• Persistent headache
• Vision changes
• Upper stomach pain
• Nausea or vomiting
• Swelling of the face or hands
• Sudden weight gain
• Trouble breathing

Preeclampsia can happen to any pregnant person, but some people are at greater risk. Black women in the U.S. have a 60% higher risk of developing preeclampsia compared to white women. Also, there may be a higher risk of developing preeclampsia if you have:

• Chronic high blood pressure or kidney disease before pregnancy
• Obesity: If overweight or obese, you are also more likely to have preeclampsia in more than one pregnancy.
• Age: Pregnant women over 40 are at a higher risk
• African American ethnicity: Among those who have had preeclampsia, non-white pregnant women are more likely than white women to develop preeclampsia again if pregnant.
• Previous diagnosis of preeclampsia.
• Family history of preeclampsia 
• Carrying multiples (twins, triplets, etc.)

Patients with risk factors are often prescribed low-dose aspirin to lower their risk of developing preeclampsia. However, using risk factors alone misses many women who go on to develop preeclampsia. 

Preeclampsia screening in the first trimester

You and your provider can now understand if you are at risk for preeclampsia.  

Preeclampsia testing during the first trimester is now available. This new screening is done between 11 and 14 weeks of pregnancy via a simple blood test ordered by your healthcare provider. The test is an option for anyone pregnant, including those with a low to average risk for preeclampsia or first-time pregnancies.

How does it work?

The test checks your protein levels and how your placenta is working and growing. It looks at two biophysical markers – mean arterial pressure (MAP) and uterine artery pulsatility index (UtAPI)-in addition to the placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A). These markers provide important insights into your preeclampsia risk. Low levels of PlGF and PAPP-A can indicate that the placenta isn’t functioning well. High levels of MAP and UtAPI suggest high blood pressure and resistance to blood flow. These are all potential indicators of preeclampsia.

This new test is one of the many screenings and exams you will take during pregnancy. It’s important to have a shared discussion with your provider about the testing process. You are your best advocate, so ask about the tests you believe are right for you. Regular visits and tests from your healthcare provider are crucial. They are key for monitoring your health and finding early signs of preeclampsia. Make sure to follow up with your healthcare provider to continue testing for preeclampsia risk throughout your pregnancy, especially if you’re in a high-risk group. 

For more information about this new preeclampsia screening test and other preeclampsia screening tests, visit https://womenshealth.labcorp.com/patients/pregnancy/preeclampsia.

Read more

• Preeclampsia: how healthcare providers detect it
• Blood pressure during pregnancy: why you should track it

Sources

• “Preeclampsia and Pregnancy.” American College of Obstetrics and Gynecologists (ACOG). ACOG. October 2020.  https://www.acog.org/womens-health/infographics/preeclampsia-and-pregnancy.
• “Who is at risk of preeclampsia?” National Institute of Child Health and Human Development (NICHD) National Institute of Health (NIH), NICHD.NIH June 2022 https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/risk.

How much should I exercise?

A 2017 study showed that 30 to 60 minutes of exercise two to seven times per week may reduce hypertension. If possible, try to space out exercise during the week. This rest may help your body recharge. 

What is the best kind of exercise?

There isn’t one “best” kind of exercise. It depends on your level of comfort and what you enjoy. For example, if you were a runner before becoming pregnant, you can likely continue. If you’re new to exercise, try fast walks and low-impact options such as prenatal yoga, walking, light weights, and swimming. See how you feel and shift your plan as needed. 

What exercise should I not do?

This will depend on your health. However, some exercises are usually riskier than others. Try to avoid exercises that:

1. Involve collision, physical contact, and falling
2. You haven’t done it before becoming pregnant
3. Make you feel overly tired

What are the risks?

If you have a healthy pregnancy, exercising while pregnant has no known risks. It will not increase your risk of miscarriage, low birth weight, or early delivery. 

Is there anything else I should remember?

Yes! Here’s what to keep in mind:

1. Listen to your body 
2. Focus on what works for you 
3. Work with a trusted healthcare provider 

You and your healthcare provider can work together to make sure you are safe and comfortable. You can also read more about preeclampsia and exercise below.

Reviewed by the Ovia Health Clinical Team

Read More

• Preeclampsia: What you need to know 
• Being your own health care advocate
• Low-impact exercise during pregnancy
• What’s a risky exercise during pregnancy?

Sources

• Magro-Malosso, Elena R. “Exercise during pregnancy and risk of gestational hypertensive disorders: A systematic review and meta-analysis.” Obstetrics and Gynecology. 96(80: 921-931. Web. August 2017. 
• “Healthy Pregnant or Postpartum Women.” Centers for Disease Control & Prevention. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. June 3, 2022. https://www.cdc.gov/physicalactivity/ basics/pregnancy/index.htm
• “Exercise During Pregnancy: Frequently Asked Questions.” The American College of Obstetricians and Gynecologists. The American College of Obstetricians and Gynecologists. December 2021. https://www.acog.org/womens-health/faqs/exercise-during-pregnancy#:~:text=Regular%

One of the advances in Covid care is the medication Paxlovid. Wondering if this might be a good fit for you? You’ve come to the right place!

What is Paxlovid

Paxlovid is a combination of two medications, nirmatrelvir and ritonavir. For it to be effective, you need to start it within five days of your first symptoms and take it for five days. The goal of treatment with Paxlovid is to reduce the chances of hospitalization and death for people at increased risk.

Providers have used ritonavir for a long time to treat pregnant people, and it has a good safety profile. We have less information about nirmatrelvir, but expert opinion is that its benefits in helping people avoid serious illness from Covid likely outweigh any unknown risks. 

Paxlovid during pregnancy

If you’re pregnant, at the very least your provider should offer you Paxlovid and feel comfortable discussing its risks and benefits given your unique health situation. They will consider your vaccination status and additional risk factors like diabetes, kidney disease, and any challenges to your cardiovascular health. 

Paxlovid while breastfeeding

If you’re breastfeeding, then you’re aware that it’s important to check the safety of all of your medications, as many pass into your breast milk. If you have risk factors for severe illness or are not vaccinated, you may want to talk to your provider about Paxlovid. 

Again, there isn’t a lot of safety data on nirmatrelvir, so it’s important to have a risk and benefit discussion with your provider. There is conflicting information on breastfeeding safety, and that can be very difficult to navigate. Parents are choosing a range of solutions, including continuing to breastfeed and pumping and dumping. The experts at the Infant Risk Center are updating information as it becomes available and are available for free consultation by phone. 

If you have questions or are interested in taking Paxlovid or understanding more about it so you can be prepared if you get Covid, reach out to your provider for more details. They have all the most up-to-date information and should be able to talk through your options. 

Read more

COVID-19, postpartum, and breastfeeding: your questions answered

Everything you need to know about the COVID-19 vaccines

 

Content created withThe National Birth Equity Collaborative

Preterm birth increases the risk of complications and often results in a NICU (Neonatal Intensive Care Unit) stay. Preterm delivery can be scary to think about, but there are many ways that you can prevent it, in some cases with zero complications. Read on to learn more. 

Preterm birth impacts Black women and babies 50% more than their white peers. This disparity exists due to racism and bias within the healthcare system itself. Still, there are actions you can take early in your prenatal care to advocate for yourself and your baby.  

Understanding the risk factors

We don’t know all of the causes of preterm delivery, but what we do know is that the chances of preterm birth  can be impacted by the following conditions:

• A history of having a procedure done on your cervix after an abnormal pap smear
• Shortened cervical length early in pregnancy
• A previous preterm birth
• Carrying multiples (twins, triplets, etc.)
• Using tobacco and/or other substances 
• Hypertension
• Diabetes

Becoming pregnant shortly after delivering a previous baby (less than 18 months)

Ask what you can do

Talk to your provider about what you can be doing to minimize your chances of delivering early. Providers will frequently recommend:

• Quitting smoking or drug use, if applicable
• Eliminating alcohol 
• Checking your cervical length
• Taking a progesterone treatment if you have a history of preterm birth 
• Managing your blood pressure and blood glucose through the use of medication and physical activity alongside a nutritious diet

Listen to your body

You know your body best, so if you’re ever concerned that something is wrong, reach out to your provider right away. If you’re not sure that what you’re feeling is normal and want to get a better understanding of what people at your point in pregnancy typically experience, reach out to an Ovia Health Coach any time, 7 days a week. You have a right to understand what is going on in your body and to receive care and support throughout your pregnancy.

Read more

• The power of preparing for preterm birth
• Risk factors for preterm labor and birth

Sources 

• “A Health Crisis Impacting Women and Babies of Color.” March of Dimes. March of Dimes. https://www.marchofdimes.org/mission/health-disparities.aspx. 
• “Premature Birth.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. November 1, 2021. https://www.cdc.gov/reproductivehealth/features/premature-birth/index.html. 
• “Preterm Birth.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. November 1, 2021. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm. 
• Office of Communications. “What Are the Risk Factors for Preterm Labor and Birth?” Eunice Kennedy Shriver National Institute of Child Health and Human Development, U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/who_risk. 

 

Content created withThe National Birth Equity Collaborative

Blood pressure (BP) measures the force that your flowing blood applies to the walls of veins and arteries — in other words, BP measures how hard your heart is working to pump blood throughout your whole body.

Blood pressure is measured using a sphygmomanometer (also known as a blood pressure cuff), and given as a two-number result, “systolic” and “diastolic”. Only one of these numbers needs to be above or below normal to be considered diagnostically elevated. High blood pressure (hypertension) can be especially dangerous during pregnancy, so it’s important to do your best to keep your blood pressure in the optimal range, which is generally under 120/80.

High blood pressure during pregnancy

High blood pressure can be problematic for everyone, but when you’re pregnant, it could put both of you at risk. High blood pressure may not be the direct cause of a certain complication but can indicate a greater problem. There are many possible risks of high blood pressure during pregnancy.  

• High blood pressure and protein in the urine are the two main symptoms of the pregnancy condition known as preeclampsia. In rare cases, preeclampsia can lead to other conditions causing internal bleeding, seizures, and strokes.
• High blood pressure may often indicate excess stress. Stress has been linked to a higher incidence of miscarriage and overly intense pregnancy symptoms. While it is certainly not always possible to just “stress less,” tracking your blood pressure along with your emotions may help you recognize when to seek advice from your healthcare provider.
• Sometimes, high blood pressure can cause conditions that increase the risk of your baby being born prematurely. A placental abruption, when the placenta is separated early from the baby, is another possible complication of conditions related to high blood pressure during pregnancy.

Heightened risk factors

According to the U.S. Department of Health and Human Services, high blood pressure is 40% more common in Black adults than white adults. This is due to a range of factors including racism and bias in the healthcare system and socioeconomic inequalities and inequities. According to the Healthcare Cost Utilization Project, Black women are also about 60% more likely to develop preeclampsia during pregnancy than white women.

Knowing your body and how it changes during pregnancy, especially your blood pressure, empowers you to seek care accordingly. Monitor your blood pressure and communicate to your healthcare provider any concerns you may have.

Taking control

Blood pressure levels can be an excellent indicator of the health of your pregnancy, and is a great way to monitor against certain complications like preeclampsia. Tracking your blood pressure along with other data can also help draw patterns between certain behaviors. You’ll know how your sleep, nutrition, activity or other behaviors may affect your blood pressure, and vice versa. It’s important to let your healthcare provider know if your blood pressure is consistently elevated.

Read more

• Pregnancy complications and your risk of cardiovascular disease
• Lowering your blood pressure with heart-healthy foods

Sources

• P Kristiansson, JX Wang. “Reproductive hormones and blood pressure during pregnancy.” Human Reproduction. Vol.16, No.1 oo. 13-17. Web. 2001.
• S Kulkarni, I O’Farrell, M Erasi, MS Kochar. “Stress and hypertension.” Wisconsin Medical Journal. 97(11):34-8. Web. Dec-98.
• “Preeclampsia and High Blood Pressure During Pregnancy: FAQ034.” ACOG. American College of Obstetricians and Gynecologists, 9/14/2015. Web.
• “High Blood Pressure in Pregnancy.” National Heart, Lung, and Blood Institute. National Heart, Lung, and Blood Institute, n.d. Web.
• “Placental abruption.” March of Dimes. March of Dimes, 1/12/2015. Web.
• Norton Healthcare. “Pregnant African-American women far more likely to have pre-eclampsia than white women.” Norton Healthcare. Norton Healthcare. May 16, 2018. https://nortonhealthcare.com/news/pregnant-african-american-women-pre-eclampsia/. 
• Heart Disease and African Americans. Office of Minority Health. U.S. Department of health and human services. February 11, 2021. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=19#:~:text=Although%20African%20American%20adults%20are,to%20non%2DHispanic%20white%20women
• Kathryn R. Fingar, Ph.D., M.P.H., Iris Mabry-Hernandez, M.D., M.P.H., Quyen Ngo-Metzger, M.D., M.P.H., Tracy Wolff, M.D., M.P.H., Claudia A. Steiner, M.D., M.P.H., and Anne Elixhauser, Ph.D.

Morning sickness

According to the Cleveland Clinic, about 70% of pregnant women get morning sickness, which typically starts at six weeks and lasts until the second trimester. Other common discomforts include fatigue, heartburn and indigestion, swelling, constipation, headaches, and backaches. Those who experience severe discomfort may be put on bed rest by a provider.

These bodily changes can affect your mental health in various ways too. Some people fear that their discomfort is causing their baby harm or that it’s an indication of an unhealthy baby. This is typically not the case, however, if you are experiencing these symptoms, you should seek out your provider immediately. 

Some studies even suggest that morning sickness is a discomfort that can actually help your baby. According to a 2016 study published in JAMA Internal Medicine from researchers at the National Institutes of Health, women who reported nausea or nausea with vomiting were between 50 percent and 75 percent less likely to miscarry than those who didn’t feel sick. Most discomfort during pregnancy means your body and hormones are doing their job to help you carry a healthy baby. 

How a challenging pregnancy can impact your mental health  

When your body is changing and you’re feeling new discomforts, you might also be worried about your own health. Some women report feeling worried that there’s something wrong or that they’ll never feel like their pre-pregnant self again. This is one reason why morning sickness can lead to depression. Even for those who see these experiences as temporary, nine months is too long to just suffer through. Speak to your provider for help treating your symptoms and try these ideas to treat nausea and vomiting. 

Some can find it triggering to experience body changes or might feel worried about how their  body will look postpartum. And those with a pre-existing eating disorder may be more susceptible to this type of worry or anxiety. If you’re finding these thoughts are intruding on your daily life or causing you to eat restrictively, it’s time to seek support from a therapist. 

Ahead, you can learn about how to cope with a challenging pregnancy and keep your mental health in check.

Stay informed

Speak to your doctor or a health professional about what to expect when you’re expecting (there’s a reason why there’s a book with that title!). Understanding the ins and outs of your body and what’s considered expected and not expected can help you determine when something is discomfort or needs medical attention. 

Allow yourself to kick your feet up

If you’re not feeling well, allow yourself to take the day off. Don’t push yourself to do everything on your to-do list. Remind yourself that you’re growing a human in your body and need to take care of yourself. If you can, find a support system to take care of any tasks or chores that you can’t get done. 

Speak to a therapist

If your discomfort is getting in the way of your happiness or making you not feel like yourself, speak to a therapist who can help you overcome your concerns and find tactical solutions. 

Challenging pregnancies can lead expecting parents to feel isolated and alone in their struggle. Someone who is there to guide you and support you can go a long way.

Reviewed by the Ovia Health Clinical Team

Read more

• How to take care of your mental health during pregnancy
• Prenatal exercise and movement FAQ

Sources

• “Morning Sickness with Pregnancy: Causes, Treatment & Prevention.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/16566-morning-sickness-nausea-and-vomiting-of-pregnancy. 
• LaFrance, Adrienne. “Brutal for Mom, Good for Baby.” The Atlantic, Atlantic Media Company, 26 Sept. 2016, https://www.theatlantic.com/health/archive/2016/09/the-protective-power-of-morning-sickness/501551/. 
• Gray, Dan. “Severe Morning Sickness during Pregnancy Linked to Depression.” Healthline, Healthline Media, 27 Oct. 2020, https://www.healthline.com/health-news/severe-morning-sickness-during-pregnancy-linked-to-depression-what-you-can-do. 
• Ward, Veronica Bridget. “Eating Disorders in Pregnancy.” BMJ (Clinical Research Ed.), BMJ Publishing Group Ltd., 12 Jan. 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190274/. 

If you have given birth vaginally before, perineal massage can still be helpful as it’s been shown to decrease perineal pain at three months postpartum. 

What is perineal massage?

Perineal massage is a process of applying pressure to the pelvic muscles, by inserting one or two clean fingers into the vagina a couple inches and applying pressure. While there’s still more we need to learn about exactly how often and how long it should be done for maximum effectiveness, a couple times a week for 5 minutes is a good rule of thumb. You can start at week 34 of pregnancy.

What’re the benefits?

This practice has the most significant benefits during your first pregnancy. It decreases the relative risk of perineal trauma by 10%. It also decreases perineal pain after birth and can also be done during labor, to decrease the severity of a tear.  

How do I start perineal massage?

You can either massage your perineum yourself, or ask your partner to help. Do it after a shower or bath, when you’re feeling relaxed and comfortable.

Get some lubricant, sit comfortably, and insert a clean finger or thumb a couple inches into your vagina, gently stretching the skin to the side, then toward the back of the body, then toward the other side. Continue this U movement for 5 minutes. This will help prepare your muscles and tissues for the stretching that will happen during birth.

It can be helpful to use a handheld mirror to see what you’re doing. You may feel a bit of burning or a stretching feeling at first, but perineal massage should not hurt.   

This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic. 

Read more

• Vaginal delivery and that first bathroom trip
• Perineal massage during pregnancy

Sources

• Jen Gunter. “Massaging Away a Potential Complication of Birth?” The New York Times. January 31, 2019. https://www.nytimes.com/2019/01/31/well/live/massaging-away-a-potential-complication-of-birth.html. 
• Healthwise Staff. “Childbirth: Perineal Massage Before Labor.” Healthwise. University of Michigan Health. October 8, 2020. https://www.uofmhealth.org/health-library/tn10339. 
• Sharon Muza. “What Is the Evidence for Perineal Massage During Pregnancy to Prevent Tearing?” Lamaze International. Lamaze International. December 18, 2012. https://www.lamaze.org/Connecting-the-Dots/what-is-the-evidence-for-perineal-massage-during-pregnancy-to-prevent-tearing. 

While there are pelvic floor-related conditions unrelated to pregnancy, we won’t be discussing those here. 

What are the pelvic floor muscles?

The pelvic floor is the set of muscles beneath your pelvic organs that support them, often referred to as a hammock. The pelvic floor wraps around the bladder, rectum, and both uterus and vagina (or prostate in men). Pelvic floor muscles control bladder and bowel function — this is why you can feel your pelvic floor muscles relaxing when, for example, you go to the bathroom. They also work together with other muscles to stabilize your spine. Having trouble visualizing the pelvic floor? Head to the first episode of our pelvic floor strengthening series in Ovia Parenting with Dr. Amy Hoover, where she explains it. 

What about during pregnancy?

During pregnancy, your pelvic floor muscles are working harder than they were pre-pregnancy, providing a solid foundation for your expanding uterus. This increased pressure can cause many people to experience frequent urination, lower back pain, or incontinence during pregnancy. 

What about postpartum?

Now, let’s get into some common symptoms during pregnancy and postpartum. While some of these symptoms can feel scary, they are also all treatable and it can be helpful to prepare for them. 

The pelvic floor muscles may be strained or injured during vaginal delivery. There are other reasons the pelvic floor might be strained, for example, during surgery or with age. The most common side effect is urinary incontinence.

OAB or Overactive Bladder

An overactive bladder, or the frequent or very pressing need to urinate, can be incredibly uncomfortable and frustrating. OAB is extremely common — 40% of women in the U.S. have OAB symptoms. 

Urinary incontinence

Urinary incontinence is the inability to control your bladder, which can result in leaking urine. There are two types: stress incontinence and urge incontinence. Stress incontinence might be triggered by coughing, sneezing, or laughing. Urge incontinence, which is a form of OAB, involves the involuntary loss of urine associated with a sudden need to pass urine. 

UI is particularly common during pregnancy and after birth as it can be the result of strained pelvic floor muscles and/or hormone changes. If you’re finding that urinary incontinence is impacting your day by preventing you from doing certain activities that you enjoy, that’s your sign to contact a provider. 

Flatulence incontinence

The inability to control gas. This is common but can be extremely frustrating. As with fecal urgency and incontinence (below), strengthening your pelvic floor muscles can help.

Fecal urgency and incontinence

The inability to control bowel movements. As with urinary incontinence, those with fecal incontinence can experience a range of severity, from small occasional bowel accidents to complete loss of bowel control. 

Seeking treatment 

While many people feel uncomfortable or embarrassed about these symptoms, we guarantee you that your provider really has seen it all before. There are treatment options and you deserve to have access to them. 

Pelvic floor exercises

Exercises (like kegels) can strengthen your pelvic floor muscles, and address or prevent issues of urinary and/or fecal incontinence. To learn more about how to do these exercises head here or talk to your provider. 

Kegels

A kegel is an exercise that involves tightening and lifting the pelvic floor and is an effective way to improve symptoms associated with a strained or weakened pelvic floor. Consult a provider before doing them during pregnancy or in the postpartum period. For more information on pelvic floor strengthening head here.

Once you get good at them, you can do your kegels from anywhere, no equipment needed. To learn more, watch our pelvic floor strengthening series. 

This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic. 

Read more

• Don’t be floored by postpartum pelvic floor dysfunction 
• Mental health postpartum

Sources

• “Accidental Bowel Leakage.” American Urogynecologic Society. 2016. https://www.augs.org/assets/2/6/ABL.pdf. 
• “Pelvic Floor Dysfunction: Symptoms, Causes & Treatment.” Cleveland Clinic. my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction.
• Mayo Clinic Pelvic Floor Dysfunction Program in Minnesota. Mayo Clinic. February 5, 2021. https://www.mayoclinic.org/departments-centers/pelvic-floor-dysfunction-program/overview/ovc-20467221. 
• Mayo Clinic Staff. “What to expect after a vaginal birth. Mayo Clinic. Mayo Clinic. March 11, 2020. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-care/art-20047233.
• Yvonne Butler Tobah, M.D. “What can I do to treat hemorrhoids during pregnancy?” Mayo Clinic. Mayo Clinic. August 16, 2019. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149.

• Pregnancy complications and your risk of cardiovascular disease
• What is a molar pregnancy?

Sources

• Mayo Clinic Staff. “Molar Pregnancy: Complications.” MayoClinic. Mayo Foundation for Medical Education and Research, Oct 24 2014. Web.
• “What is gestational trophoblastic disease?” Cancer. American Cancer Society, Feb 9 2016. Web.
• “Gestational Trophoblastic Disease.” MedlinePlus. US National Library of Medicine, Jun 11 2014. Web.
• Ross Berkowitz, et al. “Gestational trophoblastic neoplasia: Epidemiology, clinical features, diagnosis, staging, and risk stratification.” Uptodate. UptoDate, Inc., Jan 5 2015. Web.

The majority of hydatidiform moles, also known as molar pregnancies, are very treatable, whether through a dilation and curettage (D&C) or a more permanent procedure like a hysterectomy. The success rates of these procedures are quite high.

Understanding potential symptoms or complications from molar pregnancy

Women should know that possible complications are associated with molar pregnancies, and also that women who have a molar pregnancy may be at greater risk of certain future health conditions.

Persistent gestational trophoblastic disease

A molar pregnancy is one of a few different conditions under the umbrella of gestational trophoblastic disease (GTD). Most of the time after treatment to remove a molar pregnancy, the body will get rid of any molar tissue that remains in the uterus. However, for some women, molar tissue remains and continues to grow. This is known as persistent gestational trophoblastic disease. Persistent GTD occurs in roughly one out of every five women who experience a molar pregnancy. It is more common after a complete molar pregnancy than a partial one.

When the remaining molar tissue grows into, or invades, the tissue surrounding the uterus, gestational trophoblastic neoplasm (GTN) has occurred. GTN can be dangerous, and it is considered a malignancy because it has the potential to spread to other parts of the body. To make sure that the tissue isn’t still growing, your healthcare provider will regularly measure your hCG level and check to make sure it is decreasing over time. A sign of GTN is high hCG levels after the removal of molar tissue.

If it’s determined that a woman has GTN, the condition requires additional treatment, but it can usually be treated with chemotherapy or a hysterectomy, depending on what the provider and the woman decide is best.

Invasive mole

Invasive moles occur when molar tissue remains in the uterus after treatment and grows into the uterine muscle wall. Most of the time, invasive moles will remain localized to the uterus, but invasive moles do have the ability to spread to other parts of the body, which is why they require additional treatment.

Choriocarcinoma

Choriocarcinoma is a cancerous and rarer type of GTD, and while they can develop spontaneously, half of all cases of choriocarcinoma occur after a molar pregnancy. The condition grows quickly and can spread to other organs in the body, so it needs to be treated right away. Cancer drugs are usually used to treat choriocarcinoma.

Knowing your risk

It’s important to understand that these complications are uncommon, and they don’t affect the majority of women who experience a molar pregnancy. However, knowing the possible complications can help you prepare for your appointments and understand why your provider takes certain measures to monitor things like your hCG levels. If you have any questions about possible risks of GTD, make sure to ask your provider to tell you more about them, and how they may or may not relate to your health.

Reviewed by the Ovia Health Clinical Team

Read more

• Pregnancy complications and your risk of cardiovascular disease
• What is a molar pregnancy?

Sources

• Mayo Clinic Staff. “Molar Pregnancy: Complications.” MayoClinic. Mayo Foundation for Medical Education and Research, Oct 24 2014. Web.
• “What is gestational trophoblastic disease?” Cancer. American Cancer Society, Feb 9 2016. Web.
• “Gestational Trophoblastic Disease.” MedlinePlus. US National Library of Medicine, Jun 11 2014. Web.
• Ross Berkowitz, et al. “Gestational trophoblastic neoplasia: Epidemiology, clinical features, diagnosis, staging, and risk stratification.” Uptodate. UptoDate, Inc., Jan 5 2015. Web.

How does an ectopic pregnancy happen?

Normally, an egg is fertilized in the fallopian tube and then travels down the tube to the uterus (womb).  When in the uterus, it implants itself into the uterine wall, where it will grow for the next 40 weeks. However, some embryos make a wrong turn and implant in the fallopian tube, ovary or inside your abdomen.

Are there symptoms of an ectopic pregnancy?

Early symptoms of an ectopic pregnancy are the same as those of a normal pregnancy. You may have morning sickness and sore breasts, and you’ll have a positive urine or blood test.

If you have increasing pelvic or abdominal pain (often only on one side), bleeding, and weakness or dizziness, this may be an indication of an ectopic pregnancy. Another hallmark of an ectopic pregnancy is pain in the shoulder blades. If you have these symptoms, it’s important to get medical help immediately.

What happens next?

An ectopic pregnancy in the fallopian tube may also damage the tube, cause internal bleeding and require surgery. When an ectopic pregnancy is found early enough, a medication called methotrexate can end the pregnancy before the tube ruptures. This approach requires careful monitoring of your pregnancy hormone levels in the weeks after treatment.

If the methotrexate injection was not successful, or the pregnancy was advanced, doctors perform surgery to remove the pregnancy and attempt to repair any damage. Doctors may have to remove the fallopian tube, in some cases, which may negatively impact future fertility. Some people have so much bleeding they may require a longer hospital stay and blood transfusions. Getting care as soon as any symptoms appear, and certainly as soon as the diagnosis of an ectopic pregnancy is made – is crucial. We acknowledge that abortion bans in some states have made this extremely complex and delayed care in some cases, despite the medical consensus that this is a life-threatening emergency.

Getting pregnant again.

Having a previous ectopic pregnancy can make conceiving again more difficult if a tube was removed or other major surgery took place. Additionally, those who experience an ectopic pregnancy are at an increased risk for another in the future. Your OB provider will be able to discuss the risks and benefits of when to try again when you’re ready. Just as with any pregnancy loss, trying again can be much more complex after experiencing an ectopic. Counseling and talking to those you trust can help you feel supported and process this traumatic experience.

Reviewed by the Ovia Health Clinical Team

Read more

• Heavy vaginal bleeding when pregnant
• What happens after miscarriage

Sources

• “Ectopic Pregnancy: FAQ 155.” ACOG. American College of Obstetricians and Gynecologists, 8/11/2015. Web.
• “Ectopic Pregnancy.” U.S National Library of Medicine. MedlinePlus, 2/24/2014. Web.