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Wednesday, August 31, 2005

Severe headaches after childbirth

Dear Dr. Amy,

This question is for my best friend. She just had a baby 3 weeks ago. Ever since she gave birth, she's been having killer headaches. She said that they didn't give her any drugs, because it was too late. She was a couple of day's late from her due date. She had the baby normally. She's not sure why she is getting these headaches. She said with her other 2 kids, this never happen. She just turn 20 last week. So, what could be the problem? Does she need to go see a doctor right away? Thanks Dr. Amy.

Yours Truly,
Aleia,

Dear Aleia,

Your friend needs to talk to her doctor right away. It's not common, but some women get pre-eclampsia after the baby is born. Pre-eclampsia can cause high blood pressure and strokes. It is important for your friend be examined as soon as possible.

Sincerely,
Amy

Is the baby growing?

I'm nearly 29 weeks pregnant, and the midwife says that the baby hasn't grown much since my previous check up four weeks ago. I am booked in for an ultrasound tomorrow, but I am really anxious.

seg

Dear seg,

Measuring your uterus gives only an estimate of how the baby is growing. You may measure smaller than expected, but the baby may be growing normally. The ultrasound will give more accurate information. Usually the ultrasound shows that the baby is fine.

Sincerely,
Amy

Trying to conceive

Hi,

I am 22 years old and trying have a second child. I have had problems with my periods since I started getting them. Before my first child they would come every 2 to 7 months. My doctor put me on birth control pills when i was 13 to regulate me. I went off when I was 19 and had my son after my 21st birthday.

I went on the depo shot after I had him (Dec. 8 2003). And went off in July of 2004. I have been getting my period every other week since which is putting a damper on having the second child. My doctor wants to put me back on birthcontrol but I dont want that. What should I do?

PF

Dear PF,

It sounds like you are not ovulating at all. Since you are not ovulating, you don't get a period, and the frequent bleeding could be caused by constantly shedding uterine lining.

There are a number of possible approaches to this situation, and only someone who has examined you and is familiar with your medical history could tell you what is best for you.

A 5 or 10 day course of Provera will stimulate a period. Sometimes that is enough to reset your hormonal system and get you started on normal cycles. If that doesn't work, you might also need medication such as Clomid to stimulate ovulation.

You might want to get a second opinion from another gynecologist or an infertility doctor to find out about all your options.

Sincerely,
Amy

Two miscarriages, can it happen again?

Hi Dr. Amy,

I am doing so research to ease my sister's mind. She is currently 12 1/2 weeks pregnant and stopped using progesterone two days ago following her doctor's orders. She had previously suffered 2 miscarriages and is paralyzed with fear of it happening again. She had a perfectly normal sonogram at 11 weeks (heart function, kidney function all normal - heartbeat at 164 per minute, brain forming and split). She is just so devastated by the thought of something happening again she is missing out on all the enjoyment of pregnancy. Her doctor is on vacation and is desperate for someone to ease her mind. Please help.

Patricia

Dear Patricia,

The chance of miscarriage in any pregnancy is 20%. That falls to 10% once the heartbeat is seen, and drops much further after 12 weeks. Obviously, no one can say for sure that everything is guaranteed to be fine, but the odds are on her side now.

Sincerely,
Amy

What causes PCOS?

Blood tests confirm that I have PCOS. My LH hormone level was 22.3, which is very high, and they they put me on metformin. The doctor said that if i'm not ovulating or pregnant within
two months he is going to put me on either clomid or both??? Is that heathly?

Is PCOS caused by bad diet and habits? Would more exercising and better habits help get rid of it since I'm borderline type 2 diabetic. Any suggestions? I've been off of my b/c pills since late january and still not pregnant. I'm only 23! we tested my partner for his sperm count and he is fine. Thanks

SK

Dear SK,

Polycystic ovary syndrome (also called Stein-Leventhal Syndrome) is caused by a hormone imbalance. Women with PCOS have enlarged ovaries that are filled with small cysts. In addition, they may have very irregular periods and excess body hair.

An excess of testosterone causes PCOS. Although testosterone is the male hormone, women also produce small amounts of testosterone from the ovaries and adrenal glands. Too much testosterone prevents ovulation, leading to infrequent periods or no periods at all.

Diet and exercise will not make PCOS go away. However, women with PCOS often have adult onset diabetes and diet and exercise will improve blood sugar. Metformin should also help.

Women who have PCOS often need medication to help them ovulate. Metformin seems to control the hormone imbalance in such a way that ovulation can occur. Metformin does not work for everyone though. In that case, stronger medications such as Clomid are needed. Clomid acts to stimulate the ovary to produce and release an egg. Some women cannot get pregnant at all without Metformin or Clomid or both.

Sincerely,
Amy

A Provera period and a followup question

Dear Dr. Amy,

If I took Provera before, will this second time be has bad as it was the first time? The first time I took it, my period was really heavy and I had a lot of blood clots. My OB/GYN doctor told me to take 10 mg of Provera for only 5 days. That was the same information when I first took them in May.

I'm just wondering, because I'm kinda afraid to go to school. I don't want to bleed everywhere. The reason I'm taking these pills is because I haven't had a period in almost 8 years. I had everything checked and nothing was wrong. So, my OB/GYN doctor gave me these pills for me to take so I can restart my period. Thanks Dr. Amy.

Yours Truly,
Aleia

Dear Aleia,

Yes, Provera will probably give you another very heavy period.

It's difficult to believe there is nothing wrong if you didn't get your period for almost 8 years. Did you have blood tests to make sure that you don't have any hormonal problems such as polycystic ovary syndrome (PCOS) or a thyroid problem.

You took the Provera in May and you got a period, but it did not lead to getting regular periods. I'm not sure why your doctor wants to try the same thing again. Has your doctor mentioned the possibility of taking birth control pills? Birth control pills will give you regular periods.

Sincerely,
Amy

Follow up question

Dear Dr. Amy,

I did have some blood test done and everything came back normal. Even my pap test came back normal. My doctor told me that me not having my period may have something to do with how my brain functions. She was going to put me on birth control, but at the time my blood pressure was kind of high and she didn't want to take any risk.

If I did have PCOS, would that show up on the pap test and the blood tests? My doctor told me to take Provera every 3 months if I don't have a period. She wants me to go back in December. She told me that taking this pill will help clean my inside out, because I haven't had a period in so long. Do you know any reason on why this is happening to me?

Aleia

Dear Aleia,

Only certain blood tests can tell if you have PCOS. You need to know if you had tests for LH, FSH and other female hormones. You'd also need to have tests for thyroid and pituitary problems. A Pap smear looks at cervical cells and has nothing to do with periods.

I suspect that there is a better explanation than you have been offered. It sounds like you may need a second opinion from another gynecologist or an endocrinologist (a specialist in hormones).

It is true that you should talk Provera if you don't get your periods for months at a time, but there should be an identifiable cause and possibly a better treatment.

Sincerely,
Amy

Two tests, two different results

Dr. Amy,

I am really confused. Then on the 26th it was time for my period to begin. It started late that afternoon but there was just light blood when I urinated. Then I slept with a pad on and it came out on the bad a little darker. I decided to take a test. The test was an ept. Its results looked as if they said postive. The negative bar was really dark but the cross in the other window was not as dark.

I didn't know what to do so I took another one last night Aug 30th which was first response. This one said negative. I don't know what to believe or do. Can those test be wrong?? Should I have bought another ept?? Please help me to understand and what should I do??

E

Dear E,

It isn't clear from your post, but it sounds like you did not have a normal period. Then you took two different pregnancy tests. The first one was positive, the second one negative. A positive result is usually correct; a negative result can mean that the amount of pregnancy hormone is still too small for that test to detect.

The best way to resolve the issue is to wait several more days and take another test, or to ask your doctor for a blood pregnancy test. Since the amount of pregnancy hormone doubles approximately evey 48 hours, there should be enough pregnancy hormone then to turn any test positive.

Sincerely,
Amy

Pap smear during pregnancy

Hi Dr Amy,

I live in Australia and we are recommended for pap smears every 2 years. I had one in January 2004 following the birth of my first child, therefore due again next January. I had a miscarriage 2 months ago (baby would have been due in January so would have had a pap smear after the birth) and now don’t know what to do. I have heard it is better not to have a pap smear during pregnancy so should I get one now?

We want to TTC again, but my periods are not back to normal yet, hope to conceive before the end of the year which means not due until middle or late 2006 making it nearly 3 years since last pap smear. Should I have one now and a gynae exam to reassure me that everything is OK and we can TTC again? Or should I wait until pregnant and then have one, after my miscarriage (I don’t know why it happened). I am so nervous to do anything that might disturb another pregnancy and would prefer to not risk a pap smear during pregnancy if it could possibly cause a miscarriage. What should I do?

Many thanks,
Anonymous from Australia

Dear Anonymous,

You ask a number of different questions.

1. Do you need to have a Pap smear every 2 years? That is the recommendation, but it does not have to be exactly every 2 years unless you have a history of abnormal cells or HPV (human papilloma virus). Talk to your doctor to find out what he or she recommends.

2. Can a Pap smear be performed during pregnancy? Yes, it can, though it is usually done differently in pregnant women than in non-pregnant women. Instead of using a brush to take cells from the cervix, the doctor uses a smooth swab to prevent any injury to the cervix.

3. Can a Pap smear cause a miscarriage? Almost all miscarriages are caused be one time, non-repeating genetic defects in the baby. This is determined at the moment of conception, and miscarriage is inevitable. Pap smears do not cause miscarriages.

So, depending on your medical history, you may need to have a Pap smear within the next 5 months which can be done before you get pregnant, or during pregnancy. If you don't need to have a Pap smear exactly 2 years after the previous one, you could wait until later in the year.

Sincerely,
Amy

Two vessel umbilical cord

I had an ultrasound at 16 wks because the doctor said I am not getting any bigger. He said that in the ultrasound it looked as though the baby had only two vessels instead of three. This makes me worry a bit. I am wondering what the causes and side effects of a two vessel umbilical cord. Will my baby be ok?

Thanks,
Brittany

Dear Brittany,

It sounds like your doctor ordered the ultrasound because he is concerned that your baby is not growing as expected. The ultrasound shows additional reason for concern.

A normal umbilical cord has three blood vessels. If one of the blood vessels is missing, it may be a sign that there are other problems as well. About 25% of babies with a two vessel cord have birth defects. Of course, that means that 75% have no other problems.

If the ultrasound shows a two vessel cord, a more comprehensive ultrasound (often called a level II ultrasound) should be performed by someone who is expert at identifying abnormalities. If any other abnormalities are found, you may wish to consider amniocentesis to find out if the baby has a chromosomal problem. This will give you more information about what to expect.

If your baby has a two vessel cord, but no other abnormalities can be found, the odds are high that the baby is perfectly fine.

Sincerely,
Amy

Low lying placenta

Hi Dr Amy,

I am approaching my 20th week of pregnancy and my last ultrasound showed a low lying placenta. How could this have been prevented? Is it fixable?

Tonia

Dear Tonia,

The location of the placenta depends on where the fertilized egg implanted in your uterus. There is no way to control that, so a low lying placenta can't be prevented.

It also can't be fixed, but it often fixes itself. That's because as the uterus grows, the placenta tends to move up, so a low lying placenta at 20 weeks is usually a normal placenta at the time of delivery.

If the placenta does not move up and out of the way, it is at risk for bleeding during labor. In that case, a C-section may be necessary. A placenta that is lying completely over the cervix is called a placenta previa. A C-section is always necessary for placenta previa.

Sincerely,
Amy

Tuesday, August 30, 2005

Unexplained anger

Hi Dr. Amy,

I am a 30 yr. old mother of a 10 yr. old girl and 7 yr. old boy(soon to be 8). I was recently married on July 30th to a man who my kids have been calling daddy for 5 yrs. (they do NOT see or hear from there biological father).

We found out a week ago that we are pregnant. WHY do I feel so angry all the time? I'm yelling at the kids, snapping at my new husband, and I am afraid I'm going to ruin our new marriage before it has a chance to really begin. Besides the big hormanal change, I had to quit smoking, drinking, caffeine etc. I never felt so angry through my other pregnancies.

What do I do? I'm worried, which is not healthy either. I am at work and I want to cry because of the anger I spread throughout my family this morning. Please help me. I'm so worried my husband will fall out of love with me.

MV

Dear MV,

Let's look at your stress level. You have two kids, a husband and a job. At your baseline, your life is very stressful (though it may be happy, too). You are newly married, which is a big stress and you are newly pregnant, which is a big stress, too, no matter how happy you are about it. In addition, pregnancy causes lots of hormonal changes which can lead to emotional changes. Finally, you have had to quit nicotine and caffeine. Nicotine is addictive and stopping it can also raise your stress level.

Perhaps what seems like anger is a reflection of the high stress level. It is important to keep in mind that some of these stresses are temporary. For example, early pregnancy has dramatic hormonal shifts, but by the second trimester, things tend to even out. You can apologize to your husband and kids and explain how pregnancy can affect your mood. You can ask for their understanding over the next few weeks until you are feeling better.

What else can you do to reduce your stress level? Be sure to carve out some time for yourself each week. Let your husband watch the kids while you do something that you enjoy. It may seem like a luxury, but it will benefit you and everyone else in the family.

You can also consider counseling. Counseling can be extremely helpful for temporary situations like yours.

I hope you will feel better soon.

Sincerely,
Amy

Hypothyroidism in pregnancy

Hi Dr. Amy,

I am 17 weeks pregnant expecting twins and have an underactive thyroid. It seems a bit out of control, as I am having fatigue, aches and pains, and breathing problems. Is this normal in pregnancy?

Sincerely,
Sam

Dear Sam,

Hypothyroidism (underactive thyroid) should be treated with medication. Pregnant women with hypothyroidism need to have their thyroid tested regularly. That's because they often need increased medication in pregnancy.

Ask your doctor for blood tests to check your thyroid.

Sincerely,
Amy

Hepatitis C in pregnancy

Hi,

I'm about 13 weeks pregnant and my obgyn just told me that I am hep c positive. Will this have a negative impact on the baby? If so, what kind of impact. Also, I have read some articles on the hep c therapies. Can this be done while pregnant?

Thanks!
MW

Dear MW,

First the diagnosis of hepatitis C may need to be confirmed by additional tests. Some of the tests used to screen people are not 100% accurate, so people who initially test positive need to have further tests to make sure that they are indeed hepatitis C positive.

In general, hepatitis C appears to have no impact on pregnancy. However, there is a risk (up to 7-8%) that the virus can be passed to your baby at the time of delivery.

Hepatitis C is usually not treated during pregnancy.

Sincerely,
Amy

One embryo or two for in vitro?

Hello doctor,

I'm 26 and starting my ICSI treatment within 2 weeks. The doctor gave me a choice of replacing one or two embryos, but when I said two, he refused because there are additional risks with a twin pregnancy. The doctor said that the chances of giving birth at 28 weeks are high. I would love to have twins, though. Are these risks the same for all women or does it depend on the mother's health?

Faith

Dear Faith,

It doesn't sound like the doctor is offering you a choice afterall. There is no question that twin pregnancies pose greater risks for the babies. The risk of premature birth is about 10 times higher for twins than for singletons. There is a corresponding increase in the risk of permanent disabilites due to prematurity. In addition, the risk of complications for the mother is also increased. This includes the risks of pre-eclampsia, post partum hemorrhage and even death (although death is quite rare).

In the case of assisted reproductive techniques like ICSI (intracytoplasmic sperm injection), these risks need to be balanced against the chances of achieving any pregnancy at all. You should talk with your doctor about the success rate in his practice when one embryo is implanted, versus the success rate when two embryos are implanted. If the chances of achieving a pregnancy are dramatically higher when implanting two embryos, you may be willing to accept the increased risk of a twin pregnancy.

The most important thing is to understand all the risks of the various choices so you can make an informed decision.

Sincerely,
Amy

Chest pain in pregnancy

My daughter is 9 months pregnant. She is experiencing chest pains today; is this normal?

FW

Dear FW,

Chest pain is not a normal part of pregnancy and your daughter should discuss it with her doctor (or the doctor on call) as soon as possible.

There are many possible causes of chest pain ranging from harmless, such as muscle strain, to serious, such as pneumonia or a blood clot. Your daughter should get this checked out right away.

Sincerely,
Amy

Not pregnant after 9 years of trying

Dr. Amy,

I have been trying to get pregnant for 9 yrs now and nothing has happen yet. I am almost 27 yrs old and i feel left out cause all my other family members have children but me. I am so down because I don't have a baby yet. What could possibly be the problem?

Ms. SB

Dear Ms. SB,

I'm not sure what the problem is, but there is likely to be a problem, and it could be treatable. You need to see a gynecologist or an infertility specialist for a complete exam and tests. Once the problem is identified, you can start treatment.

Sincerely,
Amy

Monday, August 29, 2005

Can a pregnant woman be near a person being treated for cancer?

Hi Dr. Amy,

My mother is receiving chemotherapy (Methotrexate) and will be going through radiation soon.
I am 8 weeks pregnant. Is it safe for me to visit her while she's in the hospital?

LB

Dear LB,

Yes, it is safe for you to visit your mother. In fact, you probably pose more of a risk to her (because of her weakened immune system), than she does to you.

Patients undergoing cancer treatment pose no risk to anyone else, except in the case of radioactive implants. These procedures are done in the hospital and no one can visit the patient unless wearing a lead shield.

Sincerely,
Amy

Breast infection

I am a 45 year old women who recently had a breast infection in my left breast. I have had 3 ultrsounds and a mamogram. I still have a lump in my breast, and the doctor wants to do a biospy. Does this mean its cancer?

Thanks,
June

Dear June,

Breast infections are not very common in women who are not currently breastfeeding. Sometimes a breast infection can be a sign of a lump blocking the breast ducts. It is not necessarily cancer, but it makes sense to biopsy the breast lump that you have, to be sure that it isn't cancer.

Sincerely,
Amy

Is it amniotic fluid?

Dear Dr. Amy,

Can I get test strips to tell if I am leaking amniotic fluid? I don't want to rush to the doctors or ER everytime I feel like this may be happening, I would like to check first and then go if there is any reason to. I found a place that sells a panty liner that detects this, it is called AmnioSense. But it costs about $30 before shipping costs, and there is only 7 to a box. I would rather not wear a panty liner. I would like to have a test strip for when I feel that I am leaking.

Sincerely,
MARS

Dear Mars,

It sounds like you are referring to nitrazine test paper. It tests the pH of the fluid. Amniotic fluid is usually around 7, while urine is much lower. Nitrazine test strips are sold in packages of 100 for about $10 so it sounds like the pantiliners are very overpriced.

Vaginal discharge increases throughout pregnancy, and this is what you are probably noticing. If there is any reason to think that you might have ruptured your membranes, you should see a doctor. That's because the nitrazine test is not very accurate. There are a lot of false positives and false negatives. Looking at dried amniotic fluid under the microscope, checking for a characteristic crystal pattern is more accurate.

Sincerely,
Amy

Pain in early pregnancy

Dear Dr Amy,

I am 7 weeks pregnant and am experiencing light bleeding and cramping. Pain is shooting down my right leg and my stomach feels as though it will explode. I have two healthy girls already and did not experience any of these symtoms with them. Should I go to my gp or am I just worrying about nothing.

Michelle

Dear Michelle,

You need to speak to your doctor immediately (or whoever is covering for your doctor). It sounds like you could have an ectopic (tubal) pregnancy. An ectopic pregnancy happens when the fertilized egg gets stuck in the fallopian tube and starts growing there, instead of in the uterus where it belongs. An ectopic pregnancy can be quite dangerous because the pregnancy tissue can grow until it ruptures the fallopian tube. This leads to internal bleeding that can be life threatening.

The classic signs of an ectopic pregnancy are vaginal bleeding, abdominal pain and a positive pregnancy test. That doesn't mean that you definitely have an ectopic pregnancy, but it means that the doctors must prove that you don't have an ectopic pregnancy before you can be sure that you are safe.

An ectopic pregnancy cannot be sustained. In most cases, there is no embryo, but even if there were, it cannot be implanted in the uterus. An ectopic pregnancy must be removed. If there is no evidence of internal bleeding, medication (methotrexate) can be used to kill the pregnancy tissue. If there is any chance that the tube is already bleeding, surgery (usually through the laparoscope) is needed to remove the pregnancy tissue from the tube and stop any bleeding.

Call your doctor immediately or head to the emergency room.

Sincerely,

Amy



Sunday, August 28, 2005

Small collection of blood behind the placenta

Dear Dr. Amy,

I had an ultrasound done the other day and my doctor called me to tell me that everything looked good and accurate for being 8 weeks pregnant. The baby's heart rate was 156 bpm. He said the only problem they saw was a little bleeding next to the gestational sac. I haven't been experiencing bleeding. He said we'd have to keep an eye on things. What could this be? Is there cause for concern? Should I be expecting another ultrasound to make sure things continue to go well or do they usually just give it time to make sure I don't miscarry? I should mention that I am almost 37. I have been hearing so much about advanced maternal age that my concern is probably heightened.

Sincerely,
Connie

Dear Connie,

When the pregnancy implants into the uterus and the placenta grows across the uterine wall, a small collection of blood can develop behind the placenta. If the collection stays behind the placenta, you won't see any bleeding. If it escapes through the cervix, you will notice vaginal bleeding. In either case, the pregnancy is normal. There is not an increased risk of miscarriage. If you do not have any symptoms, another ultrasound would not be necessary.

Sincerely,
Amy

Can you get pregnant after a tubal ligation?

I would like to know if you can still get pregnant after having a tubal ligation (tubes were clamped only)? Is that possible?

Cindy

Dear Cindy,

It is not common, but it is possible to get pregnant after a tubal ligation. You should take a pregnancy test to find out if you are pregnant. If the test is positive, you should talk it over with your doctor. A pregnancy after a tubal ligation has a high risk of being an ectopic (tubal) pregnancy, so you would need to be monitored to be sure that you don't have an ectopic pregnancy.

Sincerely,
Amy

Abnormal alpha-fetoprotein test

I got abnormal test results for my alpha feto-protein test. I have an increased risk for spina bifida. Would I feel my baby kick like crazy if that was the case?

Ashley

Dear Ashley,

The alpha-fetoprotein test is a screening test. That means that it identifies women whose babies are at risk of having certain problems like spina bifida or Down's Syndrome. Most of the babies who are at risk do not turn out to have either of these problems.

An ultrasound to look at your baby's spine should be able to tell whether there is an opening (spina bifida). Feeling the baby kick makes spina bifida less likely, but not impossible.

Sincerely,
Amy

Am I still pregnant if I get a period?

Amy,

I am about 1 week pregnant but I am just starting my period. Should I worry about miscarriage?

I

Dear I,

If you had a positive pregnancy test a week ago and now you have your period, it is possible that you are having an early miscarriage. However, if the bleeding you are experiencing is lighter than a normal period, you may still be pregnant.

A blood pregnancy test can provide more information. Two blood pregnancy tests two days apart can show if the level of pregnancy hormone is falling (a miscarriage) or rising (a pregnancy).

Sincerely,
Amy

Period after IUD removal

I had my coil (IUD) taken out five weeks ago and only bled for two days. Since then i have not had a period and pregnancy tests are coming out negitive. I have not been using contraception.
What's wrong?

Susan

Dear Susan,

You did not mention if your periods were regular before your IUD was removed. If you are typically irregular, your period could just be following your usual pattern.

Some IUDs contain progesterone. When you stop progesterone containing IUDs, the return of your period can be delayed.

It is possible that you are pregnant, but it is just too soon to register on a home pregnancy test. You can retest in a few days if you do not get your period.

Sincerely,
Amy

How do you determine day 1 of your cycle?

When is "day 1" of your period? What exactly is spotting? for example, I noticed "pink" when I used the restroom on Monday and on Tuesday it was a little more and there was "pink" on my pantyliner Monday-Wednesday. On Thursday it was heavier and on Friday, it is what I would consider a period. Was Monday's pink day one or was Friday day one?

Victoria

Dear Victoria,

Day 1 is the first day of your actual period; any spotting beforehand is not counted as part of your period. Therefore, day 1 of your most recent period was Friday.

Spotting or staining refers to small amounts of vaginal bleeding whether it happens before your period, between periods or during pregnancy.

Sincerely,
Amy

Getting drunk in early pregnancy

I've just done an at home pregnancy test and it's come back positive. This is great news and my husband and I are thrilled.

I've been very drunk at least 3 times in the last 4 weeks, last night, last week and the week before that. That's 3 times where I've had more than 10 drinks in an evening and also smoking cigarettes. I've been reading about the risks just now on-line, and will definitely lay off now that I know I'm pregnant, but how much damage could I have done? Do I need to abort or something drastic because I've been irresponsible and done irreversible damage to the baby? My new joy is really clouded right now, can you please advise.

jade

Dear Jade,

Alcohol seems to cause more damage in late pregnancy than in early pregnancy. Therefore, if you stop drinking now, there is unlikely to be any lasting effect on the baby. If you were to continue drinking, however, your baby would be at risk for fetal alcohol syndrome. Fetal alcohol syndrome can result in learning disabilities, mental retardation and specific facial abnormalities.

Sincerely,
Amy

Lumps on breast self exam

Hi Dr. Amy,

I am a 37 year old thin Asian woman with 2 young children and in good health. A week and a half ago I performed a breast self exam and found a lump under both sides of my lower armpits. The lump under my left armpit is peanut sized, and the lump under my right armpit is pea sized. Both lumps are movable and slips away easily when I try to pin it down with my thumb. The lumps are not tender or painful. The lumps cannot be felt when I'm lying down or when I try to feel for them with the pads of my middle 3 fingers. Rather they can only be felt when I am sitting up with my hand on the back of my head and when I probe it with my thumb. Since I don't regularly perform BSEs, I don't know how long they have been there. Could what I described be normal lymph nodes that I just never noticed before, or are they too big to be normal lymph nodes? Also, what should be my next course of action be? To see my ob/gyn, my internist, or a breast surgeon? Thank you!

Jules

Dear Jules,

You should see either your internist or your OB-GYN and you should have a mammogram.

Over 85% of breast lumps are benign, and your description suggests that these are benign, too. Nonetheless, it is important to have the lumps evaluated. A mammogram will provide more information.

It is possible that these lumps are cysts. Cysts can come and go during the menstrual cycle, and if these lumps are cysts, they may go away by themselves.

Sincerely,
Amy

Cocaine use in early pregnancy

HELP!!!!!! I just found out that I'm pregnant. I have been waiting for this day to happen. On August 24, 2005 was the day that my MD told me that i was expecting. My question is:

I'm two months pregnant and and I have been using cocaine two or three times a week.( I did not now that i was pregnant). I have also have used over the counter sleeping pills on a regular basis. I have completely stop but I'm so worried that my baby might be born w/birth defects. How could I find out if my baby will be harmed or what are the chances that I have damaged the fetus already?

mo

Dear MO,

Cocaine is a very dangerous substance to use in pregnancy. Cocaine can cause dramatic changes in your blood pressure and that can affect the amount of blood flow, oxygen and nutrients to the baby.

In general, using cocaine several times in early pregnancy does not appear to result in lasting problems. However, continued use of cocaine can cause many different problems such as prematurity and learning issues. In addition, the baby can become addicted to cocaine and go through withdrawal after birth (a very painful process).

Non-prescription sleeping pills usually contain benadryl, an antihistamine that is considered safe in pregnancy. Check the bottle of pills to find out what the active ingredient is.

If you stop using cocaine now, you will dramatically increase your chances of having a healthy baby. Sometimes, though, it is not easy to stop. You may need a lot of help to get off and stay off cocaine. In that case you should consider entering drug rehab for your baby's sake.

Sincerely,
Amy

Old pregnancy or new?

I had a complete miscarriage about 3 weeks ago per the Emergency Room Doctors diagnosis. Is it possible for me to still have a postive pregnancy test or could I be pregnant again?

AB

Dear AB,

A home pregnancy can only tell you if there is pregnancy hormone in your urine. It cannot tell you why. After a miscarriage, the level of pregnancy hormone in your body drops gradually. The farther along in the pregnancy you were, the higher the level was, and the longer it takes to return to normal. Therefore it is very likely that the pregnancy hormone you are detecting now is from the miscarriage.

There is a way to be sure. Two blood pregnancy tests done two days apart can tell you whether the level of pregnancy hormone is falling (from a miscarriage) or rising (from a new pregnancy).

Sincerely,
Amy

Saturday, August 27, 2005

Second trimester bleeding

Hi,

I am five months pregnant and began having bleeding in the mornings. The doctors have diagnosed it as a small tear in my placenta. I would really like to know more about this problem and what to expect.

Thanks,
cparkers

Dear CParkers,

Second trimester bleeding could be a sign of a serious problem, so it must be evaluated very carefully. The best way to tell what is going on is to get an ultrasound.

The most common cause of second or third trimester bleeding is that the edge of the placenta has lifted up. As long as it is only a small area and as long as it doesn't increase in size, it should not cause a problem.

A more serious cause of painless bleeding is placenta previa. Placenta previa means that the placenta covers the opening of the cervix. The cervix can stretch, but the placenta cannot. If the cervix begins to dilate, the placenta can develop a large tear and hemorrhage is the result. An emergency C-section is necessary to save the life of both the baby and the mother.

As long as you have already had an ultrasound that shows that the placenta is not covering the cervix, this probably does not represent a serious problem

Sincerely,
Amy

Is this an early pregnancy or a miscarriage?

Dr. Amy,

My daughter is 19 years old and pregnant. We went to our doctor to see how far along she was and they did a transvaginal ultrasound. We figured she was approximately 4 weeks pregnant since the last time she had sex with her boyfriend was July 30th. She does not remember when her last period was, but knows she had a period maybe 1 to 2 weeks before that time.

The doctor said according to the ultrasound that it looked like a pregnancy that did not take or a sac starting to collapse, or it could be a early pregnancy. My question is this: Could this be just an earlier pregnancy, rather than a miscarriage? The ultrasound showed an empty sac that was not a complete round circle, but maybe it was still developing. They took blood on Wed. and then again yesterday. They are going to tell us something on Monday. If hormone level is going up, she is pregnant still. If they have stayed the same, she is probably miscarrying. Why hasn't she bled or experienced any miscarrying signs?

B

Dear B,

In the US, pregnancy is dated from the first day of the last menstrual period, even though you don't get pregnant until you ovulate. So at 4 weeks after conception, the pregnancy would be dated as 6 weeks.

The sac first becomes visible between 5-6 weeks. It is usually smooth and round. The baby becomes visible between 6-7 weeks, and the heartbeat can be seen between 7-8 weeks.

If we assume that your daughter conceived on July 30th, she would have been 5 1/2 weeks on Wednesday. Therefore, it is very possible that it was simply too early to see the baby. Another ultrasound in a week or two should show the baby if the pregnancy is normal.

In a normal pregnancy, the level of HCG (pregnancy hormone) will double approximately every 48 hours. So if your daughter's HCG level is rising appropriately, it is a sign that this is a normal pregnancy.

The typical symptoms of miscarriage, bleeding and cramping, usually happen late in the process. The baby may have stopped growing long before. Therefore, the fact that she is having no symptoms is not a sign that this cannot be a miscarriage.

Good luck!

Sincerely,
Amy

Why do I look smaller than I did a few weeks ago?

Dr. Amy,

I want to know if anything is wrong or what I can do. My midwife said just last week that my son is now between 3-4 pounds, which is really good. Since my visit, I have noticed that my stomach is getting smaller again and I am now able to see my feet – so I know it’s not my imagination. Does this occur when the baby starts to drop? I looked for articles and couldn’t find anything the midwife said not to worry unless I was leaking fluid, which I don’t think I am, but I can’t shake this feeling that something is off.

Thanks,
EA

Dear EA,

The growth of the baby is estimated by measuring the uterus. You measure from the pubic bone to the top of the uterus. By a fortunate coincidence, the measurement in centimeters corresponds to the number of weeks. So if you are 25 weeks pregnant you should measure approximately 25 cm. +/- a centimeter or 2.

What you look like from the outside depends not only on the size of the baby, but on its position. So if the baby's head is deep in the pelvic, you are going to look smaller than if the baby's head is high.

A better way to estimate the baby's growth and size is by ultrasound. Ultrasound can estimate the baby's gestational age by measuring the width of its head or the length of its femur (upper leg bone). This measurement is fairly constant regardless of the weight of the baby.

Using other measurements, ultrasound can estimate the weight of the baby. In early pregnancy, the weight is fairly constant from baby to baby. In the second trimester, the weights of different babies begin to diverge depending on what the birth weight is destined to be. So a baby who is ultimately 9 pounds at 40 weeks is going to be heavier at 30 weeks than a baby who is ultimately 7 pounds at 40 weeks.

You did not mention how far along you are in pregnancy, so I don't know if the estimated weight is appropriate. If you are concerned, you can ask your midwife for an ultrasound to evaluate the size of the baby. Hopefully you can be reassured by that information.

Sincerely,
Amy

Can you have normal periods, but be pregnant?

Dr. Amy,

I have heard several times of women who did not know they were pregnant because they continued to have a cycle. Is this possible? If it is, would a pregnancy test turn out positive or negative, or would a blood test be the only way to tell?

Thank you,
CJ

Dear CJ,

It would be extremely unusual to have regular periods and still be pregnant. Whether or not you are having bleeding would not affect a pregnancy test, though. If you were pregnant, the test would still be positive.

Some pregnant women do have some bleeding around the time they expected a period, but it is rarely the same as a normal period. Some women have bleeding that they ascribe to a period even though it does not come at the time they expected their period and does not resemble a period.

Some women will have a negative pregnancy test even if they are pregnant. Usually it is because they have tested too early, but occasionally, it is because the test is faulty. In that case, though, repeated tests would not be negative, only the faulty one.

Blood pregnancy tests are extremely accurate. A false negative is rare; indeed, I have never seen one in my entire medical career, although I have read about it. Of course, it is possible for a secretary or other person to accidentally give you the results that belong to someone else.

Symptoms are very unreliable in determining if you are pregnant. Most pregnancy symptoms are also premenstrual symptoms. Many women who are anxious to be pregnant ascribe these premenstrual symptoms to pregnancy, but only a pregnancy test can tell you if you are pregnant.

The bottom line is this:

If you are having regular periods, it is extremely unlikely that you are pregnant.

If you have a negative home pregnancy test followed by another negative test a week later, it is extremely unlikely that you are pregnant.

If you have a negative blood pregnancy test, you are not pregnant.

Sincerely,
Amy

Friday, August 26, 2005

Atypical cells on Pap smear

Hi Dr. Amy,

Recently my daughter received the results from her annual PAP. The letter from the doctor said the following:

Your recent PAP done on 07/18/05 shows atypical cells. This result is significant only in women who are carriers of the Human Papilloma Virus (HPV). An HPV-DNA test was performed on your PAP specimen and the results is NEGATIVE for this virus. We recommend a repeat PAP smear in one year.

She's worried sick about these results. Can you please clarify for us?

Thank you in advance,
Anonymous

Dear Anonymous,

This result indicates that your daughter is fine and not at risk for cervical cancer.

The Pap smear showed cells that are slightly abnormal, but not precancerous cells. In women who have HPV (human papilloma virus) these abnormal cells can be a sign that precancerous cells are developing and further tests are needed. Women who do not have HPV do not have these precancerous cells and do not need further testing. They can return for a regular Pap smear in one year.

Sincerely,
Amy

From which parent does a baby receive its blood?

Dear Dr. Amy,

I realize the placenta is responsible for working as a trading post between the mother's and the baby's blood supply, but I was wondering; from which parent does a child receive its blood? Some folks attribute certain body parts from either parent (genes) and I was wondering from which parent does the child receive its blood. I've heard that the father is the primary source, via his sperm. Is this true? Thank you very much.

Kind Regards,
Mickey

Dear Mickey,

A baby does not receive its body parts from one parent or the other. A baby gets half its chromosomes from the mother, and half from the father. These chromosomes determine the traits that a baby will have.

There are 23 pairs of chromosomes, numbered from 1-22 plus the sex chromosomes (X and X for a girl, X and Y for a boy). The baby gets one chromosome 1 from mom, and one chromosome 1 from dad; one chromosome 2 from mom and 1 chromosome 2 from dad, and so on through all the chromosomes. When it comes to the sex chromosomes, the baby always gets an X from mom (since she has 2 X's), but can get either an X or Y from dad. This is what determines the baby's sex.

All the other characteristics are determined by the interactions between the two sets of chromosomes. For example, if the mom's blood type is A and the dad's blood type is B, the baby could have the blood type AB. However, if the mom's blood type is A and the dad's blood type is O, the baby will have A blood because A is dominant over (stronger than) O. I am simplifying here, but the basic principle is that every part of the baby is determined by the contribution of both parents.

Sincerely,
Amy

Can you get pregnant if you have herpes?

Dr. Amy,

My friend has herpes. She wants to have kids. Can she have kids even though she has herpes? What are her risks of getting pregnant and what are the risks if she delivers naturally?

Anonymous,

Dear Anonymous,

You can have children if you have herpes.

Herpes is a sexually transmitted disease caused by a virus. Herpes causes outbreaks of blister like lesions on the genitals. Herpes can be very dangerous to a newborn baby, but there are ways to reduce the possibility that the baby will get herpes.

A baby can only get herpes if the mother has active lesions or signs that she is about to get active lesions. If the mother has no lesions at the time the baby is born, the baby cannot get herpes, and the mother can have a vaginal delivery. If the mother has lesions at the time she goes into labor, she can have a C-section. This will prevent the baby from coming into contact with the virus.

Your friend can go ahead and get pregnant, but she must tell her doctor about the herpes. That way, the doctor will check very carefully to be sure that there are no lesions at the time of birth, or, if there are, the doctor will recommend a C-section.

Sincerely,
Amy

Pregnant but spotting

Dear Dr. Amy,

My wife and I think that she is pregnant and we did some test that came out positive. My wife still dropping a little blood every day and she gets stomach pains everyday. What could it be?

Sergio & Celia

Dear Sergio and Celia,

Your wife is pregnant, but she might have a miscarriage (lose the baby). She needs to see a doctor to find out what is going on. The doctor can tell you whether this is a normal pregnancy or a miscarriage.

Sincerely,
Amy

Polyhydramnios

My daughter-in-law is 22 weeks pregnant. The baby is measuring at 22 weeks but her uterus is measuring at 24 weeks. The baby's stomach had fluid in it so he is swallowing and his bladder was full so he is expelling. Why is the doctor so concerned about the extra fluid? My daughter-in-law will be tested for gestational diabetes at the next visit and we were told if the fluid level is still up they will test for other things. What are those other things?

Thank you,
Very Concerned Grandma

Dear Very Concerned Grandma,

If I understand correctly, your daughter-in-law is 22 weeks pregnant, but measured 24 cm. on exam. Her doctor ordered an ultrasound which showed that there is excess amniotic fluid around the baby. This is known as polyhydramnios.

In about 20% of cases of polyhydramnios there is something wrong with the baby.

Babies swallow amniotic fluid and urinate it out again. Any time there is excess amniotic fluid, the first concern is that the baby's digestive system is blocked in some way and it cannot swallow the fluid. The fluid bubble in your grandson's stomach suggests that his digestive system is normal.

Diabetes in pregnancy can also cause polyhydramnios, so they will test for that. Other causes of polyhydramnios include chromosomal problems such as Down's Syndrome, or neurological problems that affect the baby's ability to swallow.

It sounds like your daughter-in-law's doctor is already monitoring her very carefully. Further tests may provide more information. However, in the majority of cases, no obvious cause is found and the baby is fine.

Sincerely,
Amy

Seeing a gestational sac on ultrasound

Dr. Amy,

How many days past ovulation must you be before you see a gestational sac?

Ginger

Dear Ginger,

The gestational sac should be visible on ultrasound somewhere between 5-6 weeks after the first day of your last period. That would mean 3-4 weeks after ovulation.

Sincerely,
Amy

Thursday, August 25, 2005

Very irregular periods, difficulty getting pregnant

My husband and I have been trying to conceive for 18 months, but I have really irregular cycles ranging from 2 1/2-4 months. I went to the doctor in November and she drew blood and I had a ultrasound, but everything came back normal, The doctor prescribed birth control, which I only took for 2 weeks because my period came back.

I was wondering if i could have PCOS or something and maybe the ultrasound didnt pick it up. I am getting kind of impatient so we ordered Ovulex and i was wondering if maybe that could help. Thank you.

Amanda

Dear Amanda,

If you have been trying to conceive for 18 months without success, there is likely to be a problem. You need to have a complete infertility evaluation to find out the cause of the problem and beging to treat it. It could be due to PCOS, but there could be other factors as well.

You may wish to make an appointment with an infertility specialist for this evaluation, since he or she would know about the latest advances in the treatment of infertility.

Ovulex is a scam. There is nothing that you can buy without a prescription that will treat or cure an infertility problem. The people who sell Ovulex are stealing money from desperate people. There should be a law against this.

Sincerely,
Amy

No heartbeat at 8 weeks

My daughter is 8 weeks pregnant. She went to the doctor for her first visit yesterday and was given an US. She was told that the baby was the right size for 8 weeks, but they could not detect a heartbeat. They want to do a D&C in about 6 days. The same thing happed to her about 7 months ago with her first pregnancy.

I would like to know if this time she should just wait it out and see if maybe in several weeks they might do another US and maybe detect a heartbeat and if she does wait is there any danger to her health?

K

Dear K,

There is no danger to your daughter's health to wait and repeat an ultrasound in a week. If they truly saw an 8 week size embryo and there was no heartbeat, then this is certainly a miscarriage. However, if they saw an embryo that was smaller than expected, but there was no heartbeat, it could be that your daughter was not as far along as she thought. In that case, it would be very important to wait and see what happens, since it may have simply been too soon to see a heartbeat.

Sincerely,
Amy

Heavy periods and history of hyperplasia

Hello Dr. Amy,

I am 45 years old and I am experiencing extremely heavy periods with what I consider to be large clots. Some are as big as the tampons. 6 years ago I was diagnosed as having simple hyperplasia. A D&C was done and the clotting stopped for a while. The last few years it has come back. Everyone tells me this is normal and that it is pre-menopausal. I just had a pap, no results back yet. I have been told that I have fibroid cysts but that it was nothing to worry about. Is this something I should worry about?

Thanks for your help,
Karen

Dear Karen,

It is true that many premenopausal women notice that their periods become heavier and longer. However, given your history of simple hyperplasia (overgrowth of the lining of the uterus) your doctor may recommend an endometrial biopsy to be sure that you don't have any abnormal cells. Talk it over with your doctor, or, if you haven't had a complete GYN exam in the last year, make an appointment for an exam.

Sincerely,
Amy

Cats, pregnancy and toxoplasmosis

I have 3 cats in a 2 bedroom apartment. What do I do since I am 5 weeks pregnant? My mother is concerned about the changing of the litter box and everyone else is concerned that I should not be around them at all during my first pregnancy, but they were and are my children before we knew we were pregnant. Please advise so I can pass this information on to my husband.

Thank you,
Sara

Dear Sara,

Your mother and friends are concerned about toxoplasmosis. Toxoplasmosis is a parasitic disease that usually causes only mild illness. In a pregnant woman, however, it can result in severe birth defects.

Toxoplasmosis can be carried by cats and excreted into the litter box. This is no danger from being exposed to the cats, themselves, but you could get toxoplasmosis from handling the litter box. For now, you should have your husband deal with the litter box. When you see your doctor, you can ask for a test to determine if you already are immune to toxoplasmosis. Many people have immunity from being exposed in the past. If you are immune, you won't need to be concerned.

You can also get toxoplasmosis from undercooked meat. That's why it is important to eat only thoroughly cooked meat during pregnancy.

Sincerely,
Amy

Wednesday, August 24, 2005

PCOS and trying to get pregnant

Hi Dr Amy,

We have been trying to get pregnant for the past 3-4 months, but it has been difficult to conceive with my irregular periods. I missed my period sometimes for 54 days.This time around it has been late for 60 days.

My gynecologist says that I have PCOS. She says she cannot put me on fertility pills as i we have not been trying long enough. Instead she recommended Provera to get my period this time and then start taking birth control pills (Yasmin) for 2 months to regulate my cycles. Then we can start trying again and she says that will get pregnant.

I am quite apprehensive about this approach as I did not have birth control in my mind at all. I was hoping to get pregnant soon, but all this has made me feel depressed. Is there a alternative to this approach? Also i have read that the effects of birth control pills last for some time and it takes at least 6 months for its effects to wear off. I dont understand how my chance to get pregnant is increased with these pills except for the fact that they regulate ovulation. Thanks.

NB

Dear NB,

I'm a little confused, too. Birth control pills don't regulate ovulation, they stimulate periods. As far as I know, a short course of birth controls will not reestablish normal cycles in a woman who has PCOS.

I can understand the doctor's reluctance to prescribe Clomid at this point, since you may ovulate every now and then, and you don't want to increase your chance of twins or more. It is also reasonable to take Provera to stimulate your next period, so you can begin a new cycle.

You may want to get a second opinion from an infertility specialist. In the meantime, if you are uncomfortable with this plan, you can take the Provera but decline the birth control pills.
Hopefully you will ovulate on your own.

Good luck.

Sincerely,
Amy

How soon am I protected?

Hi Dr. Amy,

I just got my IUD removed on Monday. My Gyn gave me Yasmin to take immediately at the office so that I wouldn't have break through bleeding. My period is to start in 4-5 days. I have been taking the birth control now for several days. What I wanted to know is can I get pregnant now since I just got out the IUD and just started taking the birth control.....the way I look at it is that i was covered with the iud and then right away with the birth control. I just didn't know if there was a window that it could happen.

Thank you,
Kim

Dear Kim,

Actually, there is a lag time between when you start the birth control pill and when you are protected. You are usually not completely protected until you finish the first pack of pills. The risk is probably small, but it is not zero.

Sincerely,
Amy

Is this another ectopic?

Hi Dr. Amy,

I am approximately 5 weeks pregnant and am having abdominal pain on my left side. The pain is not severe, but is bothersome. I had an ectopic pregnancy one year ago and my right tube was removed. Earlier this week, I visited the doctor and he said that he was pretty sure everything looked OK and was in the right place, but he wanted to give it another week. He said that the pain could possibly be caused by some of the scarring I had from my previous surgery. Is it possible for abdominal adhesions to cause pain like this in early pregnancy? Thanks!

Amy

Dear Amy,

Women who have a previous ectopic pregnancy are at much higher risk of having a second ectopic. That's why someone in your situation needs to have a blood HCG test as soon as possible and another 2 days later. In a normal pregnancy, the HCG level will double approximately every 48 hours. In addition, you need to have an ultrasound to make sure that the pregnancy is in your uterus instead of in your fallopian tube.

You should ask your doctor about these tests so you can be sure that you don't have an ectopic pregnancy again.

Sincerely,
Amy

Home birth, postdates pregnancy

My daughter is planning a natural child birth with a midwife in her home. I am concerned as she is currently two weeks past her due date. How much longer can she safely carry this baby with no intervention?

Stacey

Dear Stacey,

It is very reasonable for you to be concerned, because the risk of intrauterine death begins to rise after 42 weeks of pregnancy (2 weeks past the due date). Most obstetricians recommend inducing labor at 42 weeks because of this risk. In addition, obstetricians recommend monitoring of the baby twice a week after 41 weeks by checking an ultrasound and the fetal heartrate to be sure that there are no signs of distress.

The risk is small, but it is real. I have seen it happen twice and it is very sad. Your daughter has every right to weigh the risks and choose to continue past 42 weeks. It's just important that she understand that there is a risk.

Sincerely,
Amy

Postpartum bleeding, now positive pregnancy test

I just gave birth June 6, 2005 and haven't stopped bleeding since I gave birth. The other day I passed a big blood clot, so I called my doctor. He sent me for anumber of blood tests to figure out the problem. Well, I found out that I am pregnant again!! I am very concerned because I never bled with my other prgnancies. Do you think it is possible I am pregnant with twins? Please let me know. Thank you.

Jodi

Dear Jodi,

If you have truly been bleeding nonstop for the past 2 1/2 months and now have a positive pregnancy test, my first concern is that you are not pregnant, but have retained pregnancy tissue from your last pregnancy. It only take a tiny amount of pregnancy tissue to make a pregnancy test positive.

There are two things that can be done to investigate this. Your blood test should be checked for the level of pregnancy hormone and then rechecked in 2 days. In a normal pregnancy, the level of pregnancy hormone (HCG) will double approximately every 48 hours. In addition, you should have an ultrasound to see if there is a gestational sac in your uterus or retained tissue.

Bleeding in early pregnancy is not a sign of twins, so there is no reason to think that this is a twin pregnancy.

Sincerely,
Amy

Multiple miscarriages

I have been pregnant 5 times and have had 4 miscarriages. I have a 5 year old son. I am now pregnant, making it 6 times ... An ultrasound today showed no heart beat. My doctor doesn't want me to have a d&c because I have had 3 before, and the risk of scarring is too great, but I have miscarried at home in the past and it is a lot on me mentally and also extremly painful.

I am scared. Tomorrow I will have a medicine inserted and be sent home to deal with this. Do you have any advise to walk me through the actual miscarriage itself?

My doctors have never done testing to help see why this is happening. Should I be asking for any specific test to be done on me or the miscarriage material? Should I ask for a certain kind of pain medication (I have delivered one child it is nothing compared to the miscarrriage I had!) My doctors are very nice but I dont feel completely included as to what is going on. I dont know what to ask. You would think I would be an expert by now.

Nancy

Dear Nancy,

I am so sorry to hear about your loss.

I can appreciate your doctor's concern about another D&C for you. Each time you have a D&C you are at risk for scarring, infection or injury to your uterus. Since you already have a problem with miscarriages, he does not want to do anything that might further lower your chances of having a successful pregnancy in the future. Although it will be very stressful for you mentally and physically, it seems like the safest approach.

You can ask your doctor for prescription strength ibuprofen to help with the pain. I'm not sure what medication he is giving you to induce the miscarriage, so I can't say how long it will take or what you can expect.

The other problem here is that you have had recurrent miscarriages and it does not sound like you have had an appropriate evaluation yet. An evaluation for recurrent miscarriages would include an endometrial biopsy to check for luteal phase deficiency, a hysteroscopy or hysterosalpingogram to make sure there are no abnormalities inside your uterus, and blood tests for immune problems and clotting problems. In addition, the pregnancy tissue should be examined for chromosomal problems (be sure to insist on this) and both you and your partner should have genetic tests to be sure that you are not carrying chromosomal abnormalities. The testing is extremely important because many of the problems can be treated so you can have a healthy pregnancy.

Recurrent pregnancy loss is not a common problem. You would benefit from seeing an infertility specialist (recurrent pregnancy loss is a form of infertility). He or she will know about the latest evaluation methods and treatments.

Good luck tomorrow.

Sincerely,
Amy

What if my baby is born at home?

I live 2 hours from where I plan to give birth. This is my second child. What if I start to have the baby and I am home alone? What do I need in case this happens? Thank you.

Jessica

Dear Jessica,

The first thing to do is to take all possible precautions that this will not happen. Most labors take many hours so you usually have plenty of time to get to the hospital.

How long was your first labor. If you had an unusually fast labor, you can talk to your doctor about being induced at the end of pregnancy to prevent an at home or on the road delivery.

For a second pregnancy, we usually tell women to call the doctor or head to the hospital once they are having regular contractions about 5 minutes apart. You might want to leave home earlier.

If you do go into active labor while you are on your own, you should call for an ambulance. The emergency medical technicians will have the right equipment and will know what to do.

Sincerely,
Amy

Feeling desperate during pregnancy

I don't know what to do. I have 3 children - 2 boys and 1 girl, and I am 19 weeks pregnant with the 4th. I went in yesterday and found out that I am going to have another boy. I was literally devastated . . . Physically sick.

With all three of my children I have suffered severe post-partum depression, and with the last boy it was so bad I had to be hospitalized. I love all 3 of my children immensely, but the deliveries of my boys were extremely difficult , and both of their personalities are so hard to deal with, and so exhausting! The thoughts of going through it all again, is more than I can bear.

I feel terribly guilty about my feelings about not wanting another boy because I know I should just be grateful, but I can't control how I'm feeling!. I feel totally disconnected to this baby now that I know it's gender. I'm very angry, but I'm not sure at who. I'm so disappointed and afraid and I no longer have any desire to have this baby. I'm numb and feeling those very depressed feelings that accompany my post-partum, and I worry that if I am feeling them now, it will be much worse after the baby is born. What do I do? Please help! ASAP!!!!!

There is no reason to feel guilty. It sounds like you are already battling a severe case of depression. Any disappointment is going to be very difficult to manage if you are depressed.

I'm sure that you already know that the hormone changes of pregnancy and delivery can cause you to feel very depressed. If you were hospitalized in the past, you should have a psychiatrist that you know already. Call him or her as soon as you read this, and tell them what you told me. It sounds like you need to get started on medication right away. You will feel better soon, and getting the depression under control now will make it much easier after the baby is born.

Please write back and let me know that you have contacted the doctor. I will be thinking about you and worrying until I hear from you again.

Sincerely,
Amy

What does ASCUS on a Pap smear mean?

Dr. Amy,

I recently had a pap smear and the doctor sent me a Test Results notification that said: Pap-ASCUS but HPUG - ck for 1 year. What does that mean? Is the Pap Smear normal? I had to have a cone biopsy a few years ago because I had the first stage cancer cells and I want to be sure this isn't something I need to be concerned about.

Thank you,

Debra

Dear Debra,

ASCUS stands for atypical squamous cells of unknown significance. That means that the cervical cells are slightly abnormal, but not as abnormal as mild dysplasia. I am not familiar with the acronym HPUG, so I don't know what it means.

The usual recommendations for an ASCUS Pap smear are any one of the following:
  • repeat the Pap smear in 4-6 months; if it is still ASCUS proceed to colposcopy
  • colposcopy
  • HPV testing to determine if you have HPV and what strain it is; if it is a high risk strain, proceed to colposcopy

Since you have history of dysplasia, your doctor may not want to wait an entire year to check another Pap smear. Talk it over directly with your doctor to find out whether he or she wants to follow the recommendation of the lab (waiting a year) or whether, in light of your history, it may be better to investigate further.

Sincerely,

Amy

Sex at the end of pregnancy

Hi Dr.,

I just wanted to know if it is safe to have sex considering that I am due in 3 weeks or so. Is so, are there any positions I should avoid to keep my baby safe.

When I have an orgasm I feel a lot of soreness througout my abdomen. Is this dangerous? I was told that orgasms and sperm can cause me to start labor because semen contains a chemical that help produce contractions. Is this true? Thanks.

Yari

Dear Yari,

Sex is safe at the end of pregnancy. Your baby is safe no matter what position you use. You should choose based on what is comfortable for you. The only thing to keep in mind is that you should not have sex if you have ruptured membranes because of the risk of infection. Of course, if you think you have ruptured membranes, you should be checked by your doctor.

Orgasm can cause mild contractions of the uterus. This is not harmful. Theoretically, sex can start labor, but it rarely happens in real life.

Sincerely,
Amy

Ectopic pregnancy vs. new pregnancy

OnJuly 20th I found out that I was pregnant. Then on the 27th I miscarried.Since then I have had 3 sets of HCG levels; the first one was 461, then 340, a week later it was 222, then 5 days later it was 376.

I got a call from my doctor telling me that he wasnt sure what it was that was causing this. In the mean time DH and I have been TTC again, so I have decided that I am not going to take the methotrexate that he prescribed. I am just going to wait it out and see what happens.

What are your thoughts?

Misty

Dear Misty,

My first thought is that you may be putting your life at risk.

You may have believed that you had a miscarriage, but your doctor was never sure. That's why you had the 3 additional blood tests. After a miscarriage, the HCG levels should steadily return to the normal range (usually less than 2.5). The doctor should have told you to postpone trying to conceive so that there would be no confusion between the old pregnancy and a new one.

Your doctor was worried about an ectopic (tubal) pregnancy. An ectopic pregnancy happens when the fertilized egg gets stuck in the fallopian tube and starts growing there instead of in the uterus where it belongs. An ectopic pregnancy can never be successful, and in many cases contains only pregnancy tissue and no baby. The pregnancy tissue can grow until is ruptures the tube and causes severe internal bleeding. This bleeding can be life threatening, and indeed, every year women die of ruptured ectopic pregnancies.

The odds are very high that this is an ectopic pregnancy. You cannot ovulate unless your HCG level returns to the normal range. That never happened, so it is unlikely that this is a new pregnancy. A fluctuating HCG level (falling, then rising again) is almost always a sign of ectopic pregnancy.

Based on what you have told me, it sounds like it is really important that you get treated as soon as possible (today). You may need an ultrasound to check the size of the ectopic pregnancy. Methotrexate will not work if the ectopic is larger than a certain size. In that case, you would need surgery to remove the ectopic.

If you have any lower abdominal pain, you need to be seen by a doctor right away to be sure that the ectopic hasn't ruptured and started internal bleeding.

Sincerely,
Amy

Tuesday, August 23, 2005

Teenage daughter with long cycles

HELP...My daughter, healthy 17 yr old, has always had a long menstrual cycle (35-40 days). She now has gone 47 days without menstrating, though she has felt slight cramps still nothing. What could be the cause of this, is it of concern, is it out of the norm and what should she do??

Sincerely,
Mary

Dear Mary,

The most common cause for very long menstrual cycles is not ovulating. Ovulation triggers a menstrual period 14 days later. If you don't ovulate, the lining of the uterus continues to grow and eventually falls off by itself. It usually results in irregular period that are widely spaced. It can often lead to long and heavy periods.

Many teenagers do not ovulate regularly. The usual recommendation is birth control pills. The hormones in the pills regulate the menstrual cycle, producing a period every 28 days. You doctor can visit her doctor or your gynecologist to investigate this further.

Sincerely,
Amy

Pregnancy after miscarriages

Hi Dr. Amy,

I am 39 and have 3 miscarriages in the last 17 years (the most recent was May 2004). I have also had STD's in my early 20's that were treated and have had normal paps ever since. My husband & I really want a baby and have been trying since the last miscarriage. Any advice?

Peg

Dear Peg,

If you have been trying to get pregnant for over a year without success, there may be a problem. You should make an appointment with a gynecologist or an infertility specialist for a complete exam and tests to find out what is wrong.

At age 39, you should make the appointment sooner rather than later because fertility declines a great deal with each passing year.

Sincerely,
Amy

Carpal tunnel syndrome in pregnancy

I am 13 weeks pregnant and have had trouble with Carpal Tunnel Syndrome for a long time. How is this treated while I am pregnant? Is there any safe treatment while I am pregnant?

Angella

Dear Angella,

Carpal tunnel syndrome often gets worse during pregnancy because most women have at least some swelling. The typical treatment during pregnancy is to wear wrist splints at night. This keeps you from compressing the nerve even further by bending your wrists while you sleep. Surgical correction (if necessary) is usually postponed until after the baby is born.

Sincerely,
Amy

Getting pregnant after endometriosis treatment

Dr. Amy,

While on Seasonale for endometriosis, I know that I can't get pregnant. How do I get pregnant if I can't get off the pill b/c of endo. I had surgery to remove it , though it could come back. I do want kids someday but not right away. I'm only 25yrs old, I've been on it for 1yr and just had my yearly check up and doing great.

Julie

Dear Julie,

The endometriosis is being suppressed by the birth control pills, but as you point out, you can't get pregnant on birth control pills. When you want to get pregnant, you will need to discontinue the pills. It usually takes some time for the endometriosis to grow back. You have the best chance of getting pregnant in the first several cycles after stopping the Pill.

There is no way to know whether the endometriosis would affect your fertility. Some women have difficulty conceiving even though they have mild endometriosis. Other women get pregnant easily, even though they have significant endomtriosis.

Sincerely,
Amy

Dysplasia in pregnancy

Dear Dr. Amy,

I am 25 and pregnant with my second child. I just found out that my PAP came back with dysplasia cells. I am 10 weeks pregnant. Is this dangerous to have while your pregnant? What are the treatment options for dysplasia and are they dangerous for my unborn baby?

Jennifer

Dear Jennifer,

Dysplasia means abnormal (pre-cancerous) cells of the cervix. The most common cause is HPV (human papilloma virus), a sexually transmitted virus that can be dormant in your body for many years before showing symptoms.

A Pap smear is a screening test. It shows who is at risk for dysplasia, but does not make the diagnosis. A colposcopy and biopsies are needed to find out who actually has dsyplasia. This involves looking at the cervix through a magnifying scope and remove tiny pieces of the abnormal areas so the pathologist can look at them under the microscope. Only the pathologist can make the actual diagnosis.

If abnormal cells are identified, they can be easily treated by freezing or laser.

Dysplasia can be mild, moderate or severe. Unless the dysplasia is severe, most doctors will wait until after the baby is born before doing a colposcopy.

Dysplasia has no effect on pregnancy and does not affect the baby.

If you have HPV, as most women with dysplasia do, it can be transmitted to the baby during delivery, but that is not common. If the baby gets HPV it can develop warts on the vocal cords. This can be treated.

Sincerely,
Amy

Fordyce spots

Dr. Amy,

I just came from the dermatologist because of some spots I have on my lips. She has told me those are Fordyce spots and I have sebaceous hyperplasia. I am very self conscious of the spots is there any herbs I could take or medicines that will help clear it up some. She said there really isn’t anything you can do and it is very common however I am only 31 years old and the info I read out on the web said it affects more older people in their 50’s and 60’s. Please help as I am single and just concerned about how it looks.

Thanks,
Deana

Dear Deana,

Fordyce spots are enlarged sebaceous (oil) glands. I don't know much about the treatment of Fordyce spots. In most cases, they are not treated because they are not harmful. However, I did come across information about treating them with medication (including retin-A) and surgical treatments that destroy the spots. You may want to get a second opinion from another dermatologist about what can be done, and if surgery will just replace the spot with a scar.

Sincerely,
Amy

Ovarian cyst and pregnancy

Can you still get pregnant if you have a cyst on your ovary? Or do you have to wait until the next cycle to get pregnant?
sya

Dear Sya,
Yes, you can get pregnant. There are many different kinds of ovarian cysts, but none interfere with pregnancy. In fact, corpus luteum cysts are very common in early pregnancy. These cysts form at the site where the egg was released. The corpus luteum produces progesterone to support the pregnancy until the placenta can take over progesterone production.
Sincerely,
Amy

What kind of warts are these?

Dr. Amy,
My boyfriend has warts on the inside of his thighs near his groin, and a few on the lower part of the shaft of his penis--the are not cauliflower type. But they make him itch. He has tried cortaid and lotrimin. He went to the doctor a year ago, and he said it was just warts which spread. I go to the OBGYN consistently and have never tested positive for genital warts. Is it possible for him to have plain warts that just multiplied, or should we be worried about genital warts? What kind of doctor should he see about this? Thanks!
Worrying

Dear Worrying,
I'm not sure what they are since itching is not a sign of regular warts or genital warts. Only someone who looks at the warts could tell what they are. He can see a dermatologist for a definite diagnosis.
Sincerely,
Amy

Pap smear during a period

Can a pap smear still be performed while you are on your period?
Kim

Dear Kim,
No, you can't have a Pap smear done while you have your period. The blood will make it difficult to see the cells and determine if they are normal or abnormal. Whenever make an appointment for a yearly visit at the gynecologist you should be sure to schedule it on a day when you won't have your period.
Sincerely,
Amy

Sunday, August 21, 2005

New Format

In an ongoing effort to find the best format for your questions, I am trying the blog format. I will post your questions and my answers in full. You won't have to click to read the contents of messages. I hope this will be easier to use, easier to read and more informative.
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