What to expect when you're expecting (213 page)

What are the signs and symptoms?
The most common sign of a cord knot is decreased fetal activity after week 37. If the knot occurs during labor, a fetal monitor will detect an abnormal heart rate.

What can you and your practitioner do?
You can keep a general eye on how your baby is doing, especially later in your pregnancy, by doing regular kick counts and calling your practitioner if you notice any change in fetal activity. If a loose knot tightens during delivery, your practitioner will be able to detect the drop in your baby’s heart rate, and will make the appropriate decisions to ensure your baby’s safe entry into the world. Immediate delivery, usually via C-section, is often the best approach.

What is it?
In a normal umbilical cord, there are three blood vessels—one vein (which brings nutrients and oxygen to the baby) and two arteries (which transport waste from the baby back to the placenta and the mother’s blood). But in some cases, the umbilical cord contains only two blood vessels—one vein and one artery.

How common is it?
About 1 percent of singletons and 5 percent of multiple pregnancies will have a two-vessel cord. Those at greater risk include Caucasian women, women over age 40, those carrying a multiple pregnancy, and those with diabetes. Female fetuses are more likely to be affected by a two-vessel cord than males.

What are the signs and symptoms?
There are no signs or symptoms with this condition; it’s detected on ultrasound examination.

What can you and your practitioner do?
In the absence of any other abnormalities, a two-vessel cord in no way harms the pregnancy. The baby is most likely to be born completely healthy. So the first thing you can do is not worry.

If you’ve been found to have a two-vessel cord, your pregnancy will be monitored more closely, since the condition comes with a small increased risk of poor fetal growth.

The following complications of pregnancy are, for the most part, rare. The average pregnant woman is extremely unlikely to encounter any of them. So, again (and this deserves repeating), read this section
only
if you need to—and even then, read just what applies to you. If you are diagnosed with any of these complications during your pregnancy, use the information here to learn about the condition and its typical treatment (as well as how to prevent it in future pregnancies), but realize that your practitioner’s protocol for treating you may be different.

What is it?
In a molar pregnancy, the placenta grows improperly, becoming a mass of cysts (also called a hydatidiform mole), but there is no accompanying fetus. In some cases, identifiable—but not viable—embryonic or fetal tissue is present; this is called a partial molar pregnancy.

The cause of a molar pregnancy is an abnormality during fertilization, in which two sets of chromosomes from the father become mixed in with either one set of chromosomes from the mother (partial mole)—or none of her chromosomes at all (complete mole). Most molar pregnancies are discovered within weeks of conception. All molar pregnancies end in miscarriage.

You’ll Want to Know …

Having had one molar pregnancy doesn’t put you at much higher risk for having another one. In fact, only 1 to 2 percent of women who have had one molar pregnancy go on to experience a second.

How common is it?
Luckily, molar pregnancies are relatively rare, occurring only in 1 out of 1,000 pregnancies. Women under the age of 15 or over the age of 45, as well as women who have had multiple miscarriages are at a slightly increased risk for a molar pregnancy.

What are the signs and symptoms?
The symptoms of a molar pregnancy can include:

A continuous or intermittent brownish discharge

Severe nausea and vomiting

Uncomfortable cramping

High blood pressure

Larger than expected uterus

Doughy uterus (rather than firm)

Absence of embryonic or fetal tissue (as seen on ultrasound)

Excessive levels of thyroid hormone in the mother’s system

What can you and your practitioner do?
Call your practitioner if you experience any of the symptoms listed above. Some of these symptoms can be difficult to differentiate from normal early pregnancy signs and symptoms (many completely normal pregnancies include some spotting and cramping, and most include nausea), but trust your instincts. If you think something’s wrong, talk to your practitioner—if only to get some much-needed reassurance.

If an ultrasound shows you do have a molar pregnancy, the abnormal tissue must be removed via a dilation and curettage (D and C). Follow-up is crucial to make sure it doesn’t progress to choriocarcinoma (see next column), though luckily, the chances of a treated molar pregnancy turning malignant are very low. Your practitioner will probably suggest that you not get pregnant for a year following a molar pregnancy.

What is it?
Choriocarcinoma, an extremely rare form of cancer related to pregnancy, grows from the cells of the placenta. This malignancy most often occurs after a molar pregnancy, miscarriage, abortion, or ectopic pregnancy, when any left-behind placental tissues continue to grow despite the absence of a fetus. Only 15 percent of choriocarcinomas occur after a normal pregnancy.

How common is it?
Choriocarcinoma is extremely rare, occurring in only 1 out of every 40,000 pregnancies.

What are the signs and symptoms?
The signs of the disease include:

Intermittent bleeding following a miscarriage, a pregnancy, or the removal of a molar pregnancy