Birth defects happen for various reasons and not all can be prevented. However, people can increase their chances of having a healthy baby by adopting healthy habits before becoming pregnant. Birth defects can be found before the birth of the child, at birth, or anytime after (usually up to a year). 

Be sure to see your healthcare provider regularly and start prenatal care as soon as you think you might be pregnant. To schedule an in-person or telehealth appointment with a UCR Health physician, give us a call at 1844-827-8000 or click here. You can also visit www.cdc.gov/birthdefects to learn more about the steps you can take to prevent birth defects.

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What is an Ectopic Pregnancy?

An ectopic pregnancy is a pregnancy in which a fertilized egg during pregnancy has implanted outside of the normal location within the womb or uterus. Women suffering from an ectopic pregnancy can present in a variety of ways, most commonly in the 1^st 3 months of pregnancy with lower abdominal pain and vaginal bleeding. These symptoms typically present anywhere from 6-8 weeks after the patients last menstrual period but can also present later. 

What are the different kinds of ectopic pregnancy?

Below are some of the different locations that can be involved in an ectopic pregnancy, with attachment to the fallopian tube occurring in 96% of cases; nonetheless all of them are abnormal. An untreated ectopic pregnancy can be a medical emergency.

What are the risk factors?

While all woman who are sexually potentially have a minor risk for an ectopic pregnancy, some women may be at much higher risk:

High Risk:

• previous history of an ectopic pregnancy
• previous pelvic surgery, abdominal surgery, or multiple abortions
• having structural abnormalities in the fallopian tubes that make it hard for the egg to travel
• current or past use of an IUD or use of Levonorgestrel IUD
• In Vitro fertilization in current pregnancy. 

Moderate Risk:

• Being 35 years or older
• Current use of Estrogen or Progestin oral contraceptives
• Previous sexually transmitted infection (chlamydia or gonorrhea)
• Previous pelvic inflammatory disease
• Current or previous smoker
• Previous unexpected abortion

Low Risk:

• history of infertility
• previous medically induced abortion
• Age > 40 years+
• Use of vaginal douche
• Previous surgical removal of appendix 

It is important to remember that even if you have one or a couple of these risk factors above, it doesn’t necessarily mean that you have or will get an ectopic pregnancy, but if you have symptoms you should speak with your gynecologist.  Below is a list of these risk factors with an Odds Ratio, which is a statistical term to express how likely an ectopic pregnancy may be.  When you meet with your gynecologist they will go over this information with you.

When do Gynecologists consider Ectopic Pregnancy as a diagnosis?

 Ectopic pregnancies are considered by providers in any sexually active woman with vaginal bleeding or abdominal pain and:

-Are pregnant but do not have a confirmed pregnancy within the uterus.

-Pregnancy was conceived in a medically assisted way via a petri dish (in vitro fertilization)

-Uncertain if pregnant but patient has not had of a period for > 4 weeks before current symptoms started

-Patients who have unstable vital signs (dangerously low blood pressure, rapid heart rate) with sudden abdominal pain unexplained by other diagnosis.

-May also have no symptoms at all.

I have been diagnosed with an Ectopic Pregnancy.  What is the treatment?

If you are diagnosed with an ectopic pregnancy, it can be a very scary.  Your gynecologist will discuss many different options with you, some of which we will review here.

Your doctor will likely measure a hormone called beta human chorionic gonadotropin (B-hCG) in order to track the ectopic pregnancy.  An ultrasound will also be performed in order to try to determine the location of the ectopic pregnancy (like in the picture above). Your blood pressure and heart rate will be checked along with a physical exam.  Based on each of these factors, medical or surgical treatment may be offered.  Your doctor will help you to determine the best course of treatment for you.

Call the UCR Silver Oaks Office at 844-827-8000 to schedule an appointment with one of our Gynecologists.

Resources:

1. Clayton HB, Schieve LA, Peterson HB, et al. Ectopic pregnancy risk with assisted reproductive technology procedures. Obstet Gynecol 2006; 107:595.
2. Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002; 17:3224.
3. Alkatout I, Honemeyer U, Strauss A, et al. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 2013; 68:571.

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Finding out you are pregnant is exciting news, often followed by many questions about what to expect and what comes next. Whether you are a first-time mom, or have multiple children, seeking prenatal care early in pregnancy is key to a healthy pregnancy for you and your baby.

What is prenatal care?

Prenatal care is the healthcare you receive while pregnant. Regular prenatal care throughout your pregnancy helps to catch potential concerns early and reduces the risk of pregnancy and birth complications.

As soon as you suspect you are pregnant, make an appointment with your OB/Gyn. If you don’t have one, call your health insurance to determine which obstetricians are covered by your insurance. (If you don’t have health insurance, reach out to your local community health center or county health department for your health care coverage options.)

You can expect to see your healthcare provider often and regularly throughout your pregnancy. Typically, you will be scheduled for your first prenatal appointment when you are at least 8 weeks pregnant. For pregnancies without complications, prenatal visits are usually scheduled as follows:

• Up to week 28: 1 prenatal visit a month
• Weeks 28 to 36: 1 prenatal visit every 2 weeks
• Weeks 36 to 40: 1 prenatal visit every week

Your doctor will want to see you more often if you had any preexisting health conditions like diabetes or high blood pressure before you became pregnant, if you are over the age of 35, or if problems develop during your pregnancy.

What to expect at your prenatal visits

At your first prenatal visit, your doctor or healthcare provider will review your medical history. She likely will perform a complete physical examination as well as urine and blood tests during this visit.

At each visit, your healthcare provider will check you and your baby. She will talk with you about the things you can do help you and your baby stay healthy, such as eating healthy foods, staying active and gaining the right amount of weight during pregnancy. Your healthcare provider may also order blood tests and imaging tests, such as an ultrasound.

Each prenatal visit is important for a healthy pregnancy

Even if you are farther along in your pregnancy, prenatal care is still important. It is not too late to begin to seek care, so call your doctor today to schedule a visit. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and have birth complications. Seeing your doctor regularly helps ensure you have the healthiest pregnancy possible.

Kim Tustison, MD is a UCR Women’s Health OB/Gyn.

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Pregnancy and childbirth are exceptional experiences in the lives of women. Although delivery usually goes smoothly, sometimes childbirth is complicated. Obstetrical perineal lacerations are tears to the skin and tissue between the vagina and anus that occur during vaginal delivery. They occur to some degree in over 90 percent of women having their first vaginal delivery. The majority of women have relatively minor lacerations that are repaired and heal easily. However, about two percent of women experience severe lacerations that involve not only the vaginal skin and underlying tissue, but also the anal sphincter muscles and even the rectum.

Risk factors for severe lacerations include:

• Need for delivery with obstetrical forceps or vacuum assistance
• Very large babies (over 8 pounds, 13 ounces)
• Prolonged duration of pushing

Usually, even these severe lacerations can be repaired in the delivery room after the birth of a woman’s baby. To repair the damaged tissue, an obstetrician will use stitches that dissolve.

Most women fully recover from perineal lacerations. Unfortunately, about 20 percent of women that experience a severe perineal laceration suffer from complications that include:

• Leaking urine (urinary incontinence), especially when exercising, coughing, laughing, or sneezing, is the most well recognized bothersome urinary symptom following delivery. Other problems include urinary frequency (eight or more times per day) or bothersome need to urinate after going to bed.
• Bowel problems including accidental leakage of stool may result from direct injury to the anal sphincter muscles or from neurologic damage to the rectum that results in needing to rush to the toilet or conversely having trouble completely emptying your bowels.
• Sexual problems including pain during or following intercourse may result from damage to the pelvic floor muscles.
• Pelvic organ prolapse, the condition in which the pelvic organs herniate into the vagina. Women become aware of this problem when they can feel (with their fingers) a lump or bulge near the entrance of the vagina (for example, during toileting or showering).

Specialized physical therapy that focuses on the pelvic floor muscles can effectively address these problems. However, in rare cases, surgery may be required to treat these conditions.

Mikio Nihira, MD is a UCR Health urogynecologist, board-certified in both Obstetrics/Gynecology and Female Pelvic Medicine and Reconstructive Surgery.

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Folic Acid

Folic acid is a critically important B vitamin. Everybody uses folic acid to create new cells in their bodies. Folic acid is used when creating new DNA, a building block of genetic material. Current dietary recommendations for adults are 400 micrograms (mcg) of folic acid per day. Many prepared foods such as cereals, pastas, and breads are fortified with folic acid to help everyone consume enough folic acid in their diets. You can also get more folic acid in your diet by eating asparagus, beets, leafy green vegetables, oranges, and dried beans, peas, and lentils. However, even with a healthy diet, it can be difficult to get the recommended amount of folic acid from food alone. 

Folic acid for pregnancy

During the earliest stages of pregnancy, embryonic and placental cells are rapidly dividing, and thus folic acid becomes very important. Before many women even know they are pregnant, folic acid is already supporting proper brain and spinal cord development. Having adequate levels of folic acid before getting pregnant and in early pregnancy can prevent certain types of neural tube defects (NTDs) − serious birth defects of the spinal cord and brain – such as spina bifida and anencephaly. 

In the United States, approximately 3,000 pregnancies per year are affected by neural tube defects. The Centers for Disease Control (CDC) estimates that 70% of these NTDs are preventable with early and adequate folic acid supplementation. At least one month prior to becoming pregnant, every woman should take a multivitamin containing 400 mcg of folic acid. During pregnancy, 400 to 600 mcg of folic acid are recommended. Some women may be higher risk based on their family or medical history and may require even higher doses of folic acid, so be sure to talk to your doctor about how much folic acid you need. 

 A recent article in the Journal of the American Medical Association suggested that most U.S. women do not have enough folic acid stored in their bodies. To prepare for a healthy pregnancy, start increasing your daily folic acid intake now by eating a healthy diet and by taking a Women’s Daily or Prenatal Vitamin.  

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Left untreated, gestational diabetes increases the risk of childhood obesity

Gestational diabetes is a form of diabetes which occurs in a pregnant woman who did not have diabetes before she was pregnant. In an expectant mother with gestational diabetes, the body does not produce adequate amounts of insulin to regulate blood sugar. Doctors usually test for gestational diabetes between 24 and 28 weeks of pregnancy. However, women who have had diabetes in a previous pregnancy, are over the age of 35, overweight, or those who have a family history of diabetes may be tested earlier and more often.

What are some of the risks associated with gestational diabetes?

If you are diagnosed with gestational diabetes, it is important to work with your physician to control your blood sugar. Often, gestational diabetes can be controlled with changes in your diet and regular exercise. Sometimes, however, a woman with gestational diabetes must also take medication which can be oral or may require insulin injections.  Maintaining normal sugar levels in pregnancy is important because high sugars in mothers can result in very low sugars for the newborn at birth.

Uncontrolled gestational diabetes can lead to increased risk of pregnancy complications, such as:

• A large baby
• Premature delivery
• Increased chance of cesarean delivery
• Higher risk of preeclampsia
• Slightly increased risk of fetal and neonatal death

Gestational diabetes and childhood obesity

The health risks associated with uncontrolled gestational diabetes go beyond pregnancy and the birth of your baby. Studies have shown that babies exposed to gestational diabetes in the womb are at high risk of developing health problems such as obesity and abnormal blood sugars even as children. When gestational diabetes is not well managed, a baby’s blood sugar can also be high. The baby becomes “overfed” and potentially predisposed to becoming obese. Infants born to mothers with untreated or uncontrolled gestational diabetes have nearly double the normal risk of becoming obese during childhood. The good news is that controlling blood sugar also normalizes risk. When gestational diabetes is well managed and blood sugar is controlled, the baby’s risk for childhood obesity is the same as children born to mothers with normal blood sugar.

For most women, gestational diabetes doesn't cause noticeable signs or symptoms, so it is important to get regular prenatal care to keep you and your baby healthy during pregnancy.

UCR Women's Health physicians provide compassionate, sensitive care for every stage of a woman's life.

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