What to expect when you're expecting (206 page)

Heavier vaginal bleeding

What can you and your practitioner do?
Occasional cramping and even slight spotting early in pregnancy is not cause for alarm, but do let your practitioner know if you experience any type of pain, spotting, or bleeding. Call right away if you experience sharp, crampy pain in the lower abdomen, heavy bleeding, or any of the other symptoms of a ruptured ectopic pregnancy just listed. If it is determined that you have an ectopic pregnancy (usually diagnosed through ultrasound and blood tests), there is, unfortunately, no way to save the pregnancy. You’ll most likely have to undergo surgery (laparoscopically) to remove the tubal pregnancy or be given drugs (methotrexate), which will end the abnormally occurring pregnancy. In some cases, it can be determined that the ectopic pregnancy is no longer developing and can be expected to disappear over time on its own, which would also eliminate the need for surgery.

You’ll Want to Know …

Occasional cramping in your lower abdomen early in pregnancy is probably the result of implantation, normally increased blood flow, or ligaments stretching as the uterus grows, not a sign of an ectopic pregnancy.

Because residual material from a pregnancy left in the tube could damage it, a follow-up test of hCG levels is performed to be sure the entire tubal pregnancy was removed or has reabsorbed.

Can it be prevented?
Getting treated for sexually transmitted diseases (STDs), and the prevention of STDs (through the practice of safe sex) can help reduce the risk of an ectopic pregnancy, as can quitting smoking.

What is it?
A subchorionic bleed (also called a subchorionic hematoma) is the accumulation of blood between the uterine lining and the chorion (the outer fetal membrane, next to the uterus) or under the placenta itself, often (but not always) causing noticeable spotting or bleeding.

In the vast majority of cases, women who have a subchorionic bleed go on to have perfectly healthy pregnancies. But because (in rare cases) bleeds or clots that occur under the placenta can cause problems if they get too large, all subchorionic bleeds are monitored.

How common is it?
Around 1 percent of all pregnancies have a subchorionic bleed. Of those women who experience first-trimester bleeding, 20 percent of them are diagnosed with a subchorionic bleed as the cause of the spotting.

What are the signs and symptoms?
Spotting or bleeding may be a sign, often beginning in the first trimester. But many subchorionic bleeds are detected during a routine ultrasound, without there being any noticeable signs or symptoms.

You’ll Want to Know …

Asubchorionic bleed does not affect the baby, and since you’ll be checked with ultrasounds until the hematoma corrects itself, you’ll get reassurance each time you see your baby’s heartbeat (and that will be more often than most expectant parents get!).

What can you and your practitioner do?
If you have spotting or bleeding, call your practitioner; an ultrasound may be ordered to see whether there is indeed a subchorionic bleed, how large it is, and where it’s located.

What is it?
Hyperemesis gravidarum is the medical term for severe pregnancy nausea and vomiting that is continuous and debilitating (not to be confused with typical morning sickness, even a pretty bad case). Hyperemesis usually starts to lift between weeks 12 and 16, but some cases can continue throughout pregnancy.

Hyperemesis gravidarum can lead to weight loss, malnutrition, and dehydration if it’s left untreated. Treatment of severe hyperemesis often requires hospitalization—mostly for the administration of IV fluids and antinausea drugs, which can effectively safeguard your well-being and your baby’s.

How common is it?
Hyperemesis gravidarum occurs in about 1 in 200 pregnancies. This pregnancy complication is more common in first-time mothers, in young mothers, in obese women, in women carrying multiple fetuses, and in women who’ve had it in a previous pregnancy. Extreme emotional stress can also increase your risk, as can endocrine imbalances and vitamin B deficiencies.

What are the signs and symptoms?
The symptoms of hyperemesis gravidarum include:

Very frequent and severe nausea and vomiting

The inability to keep any food or even liquid down

Signs of dehydration, such as infrequent urination or dark yellow urine

Weight loss of more than 5 percent

Blood in the vomit

What can you and your practitioner do?
If your symptoms are relatively mild, you can first try some of the natural remedies used to fight morning sickness, including ginger, acupuncture, and acupressure wristbands (see
page 130
). If those don’t do the trick, ask your practitioner about medications that can help (a combination of vitamin B
6
and Unisom Sleep Tabs is often prescribed for tough morning sickness cases). But if you’re vomiting continually and/or losing significant amounts of weight, your practitioner will assess your need for intravenous fluids and/or hospitalization, and possibly prescribe some sort of antiemetic (antinausea) drug. Once you’re able to keep food down again, it may help to tweak your diet to eliminate fatty and spicy foods, which are more likely to cause nausea, as well as to avoid any smells or tastes that tend to set you off. In addition, try to graze on many small high-carb and high-protein meals throughout the day, and be sure your fluid intake is adequate (keeping an eye on your urinary output is the best way to assess that; dark scant urine is a sign you’re not getting, or keeping down, enough fluids).

You’ll Want to Know …

As miserable as hyperemesis gravidarum makes you feel, it’s unlikely to affect your baby. Most studies show no health or developmental differences between infants of women who experience hyperemesis gravidarum and those who don’t.

What is it?
Gestational diabetes (GD)—a form of diabetes that appears only during pregnancy—occurs when the body does not produce adequate amounts of insulin (the hormone that lets the body turn blood sugar into energy) to regulate blood sugar effectively. GD usually begins between weeks 24 and 28 of pregnancy (which explains why a glucose screening test is routine at around 28 weeks). GD almost always goes away after delivery, but if you’ve had it, you’ll be checked postpartum to make sure it’s gone.

Diabetes, both the kind that begins in pregnancy and the kind that started before conception, is not harmful to either the fetus or the mother if it is well controlled. But if excessive sugar is allowed to circulate in a mother’s blood and thus to enter the fetal circulation through the placenta, the potential problems for both mother and baby are serious. Women who have uncontrolled GD are more likely to have a too-large baby, which can complicate delivery. They are also at risk for developing preeclampsia (pregnancy-induced hypertension). Uncontrolled diabetes could also lead to potential problems for the baby after birth, such as jaundice, breathing difficulties, and low blood sugar levels. Later in life, he or she may be at an increased risk for obesity and type 2 diabetes.

How common is it?
GD is fairly common, affecting 4 to 8 percent of expectant women. Because it’s more common among obese women, rates of GD are rising along with rising obesity rates in the United States. Older moms-to-be are more likely to develop GD, as are women with a family history of diabetes or GD. Native Americans, Latin Americans, and African Americans are also at somewhat greater risk for GD.

What are the signs and symptoms?
Most women with GD have no symptoms, though a few may experience:

Unusual thirst