Pregnancy Questions and Answers

A single X-ray exposure at the dentist is unlikely to cause harm to your pregnancy . The dose exposure is usually very low and below the threshold necessary to cause harm. Nevertheless, repeated exposure to X-rays such as that which may occur to an employee who constantly works in an X-ray environment, could potentially lead to miscarriage and or birth defects. The period of time from conception to about 9 weeks is known as organogenesis. It is a period of time characterized by organ development and is a period when exposure to excessive radiation is more likely to result in damage to your baby. The usual affect of excess exposure is miscarriage. In the remainder of cases, harmful X-rays may give rise to DNA damage, thereby resulting in birth defects. The Quad Screening , NIPT ( non-invasive prenatal diagnostic tests) can determine your risks of having a baby with chromosomal defects. A referral to a PERINATOLOGIST and geneticist may be warranted to perform an ultrasound to look for anomalies , to specify risks and to perform more invasive testing such as a CVS or AMNIOCENTESIS.

The start of the 36th week of pregnancy is considered to be a period known as "TERM" . It is a time when the baby becomes increasingly capable of breathing on it's own, and the risks of complications of prematurity become greatly diminished. Should you begin contractons at this time , you would generally be allowed to labor and to deliver. Although we have yet to figure out what causes spontaneous labor to insue, we do know that infants born at 36 weeks and greater will have lower risks of complications than those born before 36 weeks. There is a transition period between 36 and 39 weeks where a signifant number of babies born, will be born with complications of prematurity such as "RESPIRATORY DISTRESS SYNDROME" . RDS , is one such complication which will require admission to the intensive care unit for intubation and breathing assistance. Current studies show that RDS can occur in significant numbers up to 39 weeks. Therefore, The American College of Obstetricians and Gynecologist along with the March of Dimes have initiated a campaign to educate patients on the importance of waiting until the 39 th week to deliver. This is the current recommendation for those moms who chose to have an elective labor induction. Although you may opt for an elective induction at 39 weeks, there are factors to take into consideration to maximize your chance of a successful vaginal delivery. Always remember that the best way to reduce your chance of having multiple C sections in the future is to prevent the FIRST one from happening. If you are considering an elective induction and you are 39 weeks, the following are a few considerations:

1. Is your cervix open, soft and favorable for induction? Your doctor will check your cervix and assess its "ripeness" for induction . It stands to reason that the greater your dilation, the softer your cervix , and the lower in the pelvis that the baby is engaged, then the more likely you are to have a relatively short and successful labor induction. Conversely, the more unfavorable your cervix, the more likely you are to have a prolonged induction which may last 2-3 days, and result in infection, maternal fatigue and exhaustion, excessive bleeding, a need for transfusion or hysterectomy, or an eventual C-Section. Your doctor will rate your cervix's "ripeness" with a number called a "BISHOP'S SCORE". The higher this number is on a scale of 1-10, especially greater that 5, the more likely are the chance of you having a successful induction. If your cervix is favorable, then you will be given the induction agent called PITOCIN. If, however, your cervix is unfavorable, then you will be given a vaginal or oral medication called CYTOTEC.

2. Do you feel that inducting your labor at 39 weeks will prevent you from having a bigger baby at 40 weeks and thereby lower you chance of having a C- section? The literature shows that inducing your labor to prevent a C-section does not reduce your chance of having a C-section. Studies show that hundreds of unnecessary C-section wound have to be performed to prevent one case of a permanent shoulder injury at the time of delivery.

3. If you are a well controlled Gestational Diabetic, not requiring insulin,

then you can wait until 40 weeks to be induced.

AC Pickett M.D. FACOG

for more information:

If you have a history of miscarriage between 13 and 24 weeks, you may have a condition known as CERVICAL INSUFFICIENCY or CERVICAL INCOMPETENCE. Typically , when  a patient reports a history of losing her baby in the middle trimester of pregnancy on 2 or more occations, this is the usual cause. If left untreated, then you may  continue to miscarry, each time earlier than the previous loss. This condition is caused by a cervix which has been weaked by some factor.

Risk factors may include: 

Multiple abortions or D&C procedures

Cervical Cone biopsies 

A parent that was exposed to DES ( diestherstilbestrol)

Cervical lacerations suffered from a difficult birth

Forcepts used during a prior delivery

Being born with  a CERVICAL WEAKNESS for unknown causes.

The natural history and presentation is described as " painless contractions and dilation resulting in  membrane rupture and subsequent pregnancy loss. " Many patients present to the hospital for vaginal bleeding between 13-24 weeks, passing copious amounts of mucous, or breaking their bag of water. What distiguishes this form of loss  from other causes is  that  there is usually no fever, chills or abdomenal pain. If these symtoms were present, then they  would indicate that an infection is the cause for the loss, and not CERVICAL INCOMPETANCE. Many patients, upon arrival to the hospital, are found to have a bag of water that is bulging and an  infant that  is seen in the birth canal. Unfortunately,   there is very  little that can be done to save the pregnany at that stage. Babies at this early  time can only survive near 23 weeks. Fortunately, in future pregancies a CERCLAGE can be placed on the cervix at around 14 weeks. This is a stitch which, when placed,  may give the cervix the strength needed to allow you to carry the pregnancy to term. Alternantively you may be offered the opportunity to take PROGESTRONE as a vaginal suppository or as a pill to prevent cervical dilation, or you may be given both. It's important to understand, that these recommendations come from clinical experience and expert opinion because valid studies on CERVICAL INCOMPETANCe are difficult to perform. Lastly, the emergency placement of a cerclage is almost never successful. By the time that the process  of dilation is advanced, the cervix has thinned to an extent that a stitch may do more harm than good frequently resulting in an  infection or in the  incidentally breaking of  the bag of water.

 A successful cerclage will be removed at 36 wks,  or sooner if labor ensues.

A Near fainting spell ( SYNCOPE) may happen even in a normal pregnancy. In many cases it may be the first sign that a woman is pregnant. Concominant symptoms include sweating palms blured vision, nausea, and seeing spots before your eyes. It occurs commonly in the first few weeks of pregnancy and in most cases signals no potential harm to your pregnancy. There are several physiological explanations for this symptom. First , pregnancy hormones initiate cardiovascular changes that result in vasodilation, blood volume expansion and rapid stronger heart beats. This dilation in your lower extremities known as POSTURAL HYPOTENTION occurs as gravity steals blood away from from your brain, thus leaving you feeling light headed and dizzy. The solution here is off stay off your feet for extended periods, avoid the heat and maintain a good level of hydration. your body will slowly make ajustments and you should no longer have these feelings. However, continued episodes of fainting, chest pain, shortness of breath or rapid heart beat are indications of a more serious problem. These are manifestions of heart disease such as valve problems, an irregualar heart beat or heart enlargement/. Please report this to your provider. (See *HEART DISEASE) Other common causes of near syncope include low blood sugar and anemia. ( See *ANEMIA and *DIABETES). Either low or high blood sugar may cause fainting. Have your blood sugar checked and be sure to have diabetes testing done between 24 and 28 weeks ( earlier if you have risk factors). Always eat a full balanced meal and NEVER starve or fast for long periods while pregnant. Anemia is a condition caused by iron poor blood. Although there are many causes of ANEMIA, IRON DEFICIENCY IS THE MOST COMMON CAUSE DURING PREGNANCY. Be sure to know your blood count and take at least one pill of Iron daily, which contains at least 30mg of elemental iron ( usual found in a single pill of FERROUS SULFATE 325mg) If you are diagnosed with anemia , you may be instructed to take additional iron. Eat a balanced diet rich in iron containing foods. Spinach, Kale, and Post Raison Bran Cereal are excellent sources of Iron.

I've loved you before I've known you, I've prepared my body to grow you , I've changed my life to receive you , now, I open my arms to welcome you! .....Ode to mothers expecting 2 b

Lets assume for a moment that you've already had and ultrasound, you are in your first trimester, and your Provider has confirmed that you have a normal pregnancy located inside the uterus.  You've also seen and confirmed the heartbeat. If all these facts have been confirmed, then one of the following is the likely cause of your bleeding (Known as POSTCOITAL SPOTTING): 

In order, from the  most to the least likely...

a) a sensitive vascular cervix

b) a cervicitis or  sexually transmitted infection

c) threatened miscarriage

c) a cervical polyp

d) cervical cancer or precancerous lesions

e) ectopic pregnancy

f) molar pregnancy

A SENSITIVE and VASCULAR CERVIX is the diagnosis most often associated this POSTCOITAL spotting. You may have noticed that you experienced spotting after your first doctor's visit. During your pelvic exam, a cervical culture or a pap smear may have been performed. When the cervix is HIGHLY VASCULAR it will bleed even when touched with a Q-TIP. This is a normal occurance due to changes that take place within the cervix. The endo-cervical cells grow to the outside AND BECOME EXPOSED  and form a condition called EXTROPION. Just as during the office exam, this sensitive, and friable cervix will easily bleed during deep intercourse. It is diagnosed during  visual inspection of the cervix during a pelvic exam.

While performing the exam, your provider will perform cervical/vaginal cultures to look for CERVICITIS or SEXUALLY TRANSMITED INFECTIONS (STD).

Cervicitis may be caused by GARDENERELLA VAGINALIS which is NOT considered to be an STD. TRICHOMONAS VAGINALIS is another infection that may be transmitted sexually. Both CLAMYDIA and GONORRHEA are STDs which cause POSTCOITAL SPOTTING.

During the exam, your provider may note a growth of tissue attached to the cervix called a POLYP. These growths are usually benign and not cancerous, but will often be a source of bleeding.

Here, I shall discuss 3 conditions associated with bleeding after sex that are mistakenly assumed to be caused by sex:

THREATENED MISCARRIAGE

ECTOPIC PREGNANCY

MOLAR PREGNANCY

  Occationally, due to poor implantation you may start to bleed in the first trimester. This is known as a THREATENED ABORTION.  At times,   the bleeding may be so very slight, that you may not otherwise  notice it until you've had sex. The slight bleeding may have remained hidden in the upper vagina and eventually have come out as a dark brown "COFFEE GROUNDS" appearing discharge. Having intercouse may simple cause this blood to come out sooner.  See *MISCARRAIGE for further information.

For the same reason , bleeding may occur when an ECTOPIC PREGNANCY is present. This diagnosis would have been found on an earlier ultrasound.  It is included here because of its  rare occurence and potential  of being missed due to a HETEROTOPIC PREGNANCY. This is defined as TWO simultaneous pregnancies; one located in the uterus and the other outside of the uterus ie, in the tubes. This condition causes bleeding on its own, but you may mistakenly think that it was caused by intercouse.

A MOLAR PREGNANCY is a benign tumorous growth of the placenta which causes bleeding. Again, this would have been diagnosed easily by an early first trimester  ultrasound see *MOLAR PREGNANCY

CERVICAL CANCER or a rare cause of postcoital spotting. It is not usually seen  in a younger,  reproductive aged population of patients. A history of THE HPV VIRUS is a risk factor,  as well as a history of having ABNORMAL PAP SMEARS. See *CERVICAL CANCER.

The commonality amongst all of these potential causes,  is that they require a cervical exam and an early ultrasound to find the source of the bleeding. 

If you are in your 2nd or 3rd trimester, the source of bleeding is different and  often is more dangerous. Please see *SECOND TRIMESTER and *THIRD TRIMESTER BLEEDING for further explanation. 

ACPICKETT M.D. FACOG

for more info;

Nausea and vomiting is quite common in pregnancy, affecting a majority (85%) of woman up to 12 weeks. Various names have been used to describe this condition including: Morning sickness, Hyperemesis Gravidarum, and currently Nausea and Vomiting in Pregnancy (NVP). The term Morning Sickness is no longer used because, although most women feel sick between 9 am and 12 noon, many others may experience these symptoms anytime through out the day. If your Provider has excluded the long list of other conditions* that may cause NVP, then rest assured that your pregnancy should proceed without a problem. In my practice I have noticed that Nausea and Vomiting is usually a sign of a healthy pregnancy. I am often worried when my patients tell me that they feel no nausea or change in appetite in their first 12 weeks. My experience was confirmed in a study which showed that women with Nausea and Vomiting (NVP) are LESS likely to suffer a miscarriage than other women. No one knows the true cause of NVP. An interesting question is: why would nature evolve women to have Nausea and Vomiting during a time when seemingly the growing baby would need nutrients the most ?. Some theorize that vomiting serves the purpose of ridding the body of toxins and enviornmental chemicals that may harm the pregnacy during the crucial stage of organ development. Others posit that an empty stomach causes Vomiting and thus should be avoided. Therefore to prevent Nausea, a woman should keep her stomach from being empty at any given time. This would assure , theoretically, that the growing baby has all the necessary nutrients needed in order to develop. What we do know is that HIGH LEVELS of pregnancy hormone is associated with NVP. Perhaps this is why during a failing pregnancy the hormone levels start to fall. Woman in the process of miscarrying usually do not feel sick. My personal theory is that the vomiting rids the body of excess acid and the resulting shift to a less acidic or ALKALINE balance in the body is crucial for DNA developemnt and cell division and growth. Once the baby’s DNA has been synthesised and the cells have formed organs, the body no longer needs a less acidic enviornment, rather more calories are needed in order to support the baby’s growth of new tissues. Here are some tips regarding treatment : Most cases resolve sponteously by 12 weeks. Almost all cases of true NVP, will be resolved by !4 weeks. I have personally never seen it continue beyond the 14th week. If it does continue beyond this time period, then it is probably NOT Nausea and Vomiting in Pregnancy, but a more serious medical condition that needs diagnosing ( see * List of OTHER CAUSE below). Please also consider depression as a cause for cases that last beyond 14 weeks. To successfully navigate through this illness, you first need supportive family members, and partners. Also you need Providers that take your concerns seriously and support you through this difficult period. Do keep hope and know that this is a temporary adjustment period and that you will soon get relief from this condition. Do alter your diet by eating frequent smal meals throughout the day to avoid having an empty stomach. Avoid greasy, fried foods, or hot and spicy dishes. High carb foods are better tolerated. Drink fluids such as sports drinks ,GATORAIDE, and PEDIALYTE, which may replace electroltes and thus decrease stomach muscle spasms during retching. During this period, it is common to LOOSE weight. Most of the weight gain will return after 12 weeks. There are a number of medications that yourProvider may prescibe for you. The most popular today are ZOFRAN ( ondansetron), phenergan, tigan, compazine, and a newer drug call DICLEGIS ( which contains Vitamin B6 “pyidoxine phosphate” ). They have all been shown to be effective. The fact that Vitamin B6 is effective would support my theory of causation of NVP in that vitamins in particular B6, is important for DNA synthesis and growth in the baby. I personally believe that although unpleasant , suppositories work better than oral meds. Pills, oftentimes, are soon vomited after ingestion. For the patients who are interested in natural remedies, accupressure, wrist band, ginger root capsules, and hypnotherapy may be attempted. Their reported success is variable. For woman that have excessive salivation, I have recommended eating GINGER SNAP COOKIES with good success. Ensure and Boost are nutritional supplements that are beneficial in increasing your caloric intake.The next question is : When is hospitalization necessary? The answer is, when there is significant dehydation. I allow patients no more than 2 days to respond to medication and other regimens, after this point they are instructed to present to the hospital for IV HYDRATION and nutrient supplementation. An objective way for you to know that dehydration has set in , even before 2 days, is when there is fainting, parched lips, dry mouth, sunken temples, blood shot eyes , or the inability to even drink water. Your doctor may test your urine for the presence of KETONES, which is a sure indicator of starvation. A positive test would prompt rapid hospitalization. You will then be hospitalized and hydrated, supplemented with vitamins and given stronger IV anti-nausea meds. Once you no longer have ketones in the urine, and you are able to eat, then you are generally discharged to home. During this time , additional tests and exams will be performed to ascertain other more serious causes for your Nausea and Vomiting. In severe and unresponsive cases, not caused by other illnesses, I have used IV STEROIDS with great personal success.

Finally treatment must be tailored to the individual. No two woman will respond in the same way to any one treatment regimen. Therefore, avoid comparing yourself to others. Sometimes through strong support, and a small amount of trial and error, you and your Provider will find the perfect regimen to relieve your suffering. In the end , your reward is a healthy baby.

*LIST of Other Conditions:

Twins

molar pregnany

Depression

migraines

meniere's inner ear disease

otitis media

sinusitis

Brain and pituitary tumors

meningitis

increased intracanial pressure

Severe Hypertension

Hyperthyroidism

kidney infections

kidney stones

biliary cholic

hepatitis

the flu

Gallstones

appendicitis