of DNA that contain instructions for the development of a person’s physical traits and control of the processes in the body. The gene is the basic unit of heredity and can be passed from parent to child.

Lymph Nodes: Small groups of special tissue that carry lymph, a liquid that bathes body cells. Lymph nodes are connected to each other by lymph vessels. Together, these make up the lymphatic system.

Lynch Syndrome: A genetic condition that increases a person’s risk of cancer of the colon, rectum, ovary, uterus, pancreas, and bile duct.

Magnetic Resonance Imaging (MRI): A test to view internal organs and structures by using a strong magnetic field and sound waves.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Mutations: Changes in genes that can be passed from parent to child.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Ovarian Cancer: Cancer that affects one or both of the ovaries.

Ovaries: The organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Risk-Reducing Salpingo-oophorectomy: Surgery to remove both healthy fallopian tubes and both healthy ovaries. This surgery is done to reduce the risk of cancer.

Salpingectomy: Surgery to remove one or both of the fallopian tubes.

Transvaginal Ultrasound Exam: A type of ultrasound in which the device is placed in your vagina.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

BRCA1 and BRCA2 Mutations

What is cancer?

Normal cells in the body grow, divide, and are replaced on a routine basis. Sometimes, cells divide abnormally and begin to grow out of control. These cells may form growths or tumors. Tumors can be benign (not cancer) or malignant (cancer). Benign tumors do not spread to other body tissues. Cancer tumors can invade and destroy nearby healthy tissues, bones, and organs. Cancer cells also can spread to other parts of the body and form new cancerous areas.

What causes cancer?

Cancer is caused by several different factors. A few types of cancer run in families. These types are called “hereditary” or “familial” cancer. They are caused by changes in genes that can be passed from parent to child. Changes in genes are called mutations.

What is hereditary breast and ovarian cancer syndrome?

Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited increased risk of breast cancer, ovarian cancer, and other types of cancer. HBOC syndrome is linked to mutations in several genes, but the most common are called BRCA1 and BRCA2.

What are BRCA1 and BRCA2?

BRCA1 and BRCA2 are tumor suppressor genes, which means that they keep cells from growing too rapidly. Everyone has these genes. Changes or mutations in these genes mean they do not work properly and cells can grow out of control, which can lead to cancer.

How much do BRCA mutations increase the risk of breast cancer?

The risk of breast cancer for the average American woman is about 12% in her lifetime. Having a BRCA mutation greatly increases the risk. The estimated risk of breast cancer in women with a BRCA mutation is 45–85% by age 70 years.

How much do BRCA mutations increase the risk of ovarian cancer?

The risk of ovarian cancer for the average American woman is about 2% in her lifetime. The estimated risk of ovarian cancer in women with a BRCA1 mutation is 39–46% by age 70 years. For women with a BRCA2 mutation, the risk of ovarian cancer by age 70 years is 10–27%.

Do BRCA mutations increase the risk of other types of cancer?

Yes. Women who have a BRCA mutation also have an increased risk of cancer of the fallopian tube, peritoneum, pancreas, and skin (melanoma). Men who have a BRCA mutation have an increased risk of cancer of the breast, prostate, and pancreas.

How common are BRCA mutations?

About 1 in 300 people to 1 in 800 people carry a BRCA1 or BRCA2 mutation. Anyone can have these mutations, but they are found more often in certain ethnic groups. These groups include people of the following backgrounds:

  • Eastern or Central European Jewish
  • French Canadian
  • Icelandic

Should I be tested for BRCA mutations?

Your obstetrician–gynecologist (ob-gyn) or other health care professional should ask you questions about your personal and family history of breast cancer and ovarian cancer. The questions may include the following:

  • Have you had cancer of the ovary, fallopian tubes, or peritoneum?
  • Have you had breast cancer at age 45 years or younger?
  • Have you had breast cancer and do you have a close relative with breast cancer at age 50 years or younger, or a close relative with cancer of the ovary, fallopian tubes, or peritoneum?
  • Have you had breast cancer and do you have two or more close relatives with breast cancer at any age?
  • Have you had breast cancer and do you have two or more close relatives with cancer of the pancreas or prostate?
  • Have you had breast cancer and are you of Eastern or Central European Jewish ancestry?
  • Do you have a close relative with a BRCA1 or BRCA2 mutation?

If your answers to these or other questions suggest that you may have a BRCA mutation, genetic counseling and testing may be offered.

What is genetic counseling?

Before you have genetic testing, a genetic counselor or a physician who specializes in inherited types of cancer can help you understand how the testing is done, what the results may mean, and what you may do depending on the test results.

Why don’t doctors test everyone for BRCA mutations?

BRCA testing is only recommended for people with a high risk of having BRCA mutations. It is important to remember that most cases of breast and ovarian cancer are not caused by gene mutations. If there is a low chance of finding a BRCA mutation, your ob-gyn or other health care professional may not recommend genetic testing.

How is testing for BRCA mutations done?

Genetic testing requires a sample of blood or saliva. There are several ways that testing can be done:

  • If a relative with breast cancer or ovarian cancer is available, the relative’s BRCA genes can be analyzed. If your relative carries a mutation, you can have testing to see if you have the same mutation as your relative. This is the best way to know if you are at increased risk of cancer.
  • If no relative is available, and you and your family belong to an ethnic group with high numbers of people with a specific BRCA mutation, you can be tested for this mutation.
  • If you are not part of a high-risk ethnic group but your family history suggests there may be a hereditary mutation, another option is to have testing of your BRCA genes. If your family has a member with breast cancer or ovarian cancer, it is always best to test that relative first. But if that is not possible, you may have individual testing and counseling.

What does a negative test result mean?

A negative test result can mean several things:

  • When a family member with cancer gives a sample and a BRCA mutation is found, you can be tested for that mutation. If you have a negative test result for that BRCA mutation, you have not inherited it and your risk of cancer is the same as the general population.
  • If you have a family history of cancer but no family member with cancer has given a sample, and you have a negative test result for a BRCA mutation, it can mean that your family has a BRCA mutation but you did not inherit it. It also can mean your family carries a mutation in a gene that researchers have not yet identified.

What does an unclear test result mean?

An unclear test result means there is a change in a BRCA gene, but it is not known whether the change increases the risk of cancer. Researchers continue to study BRCA and other genes to find out how they may influence cancer risk. If you have an unclear result, a genetic counselor can explain strategies that may reduce your risk.

What does a positive test result mean?

A positive test result means you have a BRCA mutation for which you have been tested. That means you have an increased risk of getting cancer. It does not mean you will get cancer. There is no test that can tell which women with a BRCA mutation will develop cancer or at what age. It is important to discuss your results with your genetic counselor and learn what you can do to decrease your risk of cancer.

Having a BRCA mutation means you can pass the mutation to your children. Your siblings also may have the gene mutation. You are not obligated to tell your family members, but sharing the information could be life-saving for them. With this information, your family members can decide whether to be tested and get cancer screenings at an early age.

How can you prevent cancer if you test positive for a BRCA mutation?

If you test positive for a BRCA mutation, you may discuss prevention options with your ob-gyn, genetic counselor, or other health care professional. Prevention includes screening tests, medications, and surgery.

What breast cancer screening tests are available?

Breast cancer screening may include the following tests for women with BRCA mutations:

  • Clinical breast exam by your ob-gyn or other health care professional every 6–12 months
  • Annual breast imaging starting at age 25 years. Magnetic resonance imaging (MRI) is recommended annually for women aged 25–29 years. Beginning at age 30 years, breast MRI and mammography are recommended annually.

What ovarian screening tests are available?

Currently there is no recommended screening test for ovarian cancer for average-risk patients. For high-risk patients, one ovarian cancer screening method that has been studied is a blood test that measures levels of a marker called CA 125. A marker is a substance made by cancer cells. Levels of CA 125 sometimes are increased in women with ovarian cancer. An ultrasound exam of the ovaries also may be recommended for women with a BRCA mutation. If your ob-gyn or other health care professional recommends these tests, you may begin testing between the ages of 30 years and 35 years.

It is important to know that these screening tests have a limited ability to find ovarian cancer at an early, more treatable stage. Test results may be normal even when cancer is present. There also is a high rate of false-positive results (a positive test result in someone who does not have ovarian cancer). There are ongoing studies to find an accurate and reliable screening test for ovarian cancer.

What medication can help prevent breast cancer?

A medication called tamoxifen has been shown to reduce the risk of breast cancer in women with BRCA2 mutations. Tamoxifen is a drug that blocks the effects of estrogen on cancer cells that respond to this hormone.

Tamoxifen works better in women with BRCA2 mutations because most breast cancer tumors in this group grow in response to estrogen. Tamoxifen does not appear to reduce breast cancer risk in women with BRCA1 mutations because fewer cancer tumors in this group respond to estrogen.

What medications can help prevent ovarian cancer?

Combined hormonal birth control pills (those that contain estrogen and progestin) have been shown to reduce the risk of ovarian cancer. The longer a woman takes the pill, the more the risk is reduced—for every 5 years on the pill, a woman reduces her risk by about 20%. But this benefit needs to be balanced against the risks of using the pill. The pill is safe for most women, but it is associated with a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke. Your ob-gyn or other health care professional can help you understand how to balance the benefits and risks of using the pill.

Can surgery help prevent breast cancer?

Yes. Surgical removal of both breasts is called risk-reducing bilateral mastectomy. It can reduce the risk of breast cancer by 85–100% in women with a BRCA mutation. Total mastectomy, in which all breast tissue is removed, including the nipple, is the most effective surgery for reducing the risk of breast cancer. Mastectomy that removes the breast tissue and leaves the nipple also can be considered and is very effective. Some women choose to have breast reconstruction after a mastectomy.

What are the side effects of a mastectomy?

Side effects of a mastectomy can include the following:

  • Pain, tenderness, or swelling
  • Buildup of blood or fluid in the wound or arms
  • Limited arm or shoulder movement
  • Numbness in chest or arm
  • Burning or shooting pain in the chest, armpit, or arm
  • Inability to breastfeed

Can surgery help prevent ovarian cancer?

Yes. The removal of both ovaries and both fallopian tubes is called risk-reducing bilateral salpingo-oophorectomy. In women with a BRCA mutation, this surgery can reduce the risk of ovarian cancer by about 80%. The surgery also reduces the risk of cancer of the fallopian tubes and peritoneum. If it is done before menopause, this surgery also can reduce the risk of breast cancer. Women with a BRCA mutation should consider this surgery between the ages of 35 years and 40 years or after they have completed childbearing. Some women may be able to delay slightly longer. Removal of the ovaries means you will not be able to get pregnant.

Researchers also are studying the removal of only the fallopian tubes (salpingectomy) to prevent ovarian cancer. Some cases of ovarian cancer may start in the fallopian tubes, so removing the tubes may help prevent ovarian cancer without putting a woman into menopause. More research is needed in this area.

What are the side effects of removing the ovaries?

Removal of the ovaries before menopause will cause you to go through menopause immediately. This is called surgical menopause. Symptoms may be more severe than if you were to go through menopause naturally over several years. Menopause symptoms often can be managed with hormone therapy and other treatments. You can discuss these treatment options with your ob-gyn or other health care professional before your surgery.

What else should I think about before choosing risk-reducing surgery?

If you are thinking about having preventive surgery, you and your ob-gyn or other health care professional will discuss the risks and benefits. You should consider the psychological effects as well as short- and long-term complications. Timing of surgery should be based on your cancer risk, your desire to have children, and the effect that surgery will have on your well-being.

What should I know about direct-to-consumer genetic tests?

A direct-to-consumer genetic test is a genetic test that you can order over the internet. You do not need a doctor’s order for it. The American College of Obstetricians and Gynecologists discourages use of direct-to-consumer genetic tests because the results may be misleading. For example, one test for BRCA mutations only looks for three mutations, even though there are more than 500 BRCA mutations linked to cancer. The test results could cause unnecessary fear, or a false sense that you are not at risk. You should always see a health care professional if you want a genetic test.

I am concerned about discrimination based on genetic testing results. What should I know?

Many people are concerned about possible employment discrimination or denial of insurance coverage based on genetic testing results. The Genetic Information Nondiscrimination Act of 2008 (GINA) makes it illegal for health insurers to require genetic testing results or use results to make decisions about coverage, rates, or preexisting conditions. GINA also makes it illegal for employers to discriminate against employees or applicants because of genetic information. GINA does not apply to life insurance, long-term care insurance, or disability insurance.

BRCA1 and BRCA2 Cancer Glossary of Terms

BRCA1 and BRCA2: Genes that keep cells from growing too rapidly. Changes in these genes have been linked to an increased risk of breast cancer and ovarian cancer.

CA 125: A substance in the blood that may increase when a person has cancerous tumors.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Estrogen: A female hormone produced by the ovaries.

Fallopian Tube: A tube through which an egg travels from the ovary to the uterus.

Genes: Segments of DNA that contain instructions for the development of a person’s physical traits and control of the processes in the body. They are the basic units of heredity and can be passed from parent to child.

Genetic Counselor: A health care professional with special training in genetics who can provide expert advice about genetic disorders and prenatal testing.

Hereditary Breast and Ovarian Cancer (HBOC) Syndrome: An inherited condition in which a person has a higher risk of breast cancer, ovarian cancer, and other types of cancer.

Magnetic Resonance Imaging (MRI): A test to view internal organs and structures by using a strong magnetic field and sound waves.

Mammography: X-rays of the breast that are used to find breast cancer or other breast problems.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Mutations: Changes in genes that can be passed from parent to child.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Ovary: An organ in women that contains the eggs necessary to get pregnant and makes important hormones, such as estrogen, progesterone, and testosterone.

Peritoneum: The membrane that lines the abdominal cavity and surrounds the internal organs.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Risk-Reducing Bilateral Mastectomy: Surgery to remove both healthy breasts. In some cases, breast tissue is removed but not the nipples.

Risk-Reducing Bilateral Salpingo-oophorectomy: Surgery to remove both healthy fallopian tubes and both ovaries.

Salpingectomy: Surgery to remove one or both of the fallopian tubes.

Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

HIV Glossary of Terms

Acquired Immunodeficiency Syndrome (AIDS): A group of signs and symptoms, usually of severe infections, occurring in a person whose immune system has been damaged by infection with human immunodeficiency virus (HIV).

Amniotic Sac: Fluid-filled sac in the mother’s uterus in which the fetus develops.

Anemia: Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron.

Cesarean Delivery: Delivery of a baby through an incision made in the mother’s abdomen and uterus.

Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

How long does pregnancy last?

A normal pregnancy lasts about 40 weeks from the first day of the woman’s last menstrual period (LMP). Weeks of pregnancy are divided into three trimesters. Each trimester lasts about 3 months.

How is the due date estimated?

The estimated date that the baby will be born is called the estimated due date (EDD). This date is based on the LMP or an ultrasound exam. The LMP and ultrasound dating methods often are used together to estimate the EDD. Keep in mind that only 1 in 20 women actually give birth on their estimated due date.

Is it safe to exercise during pregnancy?

If you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise, but you may need to make a few changes. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with your obstetrician or other member of your health care team during your early prenatal visits. If your health care professional gives you the OK to exercise, you can decide together on an exercise routine that fits your needs and is safe during pregnancy.

Question 4

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How long does pregnancy last?

A normal pregnancy lasts about 40 weeks from the first day of the woman’s last menstrual period (LMP). Weeks of pregnancy are divided into three trimesters. Each trimester lasts about 3 months.

How is the due date estimated?

The estimated date that the baby will be born is called the estimated due date (EDD). This date is based on the LMP or an ultrasound exam. The LMP and ultrasound dating methods often are used together to estimate the EDD. Keep in mind that only 1 in 20 women actually give birth on their estimated due date.

Is it safe to exercise during pregnancy?

If you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise, but you may need to make a few changes. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with your obstetrician or other member of your health care team during your early prenatal visits. If your health care professional gives you the OK to exercise, you can decide together on an exercise routine that fits your needs and is safe during pregnancy.

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How long does pregnancy last?

A normal pregnancy lasts about 40 weeks from the first day of the woman’s last menstrual period (LMP). Weeks of pregnancy are divided into three trimesters. Each trimester lasts about 3 months.

How is the due date estimated?

The estimated date that the baby will be born is called the estimated due date (EDD). This date is based on the LMP or an ultrasound exam. The LMP and ultrasound dating methods often are used together to estimate the EDD. Keep in mind that only 1 in 20 women actually give birth on their estimated due date.

Is it safe to exercise during pregnancy?

If you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise, but you may need to make a few changes. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with your obstetrician or other member of your health care team during your early prenatal visits. If your health care professional gives you the OK to exercise, you can decide together on an exercise routine that fits your needs and is safe during pregnancy.

Question 4

Under Construction. Thank you for your patience.

How long does pregnancy last?

A normal pregnancy lasts about 40 weeks from the first day of the woman’s last menstrual period (LMP). Weeks of pregnancy are divided into three trimesters. Each trimester lasts about 3 months.

How is the due date estimated?

The estimated date that the baby will be born is called the estimated due date (EDD). This date is based on the LMP or an ultrasound exam. The LMP and ultrasound dating methods often are used together to estimate the EDD. Keep in mind that only 1 in 20 women actually give birth on their estimated due date.

Is it safe to exercise during pregnancy?

If you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise, but you may need to make a few changes. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with your obstetrician or other member of your health care team during your early prenatal visits. If your health care professional gives you the OK to exercise, you can decide together on an exercise routine that fits your needs and is safe during pregnancy.

Question 4

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How long does pregnancy last?

A normal pregnancy lasts about 40 weeks from the first day of the woman’s last menstrual period (LMP). Weeks of pregnancy are divided into three trimesters. Each trimester lasts about 3 months.

How is the due date estimated?

The estimated date that the baby will be born is called the estimated due date (EDD). This date is based on the LMP or an ultrasound exam. The LMP and ultrasound dating methods often are used together to estimate the EDD. Keep in mind that only 1 in 20 women actually give birth on their estimated due date.

Is it safe to exercise during pregnancy?

If you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise, but you may need to make a few changes. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with your obstetrician or other member of your health care team during your early prenatal visits. If your health care professional gives you the OK to exercise, you can decide together on an exercise routine that fits your needs and is safe during pregnancy.

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