What to expect when you're expecting (214 page)

Abnormal tissue discharge

Elevated hCG levels that do not return to normal after a pregnancy has ended

A tumor in the vagina, uterus, or lungs

Abdominal pain

What can you and your practitioner do?
Call your practitioner if you experience any of the above symptoms, but keep in mind that it’s extremely unlikely that they indicate a choriocarcinoma. If you are diagnosed, the news is very reassuring. While any type of cancer carries with it some risk, choriocarcinoma responds extremely well to chemotherapy and radiation treatments and has a cure rate of more than 90 percent. Hysterectomy is almost never necessary because of this type of tumor’s excellent response to chemotherapy drugs.

You’ll Want to Know …

With early diagnosis and treatment of choriocarcinoma, fertility is unaffected, though it’s usually recommended that pregnancy be deferred for one year after treatment for choriocarcinoma is complete and there is no evidence of residual disease.

What is it?
Eclampsia is the result of uncontrolled or unresolved preeclampsia (see
page 548
). Depending on what stage of pregnancy a woman is in when she becomes eclamptic, her baby may be at risk of being born prematurely since immediate delivery is often the only treatment. Although eclampsia is life-threatening for the mother, maternal deaths from it are quite rare in the United States. With optimum treatment and careful follow-up, the majority of women with eclampsia return to normal health after delivery.

How common is it?
Eclampsia is much less common than preeclampsia and occurs in only 1 out of every 2,000 to 3,000 pregnancies, typically among women who have not been receiving regular prenatal care.

What are the signs and symptoms?
Seizures—usually close to or during delivery—are the most characteristic symptom of eclampsia. Postpartum seizures can also occur, usually within the first 48 hours after delivery.

What can you and your practitioner do?
If you already have preeclampsia and start to seize, you’ll be given oxygen and drugs to arrest the seizures and your labor will be induced or a C-section performed when you’re stable. The majority of women rapidly return to normal after delivery, though careful follow-up is necessary to be certain blood pressure doesn’t stay up and seizures don’t continue.

Can it be prevented?
Regular checkups with your practitioner will allow him or her to pick up on any of the symptoms of preeclampsia. If you are diagnosed with preeclampsia, your practitioner will keep a close eye on you (and your blood pressure) to make sure your condition doesn’t progress to eclampsia. Taking steps to try to prevent preeclampsia can also help avoid eclampsia.

You’ll Want to Know …

Very few women receiving regular prenatal care ever progress from the manageable preeclampsia to the more serious eclampsia.

What is it?
Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is slowed (as a result of pregnancy hormones), causing the buildup of bile acids in the liver, which in turn can spill into the bloodstream. Cholestasis is most likely to occur in the last trimester, when hormones are at their peak. It usually goes away after delivery.

Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth, which is why early diagnosis and treatment are crucial.

How common is it?
Cholestasis affects 1 to 2 pregnancies in 1,000. It’s more common in women carrying multiples, women who have previous liver damage, and in women whose mother or sisters had cholestasis.

What are the signs and symptoms?
Most often, the only symptom noticed is severe itching, particularly on the hands and feet, usually late in pregnancy.

What can you and your practitioner do?
The goals of treating cholestasis of pregnancy are to relieve the itching and prevent pregnancy complications. Itching can be treated with topical anti-itch medications, lotions, or corticosteroids. Medication is sometimes used to help decrease the concentration of bile acids. If cholestasis is endangering the well-being of the mother or fetus, an early delivery may be necessary.

What is it?
Deep venous thrombosis, or DVT, is the development of a blood clot in a deep vein. These clots show up most commonly in the lower extremities, particularly the thigh. Women are more susceptible to clots during pregnancy and delivery, and particularly in the postpartum period. This happens because nature, wisely worried about too much bleeding at childbirth, tends to increase the blood’s clotting ability—occasionally too much. Another factor that can contribute is the enlarged uterus, which makes it difficult for blood in the lower body to return to the heart. If untreated, a DVT can result in the clot moving to the lungs and becoming life threatening.

How common is it?
Deep venous thrombosis occurs once in every 1,000 to 2,000 pregnancies (it can also occur postpartum). DVT is more common if you are older, a smoker, have a family or personal history of clots, or have hypertension, diabetes, or a variety of other conditions, including vascular diseases.

What are the signs and symptoms?
The most common symptoms of a deep vein thrombosis include:

A heavy or painful feeling in the leg

Tenderness in the calf or thigh

Slight to severe swelling

Distention of the superficial veins

Calf pain on flexing the foot (turning the toes up toward the chin)