Contemporary Women’s Health | Obstetrics, Gynecology, Aesthetic and Massage

Obstetrics Q&A


How much weight should I gain during my pregnancy?

The average recommended weight gain during pregnancy is 25 to 35 pounds. If you are underweight prior to your pregnancy, your average weight gain should be 30 to 40 pounds. If prior to your pregnancy you are overweight, your average weight gain should be 20 to 30 pounds. Most women gain approximately 5 to 6 pounds during the first trimester of their pregnancy. After the first trimester (at approximately 13 weeks) weight gain is approximately 1 pound per week.

During pregnancy it is important to maintain good nutrition and adequate caloric intake. The average caloric intake for a pregnant woman should be approximately 300 calories more per day than usual. If you don't gain an adequate amount of weight during your pregnancy, you run the risk of a low birth weight infant. It is important not to diet during your pregnancy. On the same note, excess weight gain can lead to large babies with resultant traumatic deliveries. It is important to watch your weight gain closely during pregnancy.

I am 18 ½ weeks pregnant. My OBGYN suggests an amniocentesis, but I do not wish to risk it.

I am 18 ½ weeks pregnant and have had a previous pregnancy with trisomy 13, which resulted in fetal demise. I have had a stage II ultrasound this time at 15 ½ weeks and everything looked good. The geniologist looked at the ultrasound and reported there were no stigmata of a trisomy, 13 or otherwise. My question is related to my AFP results, which were abnormal. My OB suggests an amniocentesis, but since 95% to 98% of these results are wrong, I do not wish to risk the amnio. I am scheduled for another ultrasound in 2 weeks. Can I tell or can the doctor see if the baby has Down’s syndrome by looking at that?

Diagnosis of chromosomal anomalies by amniocentesis is highly accurate. Although there are no major studies on error of amniocentesis, it has been shown that errors in diagnosis occur only 0.1% to 0.6 % of the time. Therefore, most of the time results from amniocentesis are correct. If you are worried about the potential risks of amniocentesis--which include preterm labor, rupturing of the membranes, and fetal loss--you should keep in mind that these complications occur in 1 in 200 amniocenteses.

If you decide against amniocentesis, your doctor can look for the stigmata of Down’s syndrome on your ultrasound. Keep in mind, however, that this is much less specific than amniocentesis. Speak with your doctor further about the risks and benefits of each of these options.

What are the symptoms of pregnancy other than morning sickness and missed periods?

There are other signs and symptoms of pregnancy. You have mentioned two of the most common and the most obvious, an absence of menses. However, you should also remember that early morning nausea and the lack of menses can also occur with other conditions not associated with pregnancy.

Many women 'just know' when they are pregnant. These women seem to have a sixth sense that alerts them. Also, breast tenderness and breast enlargement are symptoms that are associated with early pregnancy. In addition to these, many women will feel fatigue early in pregnancy that may last into the early second trimester.

By all means, if you think you are pregnant do a home pregnancy test to confirm your suspicion, and see your physician so that you can begin prenatal care early.

How soon after delivery can I have intercourse?

During the delivery of your baby, many of your vaginal tissues are stretched and often torn. Your cervix dilates and often undergoes a certain amount of trauma. It takes approximately 6 weeks for your uterus, cervix, and vaginal tissues to return to their normal pre-pregnant state. Because of this, your physician will probably ask you to wait for six weeks after delivery to have intercourse.

Many women are concerned about pain during their first intercourse after delivery. Most women do not feel significant discomfort if it has been 6 weeks since their delivery. Additionally, if you had an episiotomy, your stitches should have dissolved during this time period. You should notice minimal discomfort at the site of your episiotomy.

Flu Vaccine During Pregnancy

Vaccination against influenza has been shown to be safe in pregnancy. In fact, it is recommended for patients who are at high risk of acquiring influenza in pregnancy, such as women with underlying medical disorders or healthcare providers.

Is it safe to travel by air during pregnancy?

Many women have concerns about the safety of air travel while pregnant. Flying in airplanes is safe during pregnancy and there is no indication that it causes future complications. The change in barometric pressure noted during flight has no serious effect on pregnancy.

The biggest issue relates to the timing of your travel and whether there have been complications with the pregnancy prior to that time. Although it is safe to travel at any point during your pregnancy, many airlines have restrictions on air flight beyond 36 weeks. You may need permission from your physician to fly at a later date. Your physician may not want you to travel far distances by airplane after approximately 34 to 35 weeks. Access to medical care is restricted during the plane flight should you need medical attention. In addition, both you and your physician may prefer that you stay closer to home late in your pregnancy to ensure that you receive proper medical attention if you go into labor. If you have had complications during your pregnancy, your physician may prefer that you stay close to home so that prompt intervention may be undertaken if problems arise. Should you choose to travel, it is probably a good idea to take copies of your medical records with in case of an emergency.

Is the Consumption of Fish Dangerous During Pregnancy?

Healthcare officials have issued an advisory on the dangers of eating fish. The advisory concerns the consumption of fish by expectant mothers, nursing mothers and women who are seeking to get pregnant. Healthcare officials are concerned that the level of mercury in fish might pose certain risks to a developing fetus.

How does Mercury Affect the Nervous System? Methyl mercury is highly toxic and dangerous to babies because it can cross the placenta and the blood brain barrier. It is easy for mercury to become concentrated in the brain of the developing fetus because the metal is absorbed quickly and is not excreted efficiently.

Children exposed to mercury may be born with symptoms that resemble cerebral palsy, or other movement abnormalities. They are also more susceptible to convulsions, visual problems and abnormal reflexes. Autopsy results show loss of neurons in the cerebellum and throughout the cerebral cortex in the brains of children who have died as a result of mercury poisoning.

Mercury also appears to affect brain development by preventing neurons from finding their appropriate place in the brain. Methyl mercury targets and kills neurons in specific areas of the nervous system including the visual cortex, the cerebellum and the dorsal root ganglia. Several mechanisms have been proposed to explain how mercury kills neurons:

  • Inhibition of protein
  • Disruption of mitochondria function
  • Direct effect on ion exchange
  • Disruption of neurotransmitters
  • Destruction of the structural framework of neurons.

Each of the above functions is vital in the process of maintenance and interaction on a cellular level.

How are Fish and Water Contaminated with Mercury? Contamination from mercury in fresh waters can occur naturally through environmental factors or by contamination from industrial wastes. Larger fish (such as sharks, swordfish, king mackerel and tilefish), that prey on smaller fish accumulate the highest level of mercury and therefore pose the greatest risk.

How is Mercury Detected? Mercury levels within a person's body can be measured in blood, urine and hair samples. The normal level of mercury for someone who has not been exposed to mercury is about 2 ppm (hair) or 3-4 ug/dl of blood or 25 ug/l or urine. When levels get to about 50 ppm (hair), people may start to experience nerve damage. Because hair continues to grow, it can be used to document when and how much a person has been exposed to mercury. The developing system of a baby and a young child is more sensitive to the effects of mercury than the system of an adult or older child.

How Much Fish Should I Eat? It is recommend that pregnant women and young children limit their consumption of freshwater fish to one meal per week or the equivalent of eight ounces of uncooked fish for adults and three ounces for young children.

Pregnancy Complications

I am 16 weeks pregnant. I am having pain in both sides of my lower abdomen. Is this normal?

As pregnancy progresses, your uterus gradually enlarges. Many women have concerns regarding pain during this time period. As you reach 16 weeks, your uterus is significantly enlarged and most women become noticeably pregnant.

Although there are many reasons for abdominal pain during pregnancy, the most common condition is round ligament pain. The round ligaments are connective tissue ligaments that run from the upper aspect of the uterus down to the groin. As pregnancy progresses these ligaments enlarge and become stretched, and can cause pain. The pain sensation that women often feel involves both sides of the lower abdomen and sometimes the back. The pain is sharp in nature and can be worse on the right side. Certain movements may exacerbate the pain.

Round ligament pain has not been associated with any adverse outcomes of pregnancy. Treatments include heat on the affected area and rest. Medications often do not alleviate symptoms.

It is important to discuss any abdominal pain with your physician. There are several other causes of persistent pain. Your physician may need to do a physical exam and run other tests should your pain become severe or be associated with other symptoms.

What are your chances of being pregnant and still having a period?

You have asked a very common question, and an important one for all women to understand. Any bleeding during pregnancy is considered abnormal. Your menstrual period each month is triggered by ovulation and the production of progesterone. The progesterone support is then withdrawn and your period begins. Therefore, from a physiologic standpoint it is not possible to continue having a period while you are pregnant. While any bleeding during pregnancy is considered abnormal, it is not unusual to have some spotting early in pregnancy. You may also have some bleeding as a result of a break in one of the superficial blood vessels on the cervix. However, this should be rather minimal and should last only a short time. If you are pregnant, you should not be having any regular bleeding.

What are your chances of conceiving after a miscarriage? Are you fertile after a miscarriage?

Miscarriages are also known as spontaneous abortions in the medical literature. These losses are fairly common. It has been estimated that around 50% of pregnancies result in miscarriage. Many women do not realize that they are pregnant and assume that they are having a delayed period. Of women who know they are pregnant, approximately 20% will have a miscarriage.

Women who have more than one miscarriage consecutively are known as having recurrent abortions. If you have one prior liveborn infant, the risk of recurrent abortion is 20% to 25 % after one miscarriage, 25% after two miscarriages, and 30% after 3 miscarriages. If you have not had a liveborn infant, your risk of miscarriage after 3 prior pregnancy losses is approximately 40%. Infertility, or the inability to become pregnant, is usually not an issue after miscarriage.

It is currently debatable at what point testing for reproductive problems should be performed after miscarriage. If you are in your 30s and have a history of infertility, your physician may recommend evaluation after 2 miscarriages. All women should be evaluated after 3 consecutive miscarriages.

What is an ectopic pregnancy and how can it be treated?

Ectopic pregnancy, also known as tubal pregnancy, develops outside the uterus, usually in the fallopian tube. Due to the restricted area in the fallopian tube, fetal growth cannot occur normally. As a result, the fallopian tube becomes distended. If the rapidly growing pregnancy gets too large, it may burst through the fallopian tube and cause internal bleeding. This is a medical emergency. If not treated promptly, ectopic pregnancy can result in the death of the mother.

Once diagnosed, there are both medical and surgical options for treatment of ectopic pregnancy. Regardless of what type of treatment you and your physician choose, some form of treatment must be undertaken promptly.

If your ectopic pregnancy meets certain criteria, your physician may recommend treatment with methotrexate. This medicine is normally used to treat cancer and arthritis. When treating an ectopic pregnancy, it is used in doses much lower than those used to treat cancer, and therefore has few side effects. The physician will give you an injection of methotrexate; then follow your hormone levels closely to be certain that the pregnancy resolves. If the levels do not decrease appropriately, you may need a second injection or surgery.

If you do not meet the criteria for use of methotrexate, your physician may recommend surgery. Two approaches can be used depending on the seriousness of the situation. The first option is known as laparoscopy. With laparoscopy, a small incision is made under your navel and a small light inserted into your abdomen. The fallopian tube can then be examined. If necessary, your physician will make a few small incisions lower on your abdomen through which he or she can insert instruments and either remove the ectopic pregnancy or remove your entire fallopian tube.

The second surgical option is known as a laparotomy. This involves making a large incision lower on the abdomen and removing the ectopic pregnancy or the fallopian tube. If the ectopic pregnancy has already ruptured (burst through the tube) this will be the quickest way to remove the fallopian tube and stop the bleeding.

If you suspect an ectopic pregnancy, it is important that you contact your doctor immediately.

I am 30 weeks pregnant and having a lot of sciatic pain. What can I do? Is this common during pregnancy?

The sciatic nerve is a large nerve that follows a course from the pelvis to the back of the leg. This nerve supplies motor and sensory function to much of the leg. As pregnancy progresses, many women notice pain due to compression of this nerve by the uterus. This pain is called sciatica and often extends from the back of the thigh to the knee. Sciatic pain usually does not extend below the knee. If you have pain below the knee, be sure to contact your physician. Sciatica is a very common condition that usually occurs late in pregnancy and resolves after delivery.

Sciatic pain usually disappears after delivery. To relieve pain during pregnancy, your physician may have you take Tylenol and rest often. Many women find that sitting in a whirlpool is helpful. Do not set the whirlpool at a high temperature since it is important not to overheat. Hot water bottles may also alleviate pain. Mild pain may persist until delivery. If your pain becomes severe, your physician may have you see a physical therapist for further treatment.

I am a month pregnant and I'm cramping a lot. Is that bad?

Many women have cramping during early pregnancy. However, if you have persistent cramping, especially if it is associated with bleeding or spotting, it is important that you see your physician immediately.

I have had two miscarriages, what are my chances of having another one? Do I need any special testing?

Miscarriages are also known as spontaneous abortions. Around 50% of pregnancies result in miscarriage. Many women do not realize they are pregnant when they miscarry. They simply have a period that is a bit late or lasts a little longer than usual. Of women who know they are pregnant, approximately 20% have miscarriages.

Women who have more than one miscarriage in a row are diagnosed as having recurrent abortions. If you have a prior liveborn infant, the risk of recurrent abortion is 20% to 25% after one miscarriage, 25% after two miscarriages, and 30% after three miscarriages. If you have not had a liveborn infant, your risk of miscarriage after three prior pregnancy losses is approximately 40%.

It is debatable whether testing for reproductive problems should be performed after two miscarriages or after three miscarriages. If you are in your 30s and have a history of infertility, your physician may recommend evaluation after two miscarriages. All women should be evaluated after three consecutive miscarriages. The following tests are included in a formal evaluation.

  • Karyotyping of you and your spouse (an analysis of your chromosomes through blood testing)
  • Hysterosalpingography (an X-ray of your uterus and fallopian tubes taken while dye is being injected into your uterus). This test determines if there are any abnormalities of your uterine cavity that may be attributing to the pregnancy losses. Alternatively, your physician may order a pelvic ultrasound.
  • Blood testing. Tests may include endocrinologic and immunologic tests.
  • Endometrial biopsy (a sample of the lining of your uterus). This test helps determine whether you are ovulating regularly and producing enough progesterone. Inadequate progesterone production after ovulation is known as a luteal phase defect and may be associated with early pregnancy losses.
  • Cervical cultures (testing for infectious agents in the cervix). Pelvic infections have been associated with pregnancy.

Is there any harm in using an over-the-counter yeast infection treatment (like Monistat) when there is a possibility I may be pregnant?

Yeast infections are common. The treatment for yeast infections is over-the-counter topical regimens, such as Gynelotrimin or Monistat, or a pill form of treatment known as Diflucan. Diflucan is available by prescription only. The over-the-counter topical treatments have all been shown to be safe during pregnancy. Diflucan, however, has not been adequately studied in pregnancy, and is not used in the pregnant patient. Therefore, it is fine to treat yeast infections with topical medications only. However, if this is your first yeast infection, it is best to see your physician and get an actual diagnosis before self-treating. Please discuss this further with your physician.

I recently had a baby. I developed toxemia. What exactly is this and could it have been prevented?

Toxemia is an old name for a disease process in pregnancy known as preeclampsia. Preeclampsia is characterized by elevated blood pressure, swelling, and protein in the urine. In its most severe form women may notice headaches, blurred vision, right-side abdominal pain, or spots in front of their eyes. Pregnancies complicated by preeclampsia can result in adverse outcomes for both the fetus (including growth restriction and in the worst case death) and the mother (including seizures and in the worst case death). Therefore, you will be monitored very closely if you have been diagnosed with preeclampsia during your pregnancy. Depending on the circumstances it may be recommended that you deliver your baby early. The ultimate cure for preeclampsia is delivery of the infant.

The cause of preeclampsia is unknown and there is no means of preventing its occurrence at this time. It has been shown that first time pregnancies are at increased risk for developing preeclampsia.

I recently had my tubes tied. Now I have the most tremendous pain during my period. Are these two things related?

What you are describing is a common complaint among women and has been the subject of a number of research studies. The condition is referred to as post tubal ligation syndrome. Typically, women complain of an increased amount of pain during their periods (dysmenorrhea). The most recent studies have shown no increase in painful periods in those women who had a tubal ligation.

What is found in many women is that prior to the tubal ligation, they were taking birth control pills. After having their tubes tied, the birth control pills are stopped. These women have a return to their “normal” menstrual pattern. While they were on birth control pills, their periods were lighter and not associated with as much pain. This occurs in just about all women who take birth control pills.

As for what you can do now, there is an excellent article on this site about dysmenorrhea, its causes and treatments. This article should provide a nice overview of the subject.

I was diagnosed with complete placenta previa at my 20-week ultrasound. Should I switch to a high-risk specialist due to this condition?

Placenta previa refers to the position of the placenta. The placenta attaches to a portion of the uterus early in pregnancy. Placenta previa means that the placenta is situated directly over the cervix. The greatest risk associated with placenta previa involves vaginal bleeding from the placenta as the cervix dilates. This situation may be life-threatening for both the mother and the fetus.

Early in pregnancy, such as at 20 weeks, placenta previa is usually not a problem. The cervix usually remains tightly closed early in pregnancy, therefore no significant risk of bleeding exists. The placenta often migrates away from the cervix as the uterus grows. Therefore, someone with placenta previa at 20 weeks often does not have placenta previa 4 to 8 weeks later.

If your follow-up ultrasounds show persistent placenta previa, then your pregnancy will be followed closely. Although a high-risk specialist might be recommended by some physicians, this is not imperative. If you continue to have complete placenta previa, your physician will continue to watch you very closely until late in pregnancy. At that time, it will be necessary to deliver your baby by cesarean section. The timing of your c-section will vary from physician to physician, and may be as early as 36 weeks or as late as your due date.


How can I tell if I am in labor?

One of a woman's greatest concerns is "How will I know if I am in labor?" This is especially true in first pregnancies. There are several signs of labor or pregnancy emergencies that should cause you to phone your physician or head to the hospital.

The first sign of labor is uterine contractions. Uterine contractions are often described as tightening of the uterus or "balling up of the baby." These contractions should be of significant strength to cause you to stop a conversation and take several deep breaths. When contractions are 5 minutes apart from the beginning of one contraction to the beginning of the next contraction, contact your physician.

The second sign of labor is your water breaking. Some women notice a large gush of fluid, and some women notice a constant leaking of small amounts of fluid. In either case, you should report to the hospital.

The third sign is vaginal bleeding. If at any point you have bright red bleeding similar in volume to a period, go to the hospital. This is a medical emergency and may be a sign that your placenta is separating from your uterus. If you have a small amount of bleeding mixed with mucus, this is probably your mucus plug. You can lose the mucus plug at many points during pregnancy, but this is not a signal of impending labor.

Finally, if your baby is not moving normally, contact your physician. At a minimum you should notice at least 10 movements a day. Many people feel that you should notice at least 10 movements in 2 hours.

How do you know when it is not Braxton Hicks and time to go (to the hospital)?

Braxton Hicks contractions are also known as false labor. They usually begin sometime after the 20th week of pregnancy. Sometimes they are felt earlier and are more intense in women who have had a previous pregnancy. The contractions are usually painless, but sometimes uncomfortable. They are actually a contraction of the uterine muscle and last about 30 seconds, but may last as long as a couple of minutes. Around 36 weeks or so, the contractions become more frequent. Changing your position will help stop the contractions.

So what are the symptoms of 'real labor'? It is probably 'real labor' if:

  1. The contractions become stronger, rather than ease up with a change in position and over time, the pain begins in the lower back and spreads to the lower abdomen
  2. The contractions become progressively more frequent and painful
  3. The contractions are accompanied by a pinkish or blood-streaked discharge
  4. Your water breaks

You should begin the trip to the hospital when the contractions are 5 minutes apart for a couple of hours, your water breaks, or if you begin bleeding like a menstrual period.

Since you have had two premature deliveries, you are at risk for another premature birth. Therefore, you should be a bit more cautious about labor than someone who is already full-term. For you, if there is any question in your mind, you should be evaluated to make certain that you are not in labor.

I am 39 weeks pregnant. Should I have my labor induced?

There are several schools of thought on whether it is appropriate for a woman to choose to have her baby early. In medical terms this is known as elective induction of labor. Many factors come into play when physicians decide to induce labor. If you are experiencing medical complications associated with pregnancy, your physician may advise delivery if you are full term (greater than 37 weeks pregnant). Second, the accuracy of your due date will be an issue if plans are made to induce your labor early. If you had an ultrasound in the first trimester that verified the due date calculated by your last menstrual period, then your due date should be accurate, plus or minus one week. If you had a second trimester ultrasound that was consistent with the first, your due date should be accurate, plus or minus two weeks. Therefore, delivery at 39 weeks, even if off by 2 weeks, should still result in the delivery of a full term infant (greater than 37 weeks). Finally, the dilitation and effacement of your cervix prior to the induction of labor will be an issue. If your cervix has started to dilate and has started to efface, your physician may feel that an induction of labor is reasonable. If your cervix has not dilated or effaced, induction of your labor may significantly increase your risk of cesarean section.

Some physicians feel that electively inducing labor is not appropriate until 41 to 42 weeks, when there may be decreased functioning of the placenta. However, many physicians, including the American College of Obstetrics and Gynecology, feel it is reasonable to induce labor at 39 weeks. Please feel free to discuss this with your physician.

What are Apgar scores and what do they mean?

The Apgar score measures the need to resuscitate an infant immediately after birth. This scoring system was first coined by Virginia Apgar in 1952. Since that time it has become a common scoring system used during delivery.

Apgar scores are divided into 5 categories. These include heart rate, respirations, muscle tone, reflexes, and color. Zero to 2 points are scored in each category. Therefore, an infant may score anywhere from 0 to 10 overall. Apgar scores are awarded at 1 and 5 minutes after delivery. If the 5-minute Apgar score is 6 or less, the infant will receive a 10-minute Apgar score as well. Apgar scores are poor indicators of neonatal outcome. They do help determine the effectiveness of resuscitative efforts. Specifically, Apgar scores at 1 minute are only a gauge to determine whether immediate support is needed. Low scores (0 to 3) at these intervals, however, have correlated with a slightly increased risk of cerebral palsy.

Apgar scores alone are poor indicators of long-term outcomes for an infant who experiences hypoxia (lack of oxygenation) at birth. Multiple factors must be used to make these assessments.

What types of pain relief are available during and after childbirth?

Every pregnant woman is faced with the decision of whether she will use a form of pain relief during labor and delivery. Some women are very certain that they will want pain relief, while others are unsure. There are also those women who prefer to give birth without any form of pain relief. For women who do not desire any form of analgesia during labor, it is important that they understand the options. During an emergency delivery, some form of analgesia or anesthesia may be necessary.

Under ideal circumstances, an anesthetic agent would allow you to deliver your baby with minimal pain, minimal risk, and would allow you to push when it is time to do so. The ideal anesthetic would also not stop your contractions or make you or your baby sleepy. There are a variety of anesthesias that can be used during labor and delivery.

  • Local anesthesia: Local anesthesia requires a series of injections in the vaginal outlet. It is generally used for women who need an episiotomy or who require the placement of sutures after delivery.
  • Intravenous Sedation: Sedatives are administered as an injection or intravenously. Can help reduce the pain of labor but will not eliminate the pain entirely.
  • Pudendal block: The pudendal nerve is one of the primary nerves that provide sensation to the vaginal outlet. Pudendal block is administered using an injection of local anesthesia through the vagina and into the pudendal nerve. It is given just prior to delivery and may be supplemented with local anesthesia.
  • Epidural: An epidural is an anesthetic delivered through a tiny catheter placed in the lower part of the back in the epidural space. A woman will continue to feel touch and pressure, but the pains of labor are significantly reduced.
  • Spinal: The spinal is similar to the epidural, but the anesthetic is actually placed within the spinal fluid. Spinal anesthetics are sometimes used at the time of delivery (Saddle block) or at the time of cesarean section. Like an epidural, a spinal cannot be used if you are using blood thinners, have an infection in the back or the blood, or have an unusual spinal abnormality.
  • General: General anesthesia is administered by giving an anesthetic intravenously and through breathing an anesthetic gas. A general anesthesia may be needed for an emergency, or if a cesarean section is required and the patient cannot have an epidural or spinal. Because it carries additional risks, it is not the first choice of pain relief during labor and delivery.

What is the possibility of my passing herpes to my child during labor/delivery?

Twenty-five percent of American women have genital herpes. Eighty percent of herpes infections are asymptomatic, and therefore many women do not know that they have been exposed to herpes. If you have your initial herpes infection at the time of delivery and deliver vaginally, your infant has a 40% to 50% risk of being infected. If you have had herpes before and have a herpes recurrence at the time of delivery and deliver vaginally, your infant has a 1 in 2000 chance of being infected. Because of the risk of transmission to your infant, the American College of OB/GYN recommends cesarean section if any herpes lesions are present at the time of your delivery.

If your infant develops herpes at the time of delivery, the consequences can range from asymptomatic disease to severe eye and neurologic injury that may even result in death. Therefore it is very important to inform your obstetrician of your history of genital herpes and to notify him if you notice any lesions or have any symptoms close to the time of delivery.

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