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

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

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

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

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

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 i