Obstetrics & Pregnancy Care

Diagnosing Birth Defects

Diagnosing Birth Defects

Prenatal tests can be done to detect certain birth defects. Screening tests can help detect the risk of a possible problem. Based on the results, some pregnant women may be offered a diagnostic test.

Almost every mother-to-be worries about her baby having a problem. Most of the time, this worry is needless. Almost all children in the United States are born healthy. Out of 100 newborns, only two or three have major birth defects. A birth defect is a mental or physical problem that is present at birth. It also is called a congenital disorder. Birth defects can be genetic, occurring in genes or chromosomes, or caused by exposure to harmful agents.


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Birth Defects

Birth Defects

What is a birth defect?
A birth defect is a physical problem that is present at birth. A birth defect may affect how the body looks, functions, or both.
Many birth defects are mild, but some can be severe. Babies with birth defects may need surgery or medical treatment.
*Source ACOG
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Risk Factors

Risk Factors

Many babies with birth defects are born to couples with no risk factors. However, the risk of birth defects is increased when certain factors are present:

  • Family or personal history of birth defects
  • Previous child with a birth defect
  • Certain medicines used around the time of conception
  • Diabetes before pregnancy
  • Woman aged 35 years or older when the baby is due

Later Childbearing

Why is there a concern about having a child later in life?
Becoming pregnant after age 35 years can present a challenge. Also, having a child later in life has certain risks. These risks may affect a woman’s health as well as her baby’s health.
How does age affect fertility?
Fertility in women starts to decrease at age 32 years and becomes more rapid after age 37 years. Women become less fertile as they age because they begin life with a fixed number of eggs in their ovaries. This number decreases as they grow older. Eggs also are not as easily fertilized in older women as they are in younger women. Problems that can affect fertility, such as endometriosis and uterine fibroids, become more common with increasing age as well.
What specific health concerns are there for later childbearing?
Older women are more likely to have pre-existing health problems than younger women. For example, high blood pressure is a condition that is more common in older women (see the FAQ High Blood Pressure During Pregnancy). If you are older than 35 years, you also are more likely to develop high blood pressure and related disorders for the first time during pregnancy. The risk of developing diabetes or gestational diabetes increases with age as well (see the FAQ Gestational Diabetes)
How can high blood pressure affect pregnancy?
High blood pressure poses risks that include problems with the placenta and the growth of the fetus.
How can diabetes affect pregnancy?
If you have diabetes, you are at greater risk of having a child with birth defects. The risks of high blood pressure,

miscarriage, and macrosomia, a condition in which the fetus grows too large, are increased as well.
Do older women have an increased risk of having a child with a birth defect?
The overall risk of having a child with a birth defect is small. However, the risk of having a child with a birth defect caused by missing, damaged, or extra chromosomes is increased in older women.
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Screening Tests

Screening Tests

What is a screening test?
A screening test can give information about a pregnant woman’s risk of having a baby with certain birth defects. Not all
birth defects can be detected with screening tests before birth.
What are some of the birth defects for which there are screening tests?
  • Neural tube defect— Incomplete closure of the fetal spine that can result in spina bifida oranencephaly
  • Abdominal wall defects — One type of defect occurs when the muscle and skin that cover the wall of the abdomen are missing and the bowel sticks out through a hole in the abdominal wall (gastroschisis). Another type is when the tissue around the umbilical cord is weak and allows organs to protrude into this area (omphalocele).
  • Heart defect —The chambers or pathways through the heart are not properly developed.
  • Down syndrome — Mental retardation, abnormal features of the face, and medical problems such as heart defects occur as a result of an extra chromosome 21 (trisomy 21).
  • Trisomy 18 —There is an extra chromosome 18, which causes severe mental retardation and birth defects and sometimes death.
Who should receive screening tests?
Screening tests are offered to all pregnant women to assess their risk of having a baby with a birth defect or genetic
disorder. If a screening test shows an increased risk of having an affected baby, further tests may be used to diagnose the
problem. An abnormal screening test result, while alarming, only signals a possible problem. In most cases, the baby is healthy even if there is an abnormal screening test result. Likewise, a birth defect can occur even if the test result does not show a problem.
What screening tests are done in the first trimester?
First trimester screening tests include blood tests and an ultrasoundexam. This screening can be done as a single combined test or as part of a step-by-step process. Some women may not need further testing. First trimester screening is done between 11 weeks and 14 weeks of pregnancy to detect the risk of Down syndrome and trisomy 18. The blood tests measure the level of two substances in the mother’s blood:
1. Pregnancy-associated plasma protein-A (PAPP-A)
2. Human chorionic gonadotropin (hCG)
An ultrasound exam, called nuchal translucency screening, is used to measure the thickness at the back of the neck of the fetus. An increase in this space may be a sign of Down syndrome, trisomy 18, or other chromosomal problems. How is the risk for birth defects assessed in first trimester screening?
In first trimester screening, the results of the nuchal translucency screening are combined with those of the blood tests and the mother’s age to assess the risk for the fetus. In the first trimester, this combined test detects Down syndrome in most but not all cases (82–87%). When the nuchal translucency thickness is increased, the fetus may have a heart defect or other genetic condition. In this case, your health care provider may suggest a more detailed ultrasound exam around 20 weeks of pregnancy.
What screening tests are done in the second trimester?
In the second trimester, a test called “multiple marker screening” is offered to screen for Down syndrome, trisomy 18, and
neural tube defects. This test measures the level of three or four of the following substances in your blood:
•Alpha-fetoprotein (AFP) — A substance made by a growing fetus, which is found in amniotic fluid, fetal blood, and, in
smaller amounts, in the mother’s blood.
•Estriol — A hormone made by the placenta and the liver of the fetus.
•Human chorionic gonadotropin — A hormone made by the placenta.
•Inhibin-A — A hormone produced by the placenta.
The test using the first three of these substances is called a triple screen. When the fourth substance (inhibin-A) is added, the test is called a quadruple screen. The triple screen test detects Down syndrome in 69% of the cases. The quadruple screen detects Down syndrome in 81% of the cases. The AFP test detects neural tube defects in 80% of the cases. These tests usually are done around 15 –20 weeks of pregnancy. The stage of pregnancy at the time of the test is important because levels of the substances measured change during pregnancy.
What is combined screening?
The results from both first- and second-trimester tests can be combined to increase their ability to detect Down syndrome.
When both the first- and second-trimester tests are used, about 90–95% of Down syndrome cases can be detected. With this type of testing, the final result may not be available until all tests are completed. What happens when the results from screening tests are a cause for concern?
If the results of a screening test or other factors raise concerns about your pregnancy, diagnostic tests can be done to provide more information.
These tests include the following:
•Detailed ultrasound exam — A type of ultrasound exam that can help explain abnormal results and provide more detailed
information about the growth and development of the fetus.
•Amniocentesis — A procedure in which a small amount of amniotic fluid and cells are withdrawn from the sac surrounding
the fetus and tested.
•Chorionic villus sampling (CVS) — A procedure in which a small sample of cells from the placenta is tested
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Diagnostic Tests

Diagnostic Tests

What are diagnostic tests?
Diagnostic tests detect whether certain birth defects are present. They usually are performed if a screening test or other
factors raise concerns. The following diagnostic tests may be offered:
  • Detailed ultrasound exam —This type of ultrasound exam can help explain abnormal screening test results and provide more detailed information.
  • Amniocentesis— In this procedure, a needle is used to withdraw a small amount of amniotic fluid and cells from the sacsurrounding the fetus. The amniotic fluid and cells can be tested to detect certain chromosomal problems in the fetus.
  • Chorionic villus sampling (CVS) —A small sample of cells is taken from the placenta and tested. CVS detects some of the same chromosomal problems that amniocentesis does.
  • Fetal blood sampling — Also known as cordocentesis, this procedure tests for chromosomal defects and other problems. For this test, blood is taken from a vein in the umbilical cord. Fetal blood sampling usually is used when the results of amniocentesis, chorionic villus sampling, or ultrasound are unclear.
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Detailed Ultrasound Exam

Detailed Ultrasound Exam

What does ultrasound show?
Ultrasound creates pictures of the internal organs of the body from sound waves. There is no radiation involved. The sound
waves are directed into a specific area of the body through a
  • The sound waves hit tissues, body fluids, and bones. Waves then bounce back, like echoes, and are converted into pictures of the internal organs and—during pregnancy—the fetus
  • The images appear on a screen similar to a computer monitor. Dark areas show liquid, like amniotic fluid. Gray or light areas show denser material, like tissue or bone.
The type of ultrasound that is used most often combines still pictures to show movement, like the single frames that make a movie. This is called real-time ultrasound.
When is ultrasound used in obstetrics?
Ultrasound is used in obstetrics to examine the growing fetus inside the woman’s
uterus. A standard ultrasound exam can provide information about the fetus’s health and well-being, including:
  • Age of the fetus
  • Rate of growth of the fetus
  • Placement of the placenta
  • Fetal position, movement, breathing and heart rate
  • Amount of amniotic fluid in the uterus
  • Number of fetuses
  • Some birth defects
Other uses of ultrasound during pregnancy include a fetal cardiogram. This is a detailed ultrasound exam of the heart that may be done if heart problems are suspected in the fetus. Ultrasound also may be used for diagnosing an ectopic pregnancy or determining the cause of bleeding or pain during pregnancy.
What types of ultrasound are there?
There are many different types of ultrasound exams. The type of ultrasound you have will depend on what types of images
your health care provider needs and why the exam is being done. Types of ultrasound are listed as follows:
  • Transabdominal – The transducer is placed on the abdomen.
  • Transvaginal -The transducer is placed in the vagina
  • Doppler Ultrasound – For this exam, high-intensity sound waves are used to study the movement of blood (usually through the umbilical cord or between the uterus and the placenta.) Doppler ultrasound also can be used to listen to the baby’s heartbeat.
  • Sonohysterography – For sonohysterography you first will
    have a transvaginal ultrasound exam. A catheter (a small tube) then will be inserted through the cervix, and a saline solution (salt water) will be injected through the catheter. The saline solution fills the uterus so abnormal findings can be seen inside the uterus. It also acts as a contract material, which makes it easier to see anything abnormal.
  • Three-dimensional and four-dimensional (3D and 4D) ultrasound: these are types of transabdominal ultrasounds. A 3D ultrasound exam takes thousands of images at once. These are stored and shaded to make a 3D image, which looks more lifelike.
  • A 4D image is similar to a 3D image but it also shows movement.
What is involved in the preparation for transabdominal ultrasound?
If you are having a transabdominal ultrasound, wear loose-fitting clothes. This will allow your abdomen to be exposed easily.
You may need to drink up to six glasses of water during the 2 hours before your exam. This will make your bladder full. A full
bladder is necessary for the following reasons:
  • It pushes loops of the bowel up and out of the way, making the uterus easier to see
  • If you are pregnant, it moves the uterus higher in the belly, making the fetus easier to see

For this exam, you will lie on a table with your abdomen exposed from the lower part of the ribs to the hips. Mineral oil or gel is applied to the surface of the abdomen. This improves contact of the transducer with the skin surface. Sound waves cannot move through air, so the gel helps get rid of the air between the skin and transducer.

What is involved in the preparation for transvaginal ultrasound?

The transvaginal ultrasound, you will be asked to change into a hospital gown or undress from the waist down. You or your health care provider may wish to have a chaperone present during the exam. You will lie on your back with your feet in the stirrups, like a pelvic exam. The transducer for this exam is shaped like a wand. It is covered with latex, like a condom and lubricated before it is inserted into the vagina. This type ultrasound can give a closer look at the pelvic and organs.

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Amniocentesis usually is done at 15-20 weeks of pregnancy. To perform the procedure, a doctor guides a thin needle through your abdomen and uterus. A small sample of amniotic fluid is withdrawn and sent to a lab.

In the lab, cells from the baby that were taken from the amniotic fluid are grown in a special culture. This usually takes about 10-12 days. Next, the chromosomes in these cells are studied under a microscope. This shows if there is an extra chromosome (as in Down syndrome) or other chromosomal defects.

Complications from amniocentesis are uncommon. Side effects may include cramping, vaginal bleeding, infection and leaking amniotic fluid.

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Chorionic Villus Sampling

Chorionic Villus Sampling

Chorionic villus sampling (CVS)—For this test, a small sample of cells is taken from the placenta and tested. This test is
done in the first trimester of pregnancy.
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Fetal Blood Sampling

Fetal Blood Sampling

Also known as cordocentesis, fetal blood sampling is used to test for chromosomal defects and other problems.

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The Next Steps

The Next Steps

Most of the time, the results of a diagnostic test are normal. If diagnostic tests show that there is a problem, a counselor can help explain how the baby will be affected.

Finally . . .
If you receive abnormal results from a screening test or are at increased risk for having a baby with a birth defect, you may be offered diagnostic testing during pregnancy. Most of the time, the results of a test will confirm that the baby is healthy. If the results are abnormal, knowing about problems before the baby is born may help a woman make decisions about health care for her baby.

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © April 2005 The American College of Obstetricians and Gynecologists

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Breastfeeding: Maternal and Infant Aspects



How does breastfeeding benefit my baby?


Breastfeeding benefits your baby in the following ways:

  1. Breast milk provides the perfect mix of vitamins, protein and fat that your baby needs to grow.
  2. The colostrum that your breasts make during the last few days after childbirth helps your new born’s digestive system to grow and function.
  3. Breast milk has antibodies that help your baby’s immune system fight off viruses and bacteria
  4. Breast milk is easier to digest than formula
  5. Breastfeeding decreases the risk of sudden infant death syndrome.
  6. If your baby is born preterm, breast milk can help reduce the risk of many of the short-term problems that preterm babies face.

How does breastfeeding my baby benefit me?

Breastfeeding is good for you for the following reasons:

  1. During breastfeeding, the hormone oxytocin is released. Oxytocin causes the uterus to contract and return to its normal size more quickly.
  2. Breastfeeding may help with postpartum weight loss.
  3. Women who breastfeed have lower rates of breast cancer and ovarian cancer.
  4. Breastfeeding saves time and money.
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What problems may I encounter while breastfeeding?

It is normal for minor problems to arise in the days and weeks when you first begin breastfeeding. If any of the following problems persist, call your health care provider or ask to see a lactation specialist:

  1. Nipple pain – some soreness or discomfort is normal when breastfeeding. Nipple pain or soreness that continues past the first week or does not get better usually is not normal. Nipple pain may be caused by the baby not getting enough of the areola into his or her mouth and instead sucking mostly on the nipple. Make sure the baby’s mouth is open wide and has as much of the areola in the mouth as possible. Applying a small amount of breast milk to the nipple may speed up the healing process. Try different breastfeeding positions to avoid sore areas.
  2. Engorgement – When your breasts are full of milk, they an feel full, hard and tender. Once your body figures out just how much milk your baby needs, the problem should go away in a week or so. To ease engorgement, breastfeed more often to drain your breasts. Before breastfeeding, you can gently massage your breasts or express a little milk with your hand or a pump to soften them. Between feedings, apply warm compresses or take a warm shower to help ease the discomfort.
  3. Blocked milk duct – If a duct gets a clogged with unused milk, a hard knot will form in that breast. To clear the block and get the milk flowing again, try breastfeeding long and often on that breast that is blocked. Apply heat with a warm shower, heating pad, or hot water botle.
  4. Mastitis – If a blocked duct is not drained, it can lead to a breast infection call mastitis. Mastitis can cause flu-like symptoms such as fever, aches and fatigue. Your breast also will be swollen and painful and may be warm to the touch. If you have these symptoms call your helath care provider. You may be prescribed antibiotics to treat the infection. You may be able to continue to breastfeed while taking this medication.

What can I do to ensure that I provide the best nutrition for my baby and myslf?

The following tips will help you meet the nutritional goals needed for breastfeeding:

You need an extra 400-500 calories a day while breastfeeding

Your health care provider may recommend that you continue to take your prenatal vitamin while breastfeeding. The baby’s health care provider may recommend that you give your baby 400 international units of Vitamin D daily in drop form. This vitamin is essential for strong bones and teeth.

Drink plenty of fluids and drink more if your urine is dark yellow. It is a good idea to drink a glass of water every time you breastfeed.

Avoid foods that may cause stomach upset in your baby. Common culprits are gassy foods and spicy foods.

Drinking caffeine in moderate amounts should not affect your baby. 200 milligrams a day.

If you want to have an occasional alcoholic drink, wait at least 2 hours after you drink to breastfeed.

Always check with your health care provider before taking prescription or over the counter medications

Avoid smoking and using illegal drugs. Both can harm your baby. Taking prescription drugs for nonmedical reasons can also be harmful.

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Working Mothers and Time Away

Working Mothers and Time Away

What should I know about returning to work if I am breastfeeding?

By law, your employer is required to provide a reasonable amount of break time and space to express milk frequently as needed for up to 1 year following the birth of a child. The space provided can not be a bathroom and it must be shielded from view and free from intrusion by coworkers or the public. You will need a safe place to store milk properly. During an 8-hour workday, you should be able to pump enough milk during your breaks.

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How Long to Breastfeed

How Long to Breastfeed

How long should I breastfeed my baby?

It is recommended that babies breastfeed exclusively at least for the first 6 months of life. Your baby can continue to breastfeed beyond his or her first birthday as long as you and your baby want to.

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Changes in Your Body During Pregnancy

Nutrition During Pregnancy Exercise During Pregnancy Nausea


What is morning sickness?

Nausea and vomiting that happen during pregnancy, especially during the first part of pregnancy is called “morning sickness”. Despite its name, morning sickness can occur at any time of the day.

What causes morning sickness?

Although no one is certain what causes morning sickness, increasing levels of hormones during pregnancy may play a role.

How long should I expect morning sickness to last?

In most women, symptoms of nausea and vomiting are mild and go away after the middle of pregnancy.

What are the effects of morning sickness on pregnancy?

Most mild cases of nausea and vomiting do not harm your health or your baby’s health. Morning sickness does not mean your baby is sick.

When is morning sickness considered severe?

Morning sickness is considered severe if you cannot keep any foods or fluids down and begin to lose weight. This is called hypermesis gravidarum.

Is there a cure for morning sickness?

There is no cure for morning sickness. Some research suggests that women who are taking a multivitamin supplement regularly at the time they become pregnant are less likely to have severe cases.

What can I do to ease my symptoms of morning sickness?

If you experience morning sickness, there are several things you can do that might help you feel better. You may need to try more than one of these remedies:

  1. Get plenty of rest
  2. Avoid smells that bother you
  3. Eat five or six small meals each day instead of three large meals
  4. Eat a few crackers before you get out of bed in the morning
  5. Eat a small snack high in protein (such as a glass of milk or a cup of yogurt)
  6. Avoid spicy foods and fatty foods

Are there any herbal supplements that can help?

Ginger may be helpful for some women. Taking three 250-milligram capsules of ginger a day plus an additional capsul before bed may help relieve nausea. Remember to talk with your health care provider before taking any herbal medication or supplement or trying any treatment. You can also try ginger ale or ginger tea made with real ginger.

How are sever symptoms of morning sickness treated?

Your health care provider will first find out whether your nausea and vomiting are due to morning sickness or if there is another cause. If other causes are ruled out, certain medications can be given. Vitamin B may be suggested first. Doxylamine, a medication found in over-the-counter sleep aids, may be added if Vitamin B does not relieve symptoms. Drugs that combat nausea and vomiting may be prescribed.


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During pregnancy, the muscle contractions that normally move food through your intestines slow down because of higher levels of the hormone progesterone. Add to that the extra iron you’re getting from your prenatal vitamin, and the result is uncomfortable constipation and gas that can keep you feeling bloated throughout your pregnancy. Increase your fiber intake and drink extra fluids to keep things moving more smoothly. Physical activity can also help.

If your constipation is really bothering you, talk to your doctor about what mild laxative or stool softeners are safe to use during pregnancy.

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Backache and Leg Pains

Backache and Leg Pains

What causes back pain during pregnancy?

Back pain in pregnancy has many possible causes. It usually is caused by strain on the back muscles. In mid-pregnancy, when your uterus becomes heavier, your center of gravity changes. Your posture changes in response. Most women begin to lean backward in the later months of pregnancy, which makes their back muscles work harder.

Weakness of the abdominal muscles also can cause back pain. The abdominal muscles normally support the spine and play an important role in the health of the back. During pregnancy, these muscles become stretched and may weaken causing some back pain. These changes also make you more prone to injury when you exercise.

Pregnancy hormones may contribute to back pain. To make your baby’s passage through your pelvis easier, a hormone relaxes the ligaments in the strong, weight-bearing joints in the pelvis. This loosening makes the joints more flexible, but it can cause back pain if the joints become too mobile.

What can I do to prevent back pain during pregnancy?

To help prevent or ease back pain, be aware of how you stand, sit, and move. Here are some tips that may help:

  • Wear low-heeled (but not flat) shoes with good arch support.
  • Ask for help when lifting heavy objects.
  • When standing for long periods, place one foot on a stool or box.
  • If your bed is too soft, have someone help you place a board between the mattress and box spring.
  • Do not bend over from the waist to pick things up – squat down, bend your knees, and keep your back straight.
  • Sit in chairs with good back support, or use a small pillow behind the low part of your back.
  • Try to sleep on your side with one or two pillows between your legs for support.

What can I do to ease back pain?

Apply heat or cold to the painful area or massage it. Exercises for the back can help lessen backache. They strengthen and stretch muscles that support the back and legs and promote good posture – keeping the muscles of the back, abdomen, hips and upper body strong. These exercises not only will help ease back pain but also will help prepare you for labor and delivery. Staying active during pregnancy can help with back pain. Water exercise and walking are safe to do during pregnancy and are great for the back.

When should I contact my health care provider about back pain?

If you have severe pain, or if pain persists for more than 2 weeks, you should contact your health care provider. Do not try to treat yourself. Back pain also can be caused by other problems. Back pain is one of the main symptoms of preterm labor. You also should contact your health care provider if you are having fever, burning during urination, or vaginal bleeding.

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Emotional Changes

Emotional Changes

Depression during pregnancy can have an effect on the health of both the pregnant woman and her baby. Women who have severe depression during pregnancy may have trouble taking care of themselves. They may not eat healthfully or get enough rest. Depression during pregnancy has been linked to several problems including premature birth, problems with the growth of the fetus, having a low birth weight baby and complications after birth.

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More than half of all pregnant women report symptoms of severe heartburn, particularly during their second and third trimesters. Heartburn, also called acid indigestion, is an irritation or burning sensation of the esophagus caused by stomach contents that reflux (comes back up) from the stomach.

Heartburn in pregnancy may occur because of changing hormone levels, which can affect the muscles of the digestive tract and how different foods are tolerated. Pregnancy hormones can cause the lower esophageal sphincter (the muscular valve between the stomach and esophagus) to relax, allowing stomach acids to splash back up into the esophagus. In addition, the enlarged uterus can crowd the abdomen, pushing stomach acids upward. Although it’s rare, gallstones can also cause heartburn during pregnancy.

To reduce heartburn during pregnancy without hurting your baby, you should try the following:

  • Eat several small meals each day instead of three large ones.
  • Eat slowly.
  • Avoid fried, spicy, or rich foods, or any foods that seem to cause relaxation of the lower esophageal sphincter and increase the risk of heartburn.
  • Drink less while eating. Drinking large amounts while eating may increase the risk of acid reflux and heartburn.
  • Don’t lie down directly after eating.
  • Keep the head of your bed higher than the foot of your bed. Or place pillows under your shoulders to help prevent stomach acids from rising into your chest.
  • Ask your doctor about using over-the-counter medications such as Tums or Maalox, which are generally safe to use during pregnancy. You may find that liquid heartburn relievers are more effective in treating heartburn, because they coat the esophagus.
  • Wear loose-fitting clothing. Tight-fitting clothes can increase the pressure on your stomach and abdomen.
  • Avoid constipation.

If your heartburn persists, see your doctor. He or she may prescribe medications that are safe to take during pregnancy. Heartburn usually disappears following childbirth.

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The weight and pressure of your uterus can slow blood flow from your lower body and cause the veins in your swollen, sore and blue. These are called varicose veins. They also can appear near your vagina and rectum (usually called hemorrhoids). In most cases varicose veins are not a problem.

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Swelling in Your Hands and Feet

Swelling in Your Hands and Feet

Slight swelling is expected during pregnancy; however, if you experience sudden swelling in your hands and your face, it could be a sign of preeclampsia. It is important to contact your health care provider about any sudden swelling.

Swelling may be reduced by eating foods that are high in potassium, such as bananas, and by avoiding caffeine. Here are some other helpful hints to manage swelling during your pregnancy:

  • Avoid standing for long periods
  • Minimize outdoor time when it is hot
  • Rest with your feet elevated
  • Wear comfortable shoes, avoiding high heels if possible
  • Wear supportive tights or stockings
  • Avoid clothes that are tight around your wrists or ankles
  • Rest or swim in a pool
  • Use cold compresses on swollen areas
  • Drink water, which helps flush the body and reduce water retention
  • Minimize sodium (salt) intake and avoid adding additional salt to meals
Last Updated: 03/2007

Compiled using information from the following sources:

Mayo Clinic Guide To A Healthy Pregnancy Harms, Roger W., M.D., et al, Part 3.

Pregnancy, Childbirth and the Newborn: The Complete Guide. Simkin, Penny, P.T., et al, Ch. 6.

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Medications During Pregnancy

What over-the-counter medications can I take during pregnancy?

What over-the-counter medications can I take during pregnancy?

Heartburn, gas and bloating, upset stomach Antacids for heartburn (Maalox, Mylanta, Rolaids, Tums)

Simethicone for gas pains (Gas-X, Maalox Anti-Gas, Mylanta Gas, Mylicon)

Cough or cold Guaifenesin, an expectorant (Hytuss, Mucinex, Naldecon Senior EX, Robitussin)

Dextromethorphan, a cough suppressant (Benylin Adult, Robitussin Maximum Strength Cough, Scot-Tussin DM, Vicks 44 Cough Relief)

Guaifenesin plus dextromethorphan (Benylin Expectorant, Robitussin DM, Vicks 44E)

Cough drops

Vicks VapoRub

Not safe to take:

Cold remedies that contain alcohol

The decongestants pseudoephedrine and phenylephrine, which can affect blood flow to the placenta

Pain relief, headache, and fever Acetaminophen (Anacin Aspirin-Free, Tylenol)
Allergy relief Chlorpheniramine, an antihistamine (Chlor-Trimeton allergy tablets)

Loratadine, an antihistamine (Alavert, Claritin, Tavist ND, Triaminic Allerchews)

Diphenhydramine, an antihistamine (Banophen, Benadryl, Diphenhist, Genahist)

Constipation, hemorrhoids, and diarrhea Psyllium (Konsyl-D, Metamucil, Modane Bulk, Perdiem)

Polycarbophil (Equalactin, Fiber-Lax, FiberNorm, Konsyl-Fiber, Mitrolan)

Methylcellulose (Citrucel, Unifiber)

Other laxatives and stool softeners (Colace, Dulcolax, Maltsupex, milk of magnesia)

Hemorrhoid creams (Anusol, Preparation H, Tucks)

Loperamide, anti-diarrhea medication (Imodium, Kaopectate II, Maalox Anti-Diarrheal, Pepto Diarrhea Control)

Yeast infections and other fungal infections such as athlete’s foot Clotrimazole (Cruex, Gyne-Lotrimin 3, Lotrimin AF, Mycelex 7)

Miconazole (Desenex, Femizol-M, Micatin, Monistat 3)

Terbinafine (Lamisil AT)

Tioconazole (Monistat 1, Vagistat 1)

Butoconazole (Femstat 3, Mycelex 3)

Butenafine (Lotrimin Ultra)

Tolnaftate (Absorbine Athlete’s Foot Cream, Absorbine Footcare, Genaspor, Tinactin)

Undecylenic Acid and derivatives (Cruex, Desenex, Fungi Cure, Tinacide)

Not safe to take:
Certain antifungal products not listed here
(Certain Cruex, Desenex, and Fungi Cure products may contain other antifungal agents not listed here that should not be used during pregnancy. Check labels carefully.)

Insomnia Diphenhydramine (Benadryl, Maximum Strength Unisom SleepGels, Nytol, Sominex)

Doxylamine succinate (Unisom Nighttime Sleep-Aid)

Itching Hydrocortisone (Cortaid, Lanacort)
Cuts and scrapes Polysporin
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Labor Signs, Symptoms, and Warnings

What are the usual labor signs?

What are the usual labor signs?

As labor begins, the cervix opens (dilates). The uterus, which contains muscle, contracts at regular intervals. When it contracts, the abdomen becomes hard. Between the contractions, the uterus relaxes and becomes soft. Up to the start of labor and during early labor, the baby will continue to move.

Certain changes also may signal that labor is beginning. You may or may not notice some of them before labor begins:

Signs that you are approaching labor:

Feeling as if the baby has dropped lower. This is lightening and is known as the “baby dropping.” The baby’s head has settled deep into your pelvis. It can occur from a few weeks to a few hours before labor begins.

Increase in vaginal discharge (clear, pink or slightly bloody). This is show. A Thick mucus plug has accumulated at the cervix during pregnancy. When the cervix begins to dilate, the plug is pushed into the vagina. This can occur several days before labor begins or at the onset of labor.

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Gynecological Care

The Pap Test

The Pap Test

The Pap test, also called a Pap smear or cervical cytology screening, checks for abnormal changes in the cells of the cervix and allows early treatment so that abnormal cells do not become cancer.

What causes abnormal Pap test results?

The main cause abnormal Pap test results is infection with human papillomavirus (HPV). There are many types of HPV. Some types have been linked to cancer of the cervix, vulva, and vagina. Other types have been linked to genital warts.


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Exercise and Fitness

Exercise and Fitness

Regular exercise can provide the following health benefits:

  1. Reduce the risk of heart disease by strengthening your heart, lowering cholesterol and decreasing blood pressure.
  2. Decrease the risk of diabetes and certain types of cancer
  3. Increase your flexibility
  4. Give you more energy
  5. Strengthen your muscles
  6. Help control your weight
  7. Build and maintain strong bones
  8. Relieve stress
  9. Help you sleep better
  10. May help with depression and anxiety

What are the types of exercise?

There are two types of exercises – cardiovascular (or aerobic) exercise and strength training. A mix of both is best. In addition to these exercises, every workout should include exercises to promote flexibility. This means careful stretching of the muscles and joints. Some exercise programs such as Pilates and yoga are specifically designed to improve flexibility.

All strength training and some cardiovascular exercise is weight bearing. This means that during exercise, your body is supporting your weight against gravity. This promotes bone density and protects osteoporosis.

How often and how much should I exercise?

  • To decrease the risk of chronic disease – exercise at least 30 minutes on most days of the week.
  • To maintain weight – exercise about 60 minutes on most days of the week. You should not eat more calories than you burn.
  • To lose weight – exercise at least 60-90 minutes most days of the week.
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Hormone Replacement Therapy

Hormone Replacement Therapy

Hormone Replacement Therapy

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Acne is caused by overactive glands in the skin. They make a natural oil called sebum. During puberty, these glands make extra sebum that can clog the pores in your skin.

What can I do if I get acne?

Wash your face often with water and mild cleanser to help get rid of the extra sebum. This will reduce pimples and acne. Avoid products that dry or irritate your skin. Do not scrub or pick at your skin. If you have concerns about acne or pimples, some medications can help. Talk to your doctor about your concerns.

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Especially for Teens: Your First Gyn Visit

Especially for Teens: Your First Gyn Visit

When should I have my first gynecologic visit?

An obstetrician-gynecologist (ob-gyn) is a doctor who specializes in the health care of women. Girls should have their first gynecologic visit between the ages of 13 and 15 years.

Is it normal to be nervous before the first visit?

It is normal to feel nervous about your first visit. It may help if you talk about it with your parents or someone else you trust. You may want to let your doctor know that you are nervous. He or she can help put you at ease.

What should I expect at the first gynecologic visit?

The first visit may be just a talk between you and your doctor. You can find out what to expect at future visits and get information about how to stay healthy. You also may h ave certain exams.

Your doctor may ask a lot of questions about you and your family. Some of them may seem personal, such as questions about your menstrual period or sexual activities (including vagina, oral or anal sex). If you are concerned about confidentiality, you and your doctor should talk about it before you answer any questions. Much of the information you share can be kept confidential.

What exams are performed?

You may have certain exams at the first visit. If you choose, a nurse or family member may join you for any part of the exam. Most often, these exams are performed:

General physical exam

External genital exam

You usually do not need to have a pelvic exam at the first visit unless you are having problems, such as abnormal bleeding or pain. If you are sexually active, you may have tests for certain sexually transmitted diseases. Most of the test that teens need can be done by the doctor with a urine sample. You also may have certain vaccinations.

What happens during a general physical exam?

During the general exam, your height, weight and blood pressure will be checked. You also will be examined for any health problems you may have.

What happens during an external genital exam?

In this exam, the doctor looks at the vulva. He or she may give you a mirror so that you can look at the vulva as well. This exam is a good way to learn about your body and the names for each part.

What are the pelvic exam and Pap test?

Even though you probably will not have a pelvic exam, you should know what one is. Another test that you will have later (at age 21 years) is a Pap test. This test checks for abnormal changes in the cervix that could lead to cancer.

The pelvic exam has three parts:

  1. Looking at the vuvla
  2. Looking at the vagina and cervix with a speculum
  3. Checking the internal organs with a gloved hand

The doctor will us a speculum to look at your vagina and cervix. When you have a Pap test, a sample of cells is taken from your cervix with a small brush. To check your internal organs, the doctor will place one or two gloved, lubricated fingers into the vagina and end up to the cervix. The other hand will press on the abdomen from the outside.

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Healthy Eating

Healthy Eating

How can my diet affect my health?
Many health problems in the United States are linked to poor diet and lack of exercise. These include cardiovascular disease, diabetes, high blood pressure,
osteoporosis, obesity, constipation, and certain types of cancer. By maintaining
a healthy lifestyle that combines good food choices and exercise, many of these conditions can be prevented or controlled.
What nutrients does my body need to stay healthy?
Your body needs a regular supply of nutrients to grow, replace worn-out tissue, and provide energy. The amount of each nutrient you need each day is called the dietary reference intake (DRI). You can get your DRI of nutrients from food as well
as from supplements. However, most of the nutrients you need should come from the foods you eat. To be sure that you are getting enough nutrients, you need to know which ones are in the foods you eat. The U.S.Department of Agriculture’s web site “MyPlate” (www.choosemyplate.gov) can help you make healthy food choices.
Why is it important to get enough calcium?
Bones can become thin and brittle if your diet is low in calcium. This may cause osteoporosis (see the FAQ Osteoporosis).
Most women need 1,000 milligrams (mg) of calcium per day. To get your DRI of calcium, you need to drink about 3 cups of non-fat milk a day. Other dairy foods, such as low-fat milk, yogurt, and cheese, also are high in calcium. If you prefer non-dairy products or you are lactose intolerant , consider these sources of calcium:
  • Dark greens (collards, spinach, turnip greens, and kale)
  • Soybeans and some soy products
  • Certain canned fish and seafood (sardines, pink salmon with bone, blue crab, and clams)
  • Cereals and juices with added calcium
It also is important to get enough vitamin D, which helps the body to absorb calcium. For this reason, vitamin D often is added to milk. Exposure to sun also can help the body make vitamin D.
Why is iron important?
If you are not getting enough iron, anemia may occur. Women may become anemic because of the loss of blood during menstruation or childbirth. Anemia may make you feel tired. If it becomes severe, it can make you feel weak and look pale.
Most women of childbearing age need 18 mg of iron per day. During and after
menopause, women may not need such high levels of iron. If you are aged 51 years or older, you need 8 mg of iron per day. One serving of most breakfast cereals with added iron should provide your DRI of iron. Other foods that are good sources of iron include the following:
  • Spinach
  • Beans
  • Clams and Oysters
  • Meats
  • Organ Meats

It helps to eat foods rich in vitamin C, like oranges and tomatoes at the same meal with an iron-rich food. Vitamin C helps your body use iron better.

Why is folic acid important?
Folic acid is important for all women. It also is needed for healthy growth of a baby during pregnancy, especially during the first months. Not getting enough folic acid in your diet increases the risk of having a baby with certain birth defects of the
spine and skull. Women who can get pregnant or who are pregnant should take 0.4 mg of folic acid daily. Women who have had a child with a spine or skull defect need even higher doses of folic acid (4 mg per day) based on their health care provider’s recommendation. The richest food sources of folic acid are those that have it added to them, such as breakfast cereals, bread, pasta, flour, crackers, and orange juice. Other foods that are good sources of folic acid include dark leafy greens (such as spinach and collard greens) and citrus fruit (such as oranges and lemons).
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Reducing Your Risk of Cancer

Reducing Your Risk of Cancer

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Birth Control

Birth Control

Birth Control Pills

How do birth control pills work?

Birth control pills contain hormones that prevent ovulation. These hormones also cause other changes in the body that help prevent pregnancy. The mucus in the cervix thickens which can make it hard for sperm to enter the uterus. The lining of the uterus thins, making it less likely that a fertilized egg can attach to it.

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Hormonal Birth Control Options: Implants, injections, Rings and Patches.

What are hormonal birth control methods?

Besides oral contraceptives (birth control pills) and the hormonal intrauterine device, there are several other forms of hormonal birth control: implants, injections, rings, and patches.
The Intrauterine Device
What is an intrauterine device (IUD)?
The intrauterine device (IUD) is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy. The IUD can be used by women of all ages, including teenagers and those who have never had children.
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Premenstrual Syndrome

Premenstrual Syndrome

What is premenstrual syndrome? (PMS)

Many women feel physical or mood changes during the days before menstruation. When these happen month after month and they affect a woman’s normal life, they are known as PMS.

What are some common symptoms of PMS?

Emotional symptoms include:


-Angry outbursts


-Crying spells



-Social withdrawal

-Poor concentration


-Increased nap taking

-Changes in sexual desire

Physical symptoms include the following:

-Thirst and appetite changes (food cravings)

-Breast tenderness

-Bloating and weight gain


-Swelling of the hands and feet

-Aches and pains


-Skin problems

-Gastrointestinal symptoms

-Abdominal pain

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What is menopause?

Menopause is the time in a woman’s life when she stops having menstrual periods. The years leading up to this point are called perimenopause or “around menopause.” Menopause marks the end of the reproductive years that began in puberty.

What happens as menopause nears?

As menopause nears, the ovaries make less estrogen. One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods. Even though menstrual periods tend to be irregular around the time of menopause, you should be aware of bleeding that is not normal for you. This could be a sign of a problem (see the FAQ Abnormal Uterine Bleeding).
At some point, the ovaries stop making enough estrogen to thicken the lining of the uterus. This is when menstrual periods stop. You are not completely free of the risk of pregnancy until 1 year after your menstrual last period.
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What is osteoporosis?

Osteoporosis is a condition in which the bones become thin, brittle and weak. These changes can increase the risk of fractures. Fractures can lead to disability. Fractures caused by osteoporosis have been linked to an increased risk of death.

Is osteoporosis more common in women or in men?

Osteoporosis occurs five times more often in women than in men.

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What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is a virus that can be passed from person to person through skin to skin contact. More than 100 types of HPV have been found. About 30 of these types infect the genital areas of men and women and are spread from person to person through sexual contact.

How common is HPV?

HPV is a very common virus. Some research suggests that at least three out of four people who have sex will get a genital HPV infection at some time during their lives.

How is HPV infection spread?

HPV is primarily spread through vaginal, anal or oral sex, but intercourse is not required for infection to occur. HPV is spread by skin-to-skin contact. Sexual contact with an infected partner, regardless of the sex of the partner, is the most common way the virus is spread. Like many other sexually transmitted diseases, there often are no signs or symptoms of genital HPV infection.

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HPV Vaccine (Gardasil)

HPV Vaccine (Gardasil)

What HPV vaccines are available?

Two vaccines are currently available that protect against some types of HPV:

-One vaccine protects against type 6 and type 11, which cause the most cases of genital warts and against type 16 and type 18 which cause the most cases of cervical cancer.

-One vaccine protects against type 16 and type 18.

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Permanent birth control

Permanent birth control

Sterilization for Women and Men

What is sterilization?

Sterilization is a permanent method of birth control. It is the most popular form of birth control worldwide.

What is tubal sterilization?

Sterilization procedures for women are called tubal sterilization. Tubal sterilization involves closing off the fallopian tubes. Tubal sterilization prevents the egg from moving down the fallopian tube to the uterus and keeps the sperm from reaching the egg. It does not affect a woman’s menstrual cycle or sexual function.

Does tubal sterilization prevent sexually transmitted diseases (STDs)?

Sterilization does not protect against sexually transmitted diseases including human immunodeficiency virus (HIV).

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What is colposcopy?

Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light into the vagina and onto the cervix. A colposcope can greatly enlarge the normal view. This exam allows the health care provider to find problems that cannot be seen by the eye alone.

Why is colposcopy done?

Colposcopy is done when results of cervical cancer screening tests show abnormal changes in the cells of the cervix. Colposcopy provides more information about the abnormal cells. Colposcopy also may be used to further assess other problems:

– Genital warts on the cervix

-Cervicitis (an inflamed cervix)

-Benign (not cancer) growths, such as polyps



Sometimes colposcopy may need to be done more than once. It also can be used to check the result of a treatment.

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Evaluating Infertility

Evaluating Infertility

What is an infertility evaluation?

During an infertility evaluation, exams and tests are done to try to find the cause of infertility. If a cause is found, treatment may be possible. Infertility often can be successfully treated even if no cause is found.

When should I consider having an infertility evaluation?

You should consider having an infertility evaluation if any of the following apply to you:

-You have not become pregnant after 1 year of having regular sexual intercourse without the use of birth control.

-You are older than 35 years and have not become pregnant after 6 months of having regular sexual intercourse without the use of birth control.

-Your menstrual cycle is not regular.

-You or your partner have a known fertility problem.

What causes infertility?

Infertility can be caused by a number of factors. Both male and female factors can contribute to infertility. Female factors may involve problems with ovulation, the reproductive organs, or hormones. Male factors often involve problems with the amount or health of sperms.

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What causes infertility?

Infertility can be caused by a number of factors. Both male and female factors can contribute to infertility. Female factors may involve problems with ovulation, the reproductive organs, or hormones. Male factors often involve problems with the amount or health of sperm.

Does age affect fertility?

Yes. A woman begins life with a fixed number of eggs. This number decreases as she grows older. For healthy, young couples, the chance that a woman will become pregnant is about 20% in any single menstrual cycle. This percentage starts to decline in a woman’s early 30s. It declines more rapidly after age 37 years. A man’s fertility also declines with age, but not as predictably.

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What tests are done for infertility?

Tests for infertility include laboratory tests, imaging tests and certain procedures.

What does the basic testing for a woman consist of?

Laboratory tests include tracking basal body temperature, a urine test, a progesterone test, thyroid function tests, prolactin level test and tests of ovarian reserve. Imaging tests and procedures include an ultrasound exam, hysterosalpingography, sonohysterography, hysteroscopy, and laparoscopy. You may not have all of these tests and procedures. Some are done based on results of previous tests and procedures.

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What treatment options are available for infertility?

Treatment options depend on the cause of your infertility. Lifestyle changes, medication, surgery or assisted reproductive technology (ART) may be recommended. Several different treatments may be combined to improve results. Infertility often can be successfully treated even if no cause is found.

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What is hysterosalpingography (HSG)?

Hysterosalpingography (HSG) is an X-ray procedure that is used to view the inside of the uterus and the fallopian tubes. It often is used to see if the fallopian tubes are partly or fully blocked. It also can show if the inside of the uterus is of a normal size and shape. All of these problems can lead to infertility and pregnancy problems.

HSG also is used a few months after some tubal sterilization procedures to make sure that the fallopian tubes have been completely blocked. HSG is not done if a woman has any of the following conditions:


-Pelvic Infection

-Heavy Uterine Bleeding at the Time of the Procedure

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Uterine Fibroids

Uterine Fibroids

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.

Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.

As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.


© 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

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Ovarian Cysts

Ovarian Cysts

What is an ovarian cyst?

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. Ovarian cysts are quite common in women during their childbearing years. a Woman can develop one cyst or many cysts. Ovarian cysts can vary in size. In most cases, cysts are harmless and go away on their own. In other cases, they may cause problems and need treatment. There are different types of ovarian cysts. Most cysts are benign (not cancerous). Rarely, a few cysts may turn out to be malignant (Cancerous).

What are the symptoms of ovarian cysts?

Most ovarian cysts are small and do not cause symptoms. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.

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Pelvic Support Problems

Pelvic Support Problems

What are pelvic support problems?

The pelvic organs include the vagina, cervix, uterus, bladder, urethra, small intestines and rectum. The pelvic organs are held in place by muscles of the pelvic floor. Layers of connective tissue called fascia also provide support. These supporting muscles and fascia may become torn or stretched, or they may weaken because of aging. Problems with pelvic support often are associated with pelvic organ prolapse. In this condition, the fascia and muscles can no longer support the pelvic organs. As a result, the organs that they support can drop downward.

What are the symptoms of the pelvic organ prolapse?

Many women have no symptoms and are not bothered by their pelvic organ prolapse. The symptoms of those who do have problems can range from mild to severe.

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What is hysteroscopy?

Hysteroscopy is used to diagnose or treat problems of the uterus. A hysteroscope is a thin, lighted telescope-like device. It is inserted through your vagina into your uterus. The hysteroscope transmits the image of your uterus onto a screen. Other instruments are used along with the hysteroscope for treatment.

Why is hysteroscopy done?

One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less often or more often than normal. Bleeding between menstrual periods also is abnormal. Hysteroscopy also is used in the following situations:

-Remove adhesions that may occur because of infection or from past surgery

-Diagnose the cause of repeated miscarriage when a woman has more than two miscarriages in a row

-Locate an intrauterine device

-Perform sterilization, in which the hysteroscope is used to place small implants into a woman’s fallopian tubes as a permanent form of birth control.

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What is a hysterectomy?

The surgical removal of the uterus.

What are the reasons for having a hysterectomy?

A hysterectomy may be done to treat conditions that affect the uterus:

-Uterine fibroids


-Pelvic support problems (such as uterine prolapse)

-Abnormal uterine bleeding


Chronic pelvic pain

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