You were probably diagnosed with epilepsy before you became pregnant. This condition causes seizures and these can affect the whole body with shaking and tongue biting or only affect particular parts of the body such as losing awareness and staring into space. Ideally you will have been offered pre-conception counselling to optimise your health before pregnancy.
What does this mean?
For Me
Pregnancy can lower the threshold for seizures to occur so it is important that you have care under an obstetrician specialising in medical conditions and a neurologist. You will be asked to take 5mg folic acid (ideally for three months prior to your pregnancy) to reduce the risk of disorders like spina bifida for the baby and you might need to increase your medication during pregnancy or take extra medications around the time of the birth.
For my baby
The medication called sodium valproate should not be taken in pregnancy but the other commonly used anti-epilepsy drugs are all safe to be used in pregnancy. It is really important that your epilepsy is treated effectively as frequent seizures in pregnancy can affect the baby’s growth.
What will the medical team recommend?
You may need extra blood tests to check the level of your anti-epileptic drug in your blood and to ensure you don’t need more. You will be recommended to take 5mg of folic acid to reduce the chances of your baby having a spine abnormality. You may be offered extra scans to check your baby’s growth.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
You must tell your medical team immediately if you have any seizures in your pregnancy so that they can ensure you are on the right level of treatment and organise tests to check your baby’s wellbeing.
Your partner and close family should be shown how to place you in a recovery position if you have a seizure.
The risk of seizures is greatest around the time of the birth and in the first 24 hours after the birth.
Likely recommendations
Treatment options
It is normally recommended that you stay on the same medication that you are on at the beginning of your pregnancy (but not sodium valproate) but you may need to increase the dose or add in other medication to control your epilepsy in your pregnancy. This is particularly important around the time you give birth when your sleep may be disrupted which can also increase the chance of having seizures.
Timing of birth
Normally the timing of birth is not affected by your epilepsy. Your medical team may recommend having an epidural for pain relief in your labour so that you can rest and reduce your risk of becoming excessively tired.
How may this impact my birth choices?
It is likely your team will recommend you give birth in the hospital and in a birth setting where doctors are readily available, such as the labour ward, in case you have a seizure during or immediately after your labour. It is recommended not to labour in water in case you have a seizure.
How may this affect care after the birth?
It is really important that you follow normal epilepsy advice such as taking showers instead of baths. Additionally, you will be advised not to change your baby’s nappy on a high surface but to use a change mat on the floor. There are lots of other helpful tips available from the links below.
Parents and parents-to-be with additional needs/disability are often well adapted to their activities at home and at work, in their relationships and in interactions with their surrounding environment. Adapting to pregnancy, birth and parenting may require further adaptations. It is estimated that almost 10% of parents have a long term health condition which may result in disability or adaptation to daily living.Maternity and other services can work in partnership with parents to facilitate individualised decision-making, equal access and making adjustments for pregnancy/birth and parenting.
Tips for getting the support you need:
Report your additional needs when completing your pregnancy self-referral form and discuss these needs again when you meet your midwife for the first time.
Ask for a named midwife or to be part of a continuity of care team. Knowing your midwife facilitates partnership working and personalised planning around your own needs.
You are the expert in yourself, so talk to your midwife about what would help you through pregnancy, birth and parenting. Complete the Health and wellbeing in pregnancy personalised care and support plan with your midwife, highlighting the need for adjustments and improved access.
Consider a self-referral for a Health Needs Assessment if you require assessment of your home, care needs or benefits.
Refer yourself to your local sensory impairment team for advice and adaptive equipment i.e. vibrating mat to alert to baby’s cry if you are hearing impaired.
Ask to see an occupational therapist for further specialised adaptive advice for home and parenting. Contact the local Social Services Occupational Therapy (for adaptive equipment and home adaptations) or Community Therapy teams e.g. neuro-rehabilitation for specific conditions such as Multiple sclerosis, Stroke or Functional Neurological Disorder, or via the community Learning Disability Team. Your GP can assist with making these referrals.
You can request longer appointment times, transport and accessibility to venue for appointments to facilitate your or your supporter’s needs.
Consider if you need someone with you at appointments, i.e. British Sign Language (BSL) interpreter, advocate or supportive relative. Talk about whom you would need to have with you during your hospital inpatient stay – assistance dog/supporter/interpreting service.
Discuss your preferred mode of communication i.e. small chunks of information, emailed information to support verbal advice to support memory, large print, technical aids i.e. signing app, audio messaging.
Ask about access to antenatal classes. The BSL interpreter can be with you if you are hearing impaired; the information can also be tailored for visually impaired parents. The midwife can allocate time for a personal session to individualise to your needs.
Environment:
It may be useful to ask for a tour of the birth and after birth areas to familiarise and identify where adjustments may be required.
Talk to your midwife about accessibility of the birthing pool, bathrooms, showers, bed heights, adjustable cot height and a single room after the baby is born to facilitate your stay if needed.
Talk to your midwife about lighting, sound or temperature sensitivities or any preferences that make adapting to the environment more manageable.
Discuss birth positions in case modifications are needed.
Thinking about baby care:
Talk to the midwife about your home environment – think about inside the home and outdoors.
Baby sleeping area – would a cot attached to the bed make it easier to reach the baby overnight?
Plan your night and day equipment – safe sleeping in your bedroom and in your living room i.e. Moses basket.
Baby changing stations (e.g. mat and equipment) in day/night area – to support energy conservation.
Carrying the baby – a baby wearing sling may help to enable you to keep your hands free or a light pushchair at home to move the baby from room to room.
Transporting the baby – will you use public transport, car or walk? Consider your needs when choosing a pushchair. The weight, brake location, ease of access, assembly and storage are things to consider when choosing the pushchair.
Infant feeding – discuss with your midwife. Consider a supportive infant feeding pillow to support baby’s position for feeding. Consider your own comfort and supported position. Where will you be feeding? Modified feeding positions i.e. for one handed feeding, or equipment to support holding the bottle. Ask your midwife about collecting breast milk during the last part of pregnancy if you feel this could be useful to supplement the baby’s needs in the early days.
If fatigue is a concern, your midwife can work with you to offer tips such as sleeping when the baby sleeps, energy conservation tips such as planning, pacing and prioritising what you need to ‘do, delay, delegate or ditch’ to enable your self-care and meeting the needs of your baby.
Talk to your supporters/family to ascertain how they can help you. Plan during the pregnancy so that you are ready for when the baby arrives. Where there is limited support discuss with your midwife to explore what other services might be available to you.
This will have been made before pregnancy. All women with Type 1 diabetes should be offered preconception counselling to optimise their health.
What does this mean?
For me: Pregnancy can increase your risk of developing or worsening your pre-existing diabetic eye or kidney problems. In the first trimester you are at higher risk of having episodes of low blood sugar. In the second half of the pregnancy you are at higher risk of diabetic ketoacidosis and pre-eclampsia and preterm delivery. You will need to attend more hospital visits during pregnancy and you will be under the care of a specialist team.For my baby: There is a greater risk of having a miscarriage or stillbirth. There is an increased risk of congenital abnormalities (birth defects for your baby) when your blood glucose levels are high at the time of conception, and during the first trimester. In the second half of pregnancy high blood sugar levels can increase the size of your baby or there may be a growth restriction (slow growth). This can make it make the delivery of your baby more complex. Your baby is more likely to have low blood glucose after they are born and may have other health conditions requiring specialist support.
What will the medical team recommend?
You will be seen in a joint diabetes and pregnancy clinic. Your first scan should take place at 7-9 weeks and you will need extra scans throughout the pregnancy. You will be asked to make changes to your diet and maintain/increase your physical activity.
What tests will/may be considered? How often may they be needed?
You will be asked to measure your blood sugar levels more often. You will be given more support for blood glucose monitoring and offered a continuous glucose monitoring sensor and will be given a ketone meter. You will be reminded what your target blood glucose levels should be and you should aim to keep your blood glucose within that range at least 70% of the time. You will need regular eye check-ups during pregnancy. Your blood pressure and kidney blood tests will also be monitored very closely.
What symptoms and signs should I be looking out for?
Morning sickness in the first trimester may affect your blood sugar levels. You may need anti-sickness medication if you are vomiting, so let your specialist maternity team know. Anti-sickness medication is safe to use during pregnancy. You are more likely to be unaware of your low blood sugars. You should have a glucagon pen at home and your partner/family should know how to administer this in an emergency should you become unwell.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or unable to take your regular insulin you must attend the hospital immediately. If your baby is not moving you should attend the hospital immediately.
How are recommendations made regarding treatment options?
You should be taking 5mg folic acid daily at least 3 months before conception and up to 16 weeks of pregnancy. To reduce your risk of pre-eclampsia you should take 75mg-150mg of aspirin each night from 12 weeks until 36 weeks. Your insulin doses will change during pregnancy. For example you may notice a drop in your insulin requirements in early pregnancy (typically at 8-16 weeks) and an increase in insulin requirements in the second half of your pregnancy. Be sure to discuss all treatment with your specialist team at the hospital.
How are recommendations made regarding timing of birth
You will be advised to deliver around 38 weeks gestation. This may be earlier if there are concerns about you, your blood glucose levels, or your baby. By 36 weeks your team should be working with you to make a plan for the birth.
How may this impact my birth choices?
You may be offered an induction of labour if your team feels it is safer to do so. You will need blood glucose monitoring throughout labour.
How may this affect care after the birth?
You and your baby will need to be monitored very closely after birth. Your baby is at risk of low blood sugar levels after birth. If you are breastfeeding you may find that your glucose levels drop quickly while you are feeding, and afterwards. A birth plan prior to delivery should have been agreed to regulate your insulin requirement.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Look after your health between pregnancies.
What will this mean for future/my long-term health and how can I influence this?
Contraception and a follow up plan should be agreed before you are discharged from maternity care.
This will have been made before pregnancy. Ideally all women with type 2 diabetes should be offered preconception counselling to optimise their health.
What does this mean?
For me: Pregnancy can increase your risk of developing or worsening your pre-existing diabetic eye or kidney problems. You are at higher risk of diabetic ketoacidosis and pre-eclampsia. You will need to attend more hospital visits during pregnancy and you are more likely to be delivered early (around 38 weeks of pregnancy).For my baby: There is a greater risk of a miscarriage or stillbirth. There is an increased risk of congenital abnormalities if your blood glucose levels are consistently raised at the time of conception. In the second half of pregnancy the sugar level can increase the size of your baby or there may be growth restriction slow growth). This can make it make the birth of your baby more complex. Your baby is more likely to have low blood glucose levels (hypoglycaemia) after birth and may have other health conditions requiring specialist support.
What will the medical team recommend?
You will be seen more frequently in a joint diabetes and pregnancy clinic. Your first scan should take place at around 7-9 weeks and you will need extra scans throughout the pregnancy. You will be asked to make changes to your diet and maintain/or increase your physical activity.
What tests will/may be considered? How often may they be needed?
You will be asked to measure your blood sugar levels at least four times a day: once before breakfast (fasting) and one hour after each meal. You will be given more support for blood glucose monitoring and may be offered a continuous glucose monitoring sensor. You will need eye check-ups during pregnancy. Your blood pressure will also be checked regularly.
What symptoms and signs should I be looking out for?
Morning sickness in the first trimester may affect your blood sugar levels. You may need anti-sickness medication if you are vomiting, so let your team know. Anti-sickness medication is safe to use during pregnancy.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or are unable to take your regular insulin you must attend the hospital. If your baby is not moving you should attend the hospital immediately.
How are recommendations made regarding treatment options?
You should be taking 5mg folic acid daily at least 3 months before conception and up to 16 weeks of pregnancy. To reduce your risk of pre-eclampsia you should take 75mg-150mg of aspirin each night from 12 weeks until 36 weeks. Medications that are safe to use in pregnancy are metformin and insulin. You may need more insulin as you progress through your pregnancy.
How are recommendations made regarding timing of birth?
You will be advised to deliver around 38 weeks gestation. This may be earlier if there are concerns about you, your blood glucose levels or the size of your baby. By 36 weeks your team should be working with you to make a plan for the birth.
How may this impact my birth choices?
You may be offered an induction of labour if your team feel it is safer to do so. You will need blood glucose monitoring throughout labour.
How may this affect care after the birth?
You and your baby will need to be monitored very closely after birth. Your baby is at risk of low blood glucose levels after birth. If you are breastfeeding you may find that your glucose levels drop quickly while you are feeding, and afterwards. A birth plan prior to delivery should have been agreed to regulate your insulin requirement.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Look after your health between pregnancies.
What will this mean for future/my long-term health and how can I influence this?
Contraception and a follow up plan should be agreed before you are discharged from maternity care.
You would have been screened for GDM if you have any of the following risk factors:
obesity
previous 4.5 kg baby
family history with diabetes
your ethnicity
previous gestational diabetes: or
you have persistent sugar in your urine. A blood test measuring your blood sugar (glucose) level after a sugary drink will confirm the diagnosis.
What does this mean?
For me: GDM increases your chance of developing pre-eclampsia during your pregnancy and having type 2 diabetes mellitus later in life.For my baby: There is a greater risk of having a miscarriage. The blood sugar level can increase the size of your baby. This could make it harder for you to deliver your baby and can increase the risk of your baby having shoulder dystocia. Your baby would be at a greater risk of developing obesity and or diabetes mellitus in their later life.
What will the medical team recommend?
You will be seen more frequently in a joint diabetes and pregnancy clinic. You will be asked to make changes to your diet and increase your physical activity. These lifestyle changes will help reduce your blood sugar level.
What tests will/may be considered? How often may they be needed?
You will be shown how to check your blood sugar levels and told what your target blood levels should be. You will be asked you to measure your blood sugar levels four times a day, once before breakfast (fasting) and one hour after each meal. You will need to do this daily until you deliver your baby.
What symptoms and signs should I be looking out for?
GDM does not usually have any symptoms. If your blood sugar level is high you may feel you want to urinate more, be thirstier or have vaginal thrush (itching and white vaginal thrush.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or your baby is moving less than normal.
How are recommendations made regarding treatment options?
Firstly you will be advised on diet changes and if this does not help you could be offered metformin or insulin. All these medications are safe for your baby.
How are recommendations made regarding timing of birth?
This may change depending upon the size of a baby and your blood sugar control.
How may this impact my birth choices?
We may advise you to deliver your baby before your due date.
How may this affect care after the birth?
You can stop checking your blood glucose levels after you have had your baby.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
GDM can increases your risk of developing gestational diabetes in a future pregnancy. It’s important to eat healthily and take regular physical activity during pregnancy, and to keep it up after pregnancy. This will reduce the risk in future pregnancies.
What will this mean for future/my long-term health and how can I influence this?
GDM can increases your risk of developing Type 2 diabetes in the future. It’s important to eat healthily and take regular physical activity during pregnancy, and to keep it up after pregnancy. This will reduce your future risk of developing Type 2 diabetes. You will need to see your GP every year to check you haven’t developed type 2 diabetes mellitus.
Where can I find out more information about this condition?
Pregnancy of unknown location: Frequently asked questions
What does this mean for me?
A Pregnancy of Unknown Location (PUL) is when you have a positive pregnancy test but a pregnancy could not be seen on ultrasound scan. There are three main reasons why this can occur:
1. The pregnancy is very early and it is too small to be seen on ultrasound scan.
2. The pregnancy has ended in a miscarriage and cannot be seen on ultrasound scan. It can take up to 3 weeks for the pregnancy hormone levels to drop to non-pregnant levels, which is why a pregnancy test may still be positive. This situation is more likely if you have recently had heavy bleeding.
3. The pregnancy has implanted outside the womb, called an ectopic pregnancy, but is too small to be visualised on ultrasound scan.
What will happen next?
You will have your pregnancy hormone (βHCG) level test. Some hospitals also take a test to assess the progesterone (ovarian hormone) level. The βHCG levels may then be repeated in 48 hours according to the protocol of your local Early Pregnancy Unit (EPU).A βHCG level rise of 63% over a 48-hour period (known as the ‘doubling time’) is usually (but not exclusively) associated with a pregnancy developing in the uterus. The pattern of these blood tests will help to guide further management including when to repeat further blood tests, urine pregnancy tests or a repeat ultrasound scan.This can be a stressful time, and it is natural to feel anxious while the location of your pregnancy is uncertain, particularly if you have had a pregnancy loss before. However, the time needed to get the right diagnosis is important and you will be supported throughout by your specialist team in the EPU. You will be advised to attend for further blood tests and scans to make a correct diagnosis of the pregnancy location and to offer you the right care and support. You will be able to contact the team with any queries or concerns you have during this time.
What worrying signs should I look out for?
The risk is that this may be an ectopic pregnancy (a pregnancy implanted outside the womb), which sometimes can cause life threatening internal (abdominal) bleeding. The risk of this happening is very low and your EPU team will guide. However, you should call your local EPU for advice or attend your local Accident and Emergency (A&E) department if you have of the following concerns:
Vaginal bleeding: If you have any heavy bleeding with severe abdominal pain, fever, or offensive discharge you should seek urgent medical help. However, bleeding is pregnancy is common and may not actually be heavy. It is not always a sign of something serious but should always be investigated.
Abdominal (tummy) pain: This typically occurs in the lower part of your abdomen, often on one side and can develop gradually or suddenly and may be quite intense. The pain may come and go and may sometimes be confused with ‘trapped wind’. Pain should also always be investigated in early pregnancy.
Shoulder tip pain: This is pain around the shoulder blades, and you should seek urgent medical help if this happens. It may be linked with internal bleeding in the abdomen and irritation of the nerves in this area leads to shoulder tip pain.
Diarrhoea: This may also be linked with internal bleeding like shoulder tip pain, as described above. In such cases there will also be abdominal pain and you should also seek urgent medical help if this happens.
Ectopic pregnancy rupture: In addition to the above, any of the following symptoms could be a sign of ectopic rupture and requires urgent A&E attendance – constant, severe abdominal pain; nausea/vomiting; dizziness/feeling faint; looking pale.
A molar pregnancy is also known as a Hydatidiform mole or Gestational Trophoblastic Disease. In a molar pregnancy the placental cells grow abnormally. Molar pregnancies occur sporadically as a result of imbalance in the number of chromosomes. Because of this imbalance it is not possible for a healthy pregnancy to develop. There are two types of molar pregnancy.
1. Partial mole
This is where two sperms have fertilised an egg and there are three sets of chromosomes instead of the normal two.
2. Complete mole
This is where one sperm (or sometimes two) fertilises an empty egg (containing no genetic material).
How is it diagnosed?
The diagnosis of a molar pregnancy is often made after a miscarriage, when the pregnancy tissue has been looked under the microscope by a hospital laboratory. There are specific criteria used by the laboratory to determine if the pregnancy was partial and complete molar pregnancy. Sometimes there may be a suspicion of this diagnosis on an ultrasound scan but it can only be confirmed after a detailed examination under the microscope.
What happens next?
When there is a suspicion of a molar pregnancy, an operation to remove the pregnancy tissue from the womb will be required, as this is not a healthy pregnancy. This operation is usually done under general anaesthetic and involves a small suction tube being passed through the vagina and cervix (the neck of your womb) to remove the pregnancy. The pregnancy tissue will be sent to the laboratory for detailed assessment.If a molar pregnancy is confirmed, you will need serial blood tests to confirm that the pregnancy hormone (βHCG) reduce to negative levels. This is important as there is a small risk that some of the abnormal pregnancy cells could develop into a more severe form of molar pregnancy (see below).You will be referred to the nearest highly specialist centre near you, which are based in London, Sheffield or Dundee who will be in charge of this follow up over several weeks and months. This follow-up is very important because in some cases the molar pregnancy keeps growing and can occasionally develop into a rare form of cancer called Gestational Trophoblastic Neoplasia. This is not common and if it does occur treatment with chemotherapy is associated with extremely high cure rates (98-100% cure rate).It is very important that you do not fall pregnant until your follow-up has been complete. Nearly all methods of contraception are safe to use, but an intrauterine device such as a coil is not recommended until your betaHCG becomes negative. We recommend you discuss the most appropriate type of contraception further with your doctor. The risk of molar pregnancy happening again in future pregnancy is low and is around 1 in 100 women.
Intrauterine pregnancy of uncertain viability: Frequently asked questions
What does this mean for me?
It means the pregnancy has been seen within the womb (uterus) on ultrasound scan, but a tiny baby (embryo) was not seen, or the tiny baby was seen but no heartbeat.
Why is this happening to me?
There are two possible reasons:
This can be a completely normal finding in a very early pregnancy. A urine pregnancy test can be positive as early as 5 days before you miss your next period. An Intrauterine pregnancy of uncertain viability (IPUV) is also possible if your periods are irregular, you have recently stopped contraception, or you were recently pregnant.
It may also be that the pregnancy is not going to develop as expected, unfortunately. This is more likely if the size of the pregnancy does not match the number of weeks of your pregnancy. This may also be more likely if you develop bleeding in early pregnancy.
What happens next?
A repeat ultrasound scan in one to two weeks is offered to confirm if a tiny baby (embryo) with a heartbeat can be seen. We know this will be an anxious period of waiting but this time interval is needed to allow the pregnancy to develop. If the pregnancy does not develop as expected, there is the possibility you may be diagnosed with a miscarriage at rescan. But if we confirm at rescan your baby is developing normally and a heartbeat is seen, you should request further pregnancy (antenatal) care by completing a self-referral form for maternity care or speak to your GP about your pregnancy, if not done already.
What worrying signs should I look out for?
Vaginal bleeding in early pregnancy is common. Many women with bleeding go on to have a successful pregnancy without complication. Bleeding does increase your risk of miscarriage and may be one of the first signs of this.Symptoms of miscarriage include heavy bleeding with clots, as well as lower tummy (abdominal) cramps or contraction like pain. If you are concerned you should call your local early pregnancy unit for advice or attend your local emergency department (A&E).If the bleeding becomes severe (having to change a pad every hour or passing large clots), severe pain that is not controlled with pain relief, or you have a fever, then you should attend your nearest A&E.
What should I do if I think I am miscarrying?
Sadly, miscarriages are common and there is a risk this may happen before the next ultrasound scan. This is unlikely to be related to anything you have done or not done but unfortunately it is not possible to prevent a miscarriage at this stage. You can take pain relief such as paracetamol and codeine to help ease any pain. If you have concerns about miscarrying or managing your emotions at this difficult time of uncertainty, then you should call your local Early Pregnancy Unit (EPU) to seek advice or attend A&E if you feel unwell.
A healthy pregnancy grows inside the uterus (womb), but an ectopic pregnancy is one where the pregnancy grows outside of the uterus. This occurs in about 1 in 80 pregnancies. Unfortunately, a pregnancy that implants outside of uterus cannot survive. The most common place for an ectopic pregnancy to grow is inside the Fallopian tube (the pair of tubes along which eggs travel from the ovaries to the uterus), although it can occur in other places. It can be dangerous if the pregnancy continues to grow and bursts (ruptures) as this can cause life-threatening internal bleeding.
Why is this happening to me?
Many women have no risk factors for developing an ectopic pregnancy. Certain things do increase your risk such as: a previous ectopic pregnancy; a history of pelvic inflammatory disease or endometriosis affecting the Fallopian tubes; smoking; previous pelvic or fallopian tube surgery; use of emergency contraception; age (especially 35-40 years), a history of infertility, or a pregnancy conceived via assisted conception or fertility treatments. Pregnancy is very uncommon with an intrauterine device in situ (such as a copper coil or Mirena), or use of the progesterone-only pill, but if you were to fall pregnant with this type of contraception this can also increase your risk.
What happens next?
A diagnosis of ectopic pregnancy is usually made with a combination of an ultrasound scan and regular blood tests to look at your pregnancy hormone levels βHCG (beta human chorionic gonadotropin).
What worrying signs should I look out for?
Vaginal bleeding: this is often less than a usual period or the amount or colour is different to period. If you were not aware you were pregnant you may even mistake it as a normal period. However, bleeding in pregnancy is common and is not always a sign of something serious, but should always be investigated at your local Early Pregnancy Unit (EPU).Abdominal (tummy) pain: this typically occurs in the lower part of your abdomen often on one side and can develop gradually or suddenly and may be quite intense. The pain may come and go and may sometimes be confused with ‘trapped wind’. Pain should also always be investigated in early pregnancy.Shoulder tip pain: This is pain around the shoulder blades, and you should seek urgent medical help if this happens. It may be linked with internal bleeding in the abdomen and irritation of the nerves in this area leads to shoulder tip pain.Diarrhoea: This may also be linked with internal bleeding like shoulder tip pain, as described above. In such cases there will also be abdominal pain and you should also seek urgent medical help if this happens.Ectopic pregnancy rupture: in addition to the above, any of the following symptoms could be a sign of ectopic rupture and requires urgent A&E attendance: constant, severe abdominal pain; nausea/vomiting; dizziness/feeling faint; looking pale.
How is it treated?
There are three treatment options for ectopic pregnancy:
Expectant management (waiting to see if the ectopic pregnancy resolves by itself)
Medicine to prevent the ectopic pregnancy from developing further
Surgery to remove the ectopic pregnancy.
Treatment options will depend on many different factors including, the size and location of the ectopic pregnancy, your blood results, your symptoms, any previous medical and surgical treatments. A specialist will talk you through your options and together you can choose the most suitable management plan. It is important to highlight your future pregnancy plans in this discussion.
Expectant management
If you are suitable for this option and choose to have expectant management, you will be monitored to see if your ectopic pregnancy resolves by itself. This involves regular blood tests to check your pregnancy hormone levels (referred to as βHCG (HCG) until they fall and become negative. This can take up to 6 weeks (or longer in small number of cases). The success of expectant management is variable and ranges from 30-100%. It is more likely to be successful if the pregnancy is small and your starting βHCG levels are low. If it is unsuccessful you may require further treatment with medicine or surgery.
Medical management
If you are suitable for this method, you may be offered the option of a medicine called Methotrexate to treat the ectopic pregnancy. This is normally a single injection, however approximately 15 in 100 women require a second injection. In some cases, medical management may be unsuccessful, and 7 in 100 women will go on to require surgery.As with expectant management you will require regular follow up with blood tests to ensure your pregnancy hormone, βHCG levels fall. If medical treatment is successful it will result in a 15% fall in your βHCG level by 1 week after a single methotrexate injection. It may take up to 6 weeks for the βHCG levels to become negative.Side effects of the medication are rare but include nausea/ vomiting, feeling fatigued, skin rashes, mouth ulcers, abdominal cramping, diarrhoea, sensitivity to sunlight, temporary hair loss and lung inflammation. The medicine can briefly affect your liver, kidneys, and bone marrow (where important blood cells which help fight infection are made) and therefore you will need additional blood tests along with betaHCG levels during your follow up. You should avoid alcohol and vitamins containing folic acid.Once your βHCG levels become negative you can drink alcohol and you should restart folic acid to rebuild your folate levels during the 3-month washout period for methotrexate.It is very important that you do not fall pregnant for at least 3 months after having this medicine, if you were to fall pregnant there is a risk of birth defects to a developing baby; this risk is no longer present after 3 months. You should discuss contraception options with the doctor or nurse in the early pregnancy unit, or with your GP.
Surgical treatment
This may be offered as an option or recommended as the best course of treatment for you. This will involve general anaesthesia and the entry into the tummy can be done in two ways:
Keyhole surgery (laparoscopy) – this is the standard surgical approach for nearly all cases.
Open surgery (laparotomy) – this may be needed on an individual case basis, unique to your clinical circumstances.
Managing the ectopic pregnancy can be done in two ways and this will be influenced by the health of the other fallopian tube, the one without the ectopic pregnancy:
Salpingectomy, involves the removal of the entire fallopian tube that contains the ectopic pregnancy. This is recommended if the other tube looks healthy.
Salpingostomy is considered if the other tube (not containing the ectopic pregnancy) does not look healthy or is absent. This involves making an incision on the fallopian tube to remove the ectopic pregnancy. The fallopian tube is not removed in this operation.
Both procedures carry small risks associated with having a surgical procedure and general anaesthetic. This includes risk of damage to other organs inside the abdomen such as the bowel, bladder, ureters (tubes that connect the bladder and the kidneys) and blood vessels. The surgeon and anaesthetist will talk you through the risks involved in more details.
After the operation, if your blood group is Rhesus negative, you should be offered an injection called Anti-D to prevent a condition from Rhesus Isoimmunisation. Rhesus Isoimmunisation is where your body develops antibodies if your baby’s blood group is Rhesus positive in this pregnancy. The Anti-D injection prevents your body developing antibodies which can negatively affect a Rhesus positive baby in future pregnancies and is recommended to remove this risk.
What worrying signs should I look out for after expectant or medical treatment?
If you opt for expectant or medical management you will be able to return home. It’s important that you seek urgent medical attention and attend the A&E department, at any time of the day or night if you develop new symptoms including severe abdominal pain, shoulder tip pain, feeling unwell, faint or collapse. Inform A&E team of the diagnosis of ectopic pregnancy, who will arrange for an urgent review by gynaecology services. This is because there is still a small risk of the tubal pregnancy rupturing, which can potentially cause life-threatening internal bleeding.
When can I get pregnant again?
It is very important that you do not fall pregnant until you have completed your follow up after an ectopic pregnancy and your local Early Pregnancy Unit (EPU) confirm βHCG levels have become negative with blood or urine pregnancy tests.If you chose to have Methotrexate then you need to wait at least 3 months before trying to conceive again. If Methotrexate was not used and your EPU confirms you are no longer pregnant you should wait for at least one period before trying again to help reset your body clock.However, you should only try for another pregnancy again when you feel ready as the emotional recovery often takes longer than the physical recovery. In your next pregnancy it is most likely that the pregnancy will be in the correct place inside the uterus. However, 10-18 women per 100 will have another ectopic pregnancy. You should therefore contact your local EPU as soon as you know you are pregnant so you can get booked in for an early scan from 5-6 weeks to confirm the location of the pregnancy.
Having a blocked nose in pregnancy is quite common. Many conditions affecting the nasal passages and sinuses are sometimes caused by infection, e.g. common cold, or irritants, e.g. hayfever. Nasal infections are usually self-limiting but the symptoms can be uncomfortable and distressing.Recommended treatment aims to remove excess mucus and to alleviate congestion. Increasing fluid intake can help thin the mucus, steam inhalation may reduce the feeling of congestion and raising the head while sleeping can help to drain excess mucus.
Parents and parents-to-be with additional needs/disability are often well adapted to their activities at home and at work, in their relationships and in interactions with their surrounding environment. Adapting to pregnancy, birth and parenting may require further adaptations. It is estimated that almost 10% of parents have a long term health condition which may result in disability or adaptation to daily living.
Maternity and other services can work in partnership with parents to facilitate individualised decision-making, equal access and making adjustments for pregnancy/birth and parenting.
Having a blocked nose in pregnancy is quite common. Many conditions affecting the nasal passages and sinuses are sometimes caused by infection, e.g. common cold, or irritants, e.g. hayfever. Nasal infections are usually self-limiting but the symptoms can be uncomfortable and distressing.
Recommended treatment aims to remove excess mucus and to alleviate congestion. Increasing fluid intake can help thin the mucus, steam inhalation may reduce the feeling of congestion and raising the head while sleeping can help to drain excess mucus.
