November 2005

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Valerie asks:
Can you please tell me if everything is going to be alright with my pregnancy? I found out five days ago that I am pregnant. The
doctor didn't tell me my due date or really anything. All I can tell you is my last cycle was October 20th. She wrote me a prescription for
prenatal vitamins and told me to go see an OB/GYN.

I couldn't get an appointment till the end of December. My whole worry is almost one month ago I contracted a kidney infection. I went to my doctor on 11/03/05. They ran a pregnancy test on me and it was negative. Keep in mind I use birth control pills and didn't stop until 5 days ago. I was placed on 500MG ciprofloxain & 7.5/500MG Lortab for the severe back pain from the infection on 11/03/05.

I went back for my check up on 11/11/05 and even though I was feeling 100 percent better my urine wasn't any better. I had finished the Ciprofloxacin, so they then put me on 750MG Levaquin tablets for another week. The very next day (11/12/05) my temperature went up to 102.5, I had severe back pain again, diarrhea, and vomiting green fluid. I was placed in the hospital and given an IV. Had absolutely no clue I might be pregnant so they ran a CT Scan. Everything came back normal so they wrote me a prescription for 5MG-325Mg tablets of percocet which I only took 3 of and phenergan 25MG tablets which I only took two of.

After all the medication and the CT Scan, I want to know if my unborn child is going to be healthy and is my pregnancy going to be normal?

Dr. Dunn responds:
I am so sorry to hear about you recent illness! I can certainly understand your concerns. Here are my thoughts and my answer to your question:

1. Although I cannot promise you that everything will be alright with your pregnancy, I can reassure you that you are not at a significantly increased risk for either birth defects or miscarriage.

2. You most likely conceived around 11/3, the day you first saw your doctor for symptoms. Your due date should be July 27.

3. None of the medications you took are harmful in early pregnancy. The CT scan most likely did not expose you to risky levels of radiation. Fever in early pregnancy is associated with an increased risk for birth defects, but your fever happened too early to have been harmful.

4. If you were my patient I would ask - Have you ever been pregnant before? Did you have any complications? Have you ever had kidney infections before? Have you been evaluated for reasons for kidney infection? Some women with kidney infections have abnormal urinary tracts and may also have uterine abnormalities. At your first ultrasound, which should be performed prior to mid-January, the sonographer should check for "uterine duplication abnormalities". You can talk to you ob/gyn about this.

5. Due to your condition, you are at increased risk for having repeat urinary tract infections in pregnancy and your doctor may possibly prescribe a daily antibiotic to prevent this. In general, this treatment is started once you have a negative urine culture.

Best wishes to you for a healthy pregnancy! Remember, please discuss your concerns with your ob/gyn.

Muffy asks:
I am five weeks pregnant and have had bleeding (bright red) in color. Not too heavy but no cramps. Should I be worried?

Dr. Dunn responds:
Up to 25 percent of pregnant women will have bleeding in early pregnancy. Bleeding at five weeks is often attributed to the implantation of the embryo into the uterine wall. Half of women who have more than a brief episode of bleeding, will go on to miscarry.

I would suggest that you have an ultrasound in a week or two to reassure you and your doctor that the pregnancy is proceeding normally.

Zaza asks:
I just turned 42 this month. I already have two children and this is my third pregnancy. I went through two rounds of IUI with shots to get pregnant. I just confirmed today I was pregnant. The HCG level are good. I do have high cholesterol, though, (about 300) but a good HDL (above 90). How would that affect my pregnancy and life risk?

Dr. Dunn responds :
Congratulations, Zaza! As you experienced, women have more difficulty conceiving as they get older.

As you proceed through the pregnancy, I would offer some suggestions for your care. I would suggest that you meet with a genetic counselor to consider your age related risks for having a baby with chromosome problems (Down syndrome and others). There are many newer, noninvasive tests that you may wish to have to reassure you about the pregnancy. Of course, you could also choose to have one of the older diagnostic tests - amnio or CVS. Or you could choose to decline both genetic counseling and testing.

I would also suggest that you discuss weekly testing of the baby beginning at 32 weeks (2 months before your due date). The purpose of the testing is to prevent stillbirth (women over 40 have an increased risk for stillbirth).

Now I will answer your question about cholesterol. Cholesterol is a building block for most of the important hormones of pregnancy so doctors usually do not attempt to lower cholesterol values in pregnancy. The medications usually used to lower cholesterol (statins) have been associated with birth defects, so this is another reason not to use them during pregnancy.

Women with HDL levels above 75 have a low incidence of coronary artery disease and often enjoy a long life. I would suggest that you see your internist after you have recovered from the pregnancy to discuss your individual risk for future heart disease based on your family history and your non-pregnant levels of cholesterol, HDL, and LDL.

Zaza responds:
Dear Dr. Dunn thank you so much for the thorough answer you provided me and bringing to my attention important things to consider at my age (tests, weekly visits at 32 weeks) that I may not have thought of otherwise. May God bless you. Zaza

Coran asks:
I'm just four months post-op from gastric bypass surgery and I'm pregnant. I would like to know my chances on a successful pregnancy.

Dr. Dunn responds :
You ask a very important question and the answer is complicated.

First of all, it is recommended that women who have gastric bypass surgery not conceive until 12 to 18 months after the surgery. For women like you, who happen to conceive earlier, the time of rapid weight loss may interfere with normal fetal growth.

Secondly, certain nutrients essential to a healthy pregnancy are not adequately absorbed after gastric bypass surgery. These nutrients include folic acid, calcium, vitamin B6, and vitamin B12.

Thirdly, most likely you are still significantly overweight. Obese women have increased risks in pregnancy for gestational diabetes, hypertension, birth defects, stillbirth, and Caesarean birth. Because of "dumping", some women who have had bariatric surgery cannot tolerate the sugar solution administered as part of the test for diabetes in pregnancy. Given these risks, your pregnancy is considered a "high risk" pregnancy.

To help you have a successful pregnancy and birth, I would suggest the following care plan (please consult with your ob/gyn as well):

1. Meet with a nutritionist to discuss a healthy diet for the pregnancy.
2. Take a prenatal vitamin daily. In addition to the vitamin, take a supplement that contains folic acid, vitamin B6, and vitamin B12. One product that contains all three is called Folgard. This is an over the counter medication. Also, take a calcium supplement. A convenient way to supplement calcium is to chew three Tums Ultra tabs daily.
3. Have the quad screen blood test at 16 weeks. This test can screen for spina bifida and other related problems that more commonly affect babies of obese women.
4. Have frequent, detailed ultrasound exams performed in a high-risk pregnancy unit (not in a radiology department). The purpose of the ultrasounds is to monitor fetal growth and to check for birth defects.
5. Discuss with your doctor whether or not you should have special testing near the end of pregnancy to prevent stillbirth.

There have been a few recent studies reporting good outcomes for women pregnant after bariatric surgery. In women who conceived 1-2 years after the surgery and after significant weight loss, pregnancy risks are lower than for obese women.

Best wishes for a healthy outcome!

Sondra asks:
I am 19 weeks pregnant with twins and I have a lot of period-like cramping. Is this okay?

Dr. Dunn responds :
Congratulations on your twin pregnancy! In twin pregnancies, the uterus stretches earlier and more than in single pregnancies so some cramping is considered normal. However, there is an increased risk for pregnancy loss in twin pregnancies at 18-22 weeks.

I would advise you to report the cramping to your doctor. If, on exam, your cervix is long and closed and if your uterus is not irritable, then there is nothing to worry about. You should definitely be checked before the holiday.

If you would like to schedule an appointment with a Penn Ob/Gyn Care doctor, please call 1-800-789-PENN (7366) or request an appointment online.

Polly asks:
I am pregnant and sometimes when I start to eat, I get mucus in my mouth and cannot swallow without coughing and then I feel like I could throw up but it is only mucus.

Dr. Dunn responds :
You have a relatively common pregnancy problem called "ptyalism". The problem is overproduction of secretions by the salivary glands. Many patients experience the need to spit out the excess saliva and actually carry a disposable cup with them for this purpose.

Although this problem is very annoying, it is not serious. The excess production of saliva stops as soon as the baby delivers!

Gina asks:
I am ten weeks pregnant. I am 38 and it's my fourth pregnancy. I have had cramps for two weeks now, but no blood and was told to relax and drink plenty of fluids. Should I be worried?

I am having the CVS test on November 21 and I can't help but think and worry about the cramps. I did not have cramps the other three pregnancies. Should I go to the ER and have things checked out? Oh, and last week I did have a urinary tract infection and took amoxocylin three times a day for seven days.

Dr. Dunn responds :
I am sorry to hear about your cramping. Uterine cramping occurs in response to uterine stretching and is common in early pregnancy. Cramping may be worse if fibroid tumors are present or if there are twins (or more). The bladder is attached to the front of the uterus so bladder infections or a problem called interstitial cystitis can also cause cramping. The fact that you have not had any bleeding is very reassuring. Cramping associated with CVS is usually brief (less than an hour) and mild.

Have you had an ultrasound to check for twins and fibroids? If not, this would be my first recommendation. Usually the cramping of early pregnancy resolves near the end of the first trimester.

There's no need for you to go to the ER unless the cramping is associated with heavy bleeding. But, as always, if you are concerned definitely call your physician.

Take a look through our pregnancy health guide for more information.

Jennifer asks:
My last pregnancy was complicated by polyhydramnios. A month after the baby was born, he died of SIDS. Will my next pregnancy be concidered high risk, and should I seek care from a perinatologist immediatly or seek care from a regular ob/gyn?

Dr. Dunn responds :
I am so sorry to hear about your loss! It is difficult to say if the polyhydramnios before birth was associated with your baby's death. Polyhydramnios is a term used to describe the presence of too much amniotic fluid. In a proportion of patients, this condition is caused by birth defects that interfere with the baby's ability to swallow the amniotic fluid. Other causes may be maternal diabetes or blood group incompatibility between the mother and the baby. However, most of the time the cause for polyhydramnios is unknown.

In the unknown cases, the doctors are still concerned about the consequences of the excess fluid. The excess fluid can stretch the uterus so much that labor begins or the excess fluid can put pressure on the placenta and interfere with the supply of nutrition and oxygen to the baby. The excess fluid can also cause discomfort, heartburn, difficulty eating, difficulty sleeping, and difficulty breathing for the mom. In all cases of polyhydramnios, weekly or twice weekly testing for fetal well being is recommended. Even so, having hydramnios is associated with poor perinatal outcome.

Unless an autopsy was done, it is impossible to determine the cause of your baby's death. It is possible that an undetected prenatal condition was associated with both the polyhydramnios and the SIDS death.

Even though polyhydramnios seldom recurs, I would consider you at higher risk in future pregnancies. I would suggest that you ask your OB about a preconception consultation with a maternal fetal medicine doctor to discuss care in future pregnancies. I think that you can be cared for by a regular Ob/Gyn in consultation with an maternal fetal medicine doctor.

Mandy asks:
If giving birth for the first time at age 38, are you automatically high-risk because of advanced age?

Dr. Dunn responds :
Hi, Mandy! You have asked a very good question - one that obstetricians sometimes ask.

Women who will be 35 and older at the time of delivery are at increased risk for delivering babies with chromosome problems such as Down syndrome. These women are offered the opportunity to meet with a genetic counselor to discuss the many currently available methods of testing for Down syndrome and other chromosome disorders. Some of these methods include blood tests, ultrasound, chorionic villus sampling, and amniocentesis.

Women over 35 have increased risks for developing a pregnancy form of diabetes and for developing high blood pressure near the end of pregnancy. Women older than 40 have an increased chance of requiring Caesarean delivery and for having a stillborn baby. Elevated blood pressure and gestational diabetes can be treated effectively and stillbirth can be prevented by special heart rate testing.

Many OB's would not consider a healthy 38 year-old woman high-risk unless she developed either high blood pressure or diabetes. And most 38 year-old women will have none of these problems.

So no, a 38 year-old woman is not automatically considered high-risk, but she does need careful monitoring.

If you would like to schedule an appointment, please call
1-800-789-PENN (7366) or request an appointment online.

Theresa asks:
I was wondering what the first steps would be medically for a 10 year-old child who is obese. What testing is important? Can you refer me to a Penn doctor?

Response:
Thank you for your question. We are currently only answering questions related to high-risk pregnancy. Please visit our general contact page for more information.

If you would like to schedule an appointment, please call
1-800-789-PENN (7366) or request an appointment online.

Anthony asks:
Can you tell me if there is any medication to clean the arteries and what a diet should be? Is there something with folate and vitamin b's to take?

Also, can you tell me if the 64 CT scanner really shows the arteries suppling the heart and how can this scan be obtained and is it covered under medicare?

Response:
Thank you for your question. We are currently only answering questions related to high-risk pregnancy. Please visit our general contact page for more information.

If you would like to schedule an appointment, please call
1-800-789-PENN (7366) or request an appointment online.

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