What to expect when you're expecting (17 page)

Sometimes, a woman with fibroids notices abdominal pressure or pain. If you do, report it to your practitioner, though it usually isn’t anything to worry about. Bed rest for four or five days along with the use of safe pain relievers (ask your practitioner to recommend one) usually brings relief.

Very occasionally, fibroids can slightly increase the risk of such complications as abruption (separation) of the placenta, preterm birth, and breech birth, but these minimal risks can be reduced even further with the right precautions. Discuss the fibroids with your physician so you can find out more about the condition in general and the risks, if any, in your particular case. If your practitioner suspects that the fibroids could interfere with a safe vaginal delivery, he or she may opt to deliver by C-section. In most cases, however, even a large fibroid will move out of the baby’s way as the uterus expands during pregnancy.

“I had a couple of fibroids removed a few years ago. Will that affect my pregnancy?”

In most cases, surgery for the removal of small uterine fibroid tumors (particularly if the surgery was performed laparoscopically. doesn’t affect a subsequent pregnancy. Extensive surgery for large fibroids could, however, weaken the uterus enough so that it wouldn’t be able to handle labor. If, after reviewing your surgical records, your practitioner decides this might be true of your uterus, a C-section will be planned. Become familiar with the signs of early labor in case contractions begin before the planned surgery (see
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), and have a plan in place for getting to the hospital quickly if you do go into labor.

“After years of suffering with endometriosis, I’m finally pregnant. Will I have problems with my pregnancy?”

Endometriosis is typically associated with two challenges: difficulty in conceiving and pain. Becoming pregnant means that you’ve overcome the first of those challenges (congratulations!). And the good news gets even better. Being pregnant may actually help with the second challenge.

The symptoms of endometriosis, including pain, do improve during pregnancy. This seems to be due to hormonal changes. When ovulation takes a hiatus, the endometrial implants generally become smaller and less tender. Improvement is greater in some women than in others. Many women are symptom free during the entire pregnancy; others may feel increasing discomfort as the fetus grows and begins packing a stronger punch, particularly if those punches and kicks reach tender areas. Fortunately, however, having endometriosis doesn’t seem to raise any risks during pregnancy or childbirth (though if you’ve had uterine surgery, your practitioner will probably opt to deliver via C-section).

The less happy news is that pregnancy only provides a respite from the symptoms of endometriosis, not a cure. After pregnancy and nursing (and sometimes earlier), the symptoms usually return.

“A year before I got pregnant, I had a colposcopy and cervical biopsy performed. Is my pregnancy at risk?”

A colposcopy is usually performed only after a routine Pap smear shows some irregular cervical cells. The simple procedure involves the use of a special microscope to better visualize the vagina and cervix. If abnormal cells are noticed on a Pap smear, as they probably were in your case, your physician performs a cervical, or cone, biopsy (in which tissue samples are taken from the suspicious area of the cervix and sent to the lab for further evaluation), cryosurgery (during which the abnormal cells are frozen), or a loop electrocautery excision procedure (LEEP, during which the affected cervical tissue is cut away using a painless electrical current). The good news is that the vast majority of women who have had such procedures are able to go on to have normal pregnancies. Some women, however, depending on how much tissue was removed during the procedure, may be at increased risk for some pregnancy complications, such as incompetent cervix and preterm delivery. Be sure your prenatal practitioner is aware of your cervical history so that your pregnancy can be more closely monitored.

If abnormal cells are noted during your first prenatal visit, your practitioner may opt to perform a colposcopy, but biopsies or further procedures are usually delayed until after the baby is born.

“Can having genital HPV affect my pregnancy?”

Genital HPV is the most common sexually transmitted virus in the United States, affecting more than 75 percent of sexually active people, yet most of those who become infected with it never know. That’s because most of the time, HPV causes no obvious symptoms and usually resolves on its own within six to ten months.

There are some times, however, when HPV does cause symptoms. Some strains cause cervical cell irregularities (detected on a Pap smear); other strains can cause genital warts (in appearance they can vary from a barely visible lesion to a soft, velvety “flat” bump or a cauliflower-like growth; colors range from pale to dark pink) that will show up in and on the vagina, vulva, and rectum. Though usually painless, genital warts may occasionally burn, itch, or even bleed. In most cases, the warts clear on their own within a couple of months.

Other STDs and Pregnancy

Not surprisingly, most STDs can affect pregnancy. Fortunately, most are easily diagnosed and treated safely, even during pregnancy. But because women are often unaware of being infected, the Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be tested early in pregnancy for at least the following STDs: chlamydia, gonorrhea, trichomoniasis, hepatitis B, HIV, and syphilis.

Keep in mind that STDs don’t happen just to one group of people or only at a certain economic level. They can occur in women (and men) in every age group, of every race and ethnic background, at every income level, and among those living in small towns as well as in big cities. The major STDs include:

Gonorrhea.
Gonorrhea has long been known to cause conjunctivitis, blindness, and serious generalized infection in a fetus delivered through an infected birth canal. For this reason, pregnant women are routinely tested for the disease, usually at their first prenatal visit. Sometimes, particularly in women at high risk for STDs, the test is repeated late in pregnancy. If infection with gonorrhea is found, it is treated immediately with antibiotics. Treatment is followed by another culture, to be sure the woman is infection free. As an added precaution, an antibiotic ointment is squeezed into the eyes of every newborn at birth. (This treatment can be delayed for as long as an hour—but no longer—if you want to have some unblurry eye-to-eye contact with your baby first.)

Syphilis.
Because this disease can cause a variety of birth defects as well as stillbirth, testing is also routine at the first prenatal visit. Antibiotic treatment of infected pregnant women before the fourth month, when the infection usually begins to cross the placental barrier, almost always prevents harm to the fetus. The very good news is that mother-to-baby transmission of syphilis is down in recent years.

Chlamydia
. There are more cases of chlamydia in this country than gonorrhea or syphilis, with the disease affecting sexually active women under 26 years old most often. Chlamydia is the most common infection passed from mother to fetus, and it is considered a potential risk to the fetus and a possible risk to mothers. Which is why chlamydia screening in pregnancy is a good idea, particularly if you have had multiple sexual partners in the past, increasing your chance of infection. Because about half the women with chlamydial infection experience no symptoms, it often goes undiagnosed if it’s not tested for.

Prompt treatment of chlamydia prior to or during pregnancy can prevent chlamydial infections (pneumonia, which fortunately is most often mild, and eye infection, which is occasionally severe) from being transmitted by the mother to the baby during delivery. Though the best time for treatment is prior to conception, administering antibiotics (usually azithromycin) to the pregnant infected mother can also be effective in preventing infant infection. The antibiotic ointment routinely used at birth protects the newborn from chlamydial, as well as gonorrheal, eye infection.

Trichomoniasis.
The symptoms of this parasite-caused STD (also referred to as trichomonas infection, or “trich”) are a greenish, frothy vaginal discharge with an unpleasant fishy smell and, often, itching. About half of those affected have no symptoms at all. Though the disease does not usually cause serious illness or pregnancy problems (or affect a baby whose mom is infected), the symptoms can be irritating. Generally, women are treated during pregnancy only if they’re having symptoms.

HIV infection.
It is becoming increasingly routine for pregnant women to be tested for HIV (human immunodeficiency virus), whether or not they have a prior history of high-risk behavior. Many states actually require doctors to offer HIV counseling and testing to pregnant women, and ACOG recommends that all pregnant women, regardless of risk, be tested. Infection in pregnancy by the HIV virus, which causes AIDS, is a threat not just to the expectant mother but to her baby as well. About 25 percent of babies born to untreated mothers will develop the infection (testing will confirm it in the first six months of life). Luckily, there is plenty of hope with the treatments that are now available. But before taking any action, anyone who tests HIV positive may want to consider a second test (tests are highly accurate but can sometimes be positive in someone who does not have the virus). If a second test is positive, then formal counseling about AIDS and the treatment options is absolutely imperative. Treating an HIV-positive mother with AZT (also known as zidovudine—ZDV—or Retrovir) or other antiretroviral drugs can dramatically reduce the risk of her passing the infection on to her child, apparently without any damaging side effects. Delivering by elective C-section (before contractions begin and before membranes rupture) can reduce the risk of transmission further.

If you suspect that you may have been infected with any STD, check with your practitioner to see if you’ve been tested; if you haven’t, ask to be. If a test turns out to be positive, be sure that you—and your partner, if necessary—are treated. Treatment will protect not only your health but that of your baby.

How does genital HPV affect a pregnancy? Luckily, it’s unlikely to affect it at all. Some women, however, will find that pregnancy will affect their HPV, causing the warts to become more active. If that’s the case with you, and if the warts don’t seem to be clearing on their own, your practitioner may recommend treatment during pregnancy. The warts can be safely removed by freezing, electrical heat, or laser therapy, although in some cases, this treatment may be delayed until after delivery.

If you do have HPV, your practitioner will also want to check your cervix to make sure there are no cervical cell irregularities. If abnormalities are found, any necessary cervical biopsies to remove the abnormal cells will likely be postponed until after your baby is delivered.

Because HPV is highly contagious, practicing safe sex and sticking with one partner is the best way to prevent reoccurrence. Though there is a vaccine available now to prevent HPV in women under 26, it’s not recommended for use during pregnancy. If you started the vaccine course (it’s given in a three-dose series) and then became pregnant before completing the series, you’ll need to hold off on the remaining doses until after your baby is born.

“I have genital herpes. Can my baby catch it from me?”

Having genital herpes during pregnancy is cause for caution but definitely not for alarm. In fact, the chances are excellent that your baby will arrive safe, sound, and completely unaffected by herpes, particularly if you and your practitioner take protective steps during pregnancy and delivery. Here’s what you need to know.

First of all, infection in a newborn is quite rare. A baby has only a less than 1 percent chance of contracting the condition if the mother has a recurrent infection during pregnancy (that is, she’s had herpes before). Second, though a primary infection (one that appears for the first time) early in pregnancy increases the risk of miscarriage and premature delivery, such infection is uncommon. Even for babies at greatest risk—those whose mothers have their first herpes outbreak as delivery nears (which in itself is rare because it’s tested for routinely)—there is an up to 50 percent chance that they will escape infection. Finally, the disease, though still serious, seems to be somewhat milder in newborns these days than it was in the past.

So if you picked up your herpes infection before pregnancy, which is most likely, the risk to your baby is very low. And with good medical care it can be lowered still further.

To protect their babies, women who have a history of herpes and have recurrent herpes during pregnancy are usually given antiviral medications. Those who have active lesions at the onset of labor are usually delivered by cesarean. In the unlikely event a baby is infected, he or she will be treated with an antiviral drug.

After delivery, the right precautions can allow you to care for—and breastfeed—your baby without transmitting the virus, even during an active infection.

Signs and Symptoms of Genital Herpes

It is during a primary, or first, episode that genital herpes is most likely to be passed on to the fetus, so call your practitioner if you experience the following symptoms of infection: fever, headache, malaise, and achiness for two or more days, accompanied by genital pain, itching, pain when urinating, vaginal and urethral discharge, and tenderness in the groin, as well as lesions that blister and then crust over. Healing of the lesions generally takes place within two to three weeks, during which time the disease can still be transmitted.