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Monika Hearne, M.D.
Monika Hearne, M.D., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 5827
Experience:  With experience and compassion, I treat my patients like family.
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I am at 5 weeks with an unplanned pregnancy (the first unplanned pregnancy after 20 years

Resolved Question:

I am at 5 weeks with an unplanned pregnancy (the first unplanned pregnancy after 20 years of marriage). I will be age 39 at delivery date. I have two previous c-sections, the last in 2010. I suffer from an anxiety disorder, depression and obesity. My youngest child had a closed neural tube defect noted at delivery, which has received no further testing and has not caused any problems thus far. I was not taking folic acid before this pregnancy occurred. I was also on Wellburtrin SR (300 mg/day) and klonopin (1 mg/day). I have spoken with an advice nurse at O.B. office and received instructions for discontinuing medication. My husband is supportive if I chose to terminate or continue with pregnancy. I have a very strong concern about a 3rd c-section. Can you give me an overview (statistics are helpful) of the risks of continuing with this pregnancy - both in terms of potential for birth defects and for my complications during/at delivery?
Submitted: 1 year ago.
Category: OB GYN
Expert:  Monika Hearne, M.D. replied 1 year ago.

Monika Hearne, M.D. :

Hello, I would be happy to assist you.

Customer:

Thank you. Concerned about an unplanned pregnancy at age 38 after two previous c-sections, as detailed in my original question.

Monika Hearne, M.D. :

Just to make sure we are on the same page, 5 weeks of pregnancy means that your last period was 5 weeks ago. If this is the case, then your pregnancy is in its very early stages and body parts are just beginning to develop. If you can switch to Zoloft, Prozac, or Lexapro instead of Wellbutrin, the risk of birth defects will decrease. With Wellbutrin, there is an increased risk of cardiac defects. However, reports are conflicting and we can't say for certain. If you are able to switch to the other medications, the risk will be very low at approximately 1%.

Monika Hearne, M.D. :

Having a 3rd c-section typically is not an issue unless your doctor expressed concerns at your last c-section and recommended you not become pregnant again.

Monika Hearne, M.D. :

With obesity, there is an increased risk of diabetes, high blood pressure, miscarriage, pre-term delivery, and delivery complications. However, if you begin to walk for exercise, you can greatly reduce your risk for complications.

Customer:

Yes. First day of LMP was June 4, 2013. I meet with my family practitioner tomorrow about medications. I stopped all medications and started folic acid and prenatal on Tuesday, July 2nd when I had positive at-home pregnancy test. My periods are very regular so I tested the day after I expected period. Concerned about impact of medications up to this point as well.

Customer:

Doc. noted scar tissue at last c-section, but made no recommendations against future pregnancy.

Customer:

I have been addressing the obesity issue for several months. I currently walk 2 miles each day and I am down about 15 pounds (5 ft. 1 inches @ 185 pounds).

Monika Hearne, M.D. :

With your age, there is an increased risk of several complications, but most of the time things are fine. I recommend you begin prenatal vitamins and extra folic acid at 1mg per day. You would take the folic acid at a different time as the prenatal vitamin. You should plan to see your doctor right away and when first trimester screening is discussed, I highly recommend it. It involves checking your blood for fetal DNA to make sure there are no abnormalities that are common in women over 35 (like Down's syndrome). A special ultrasound is also performed called a nuchal translucency. With this ultrasound, the thickness on the back of the baby's neck is measured. If this is normal, the risk of heart defects and Down's syndrome are very low. There really is no concern about your medications this early in pregnancy. You should certainly consider changing your meds, but if your depression is unstable on medications ob/gyn's typically use (those listed above), then we would consider resuming your Wellbutrin. because unstable depression can lead to miscarriage, pre-term labor, postpartum depression, or psychosis (severe change in behavior with/without hallucinations).

Monika Hearne, M.D. :

Congratulations on your weight loss. Continue with your walking and don't overeat just because you're pregnant like many women do. If you discontinue your exercise and making good food choices, you will gain your 15+ pounds back very quickly. In pregnancy, you only should take in about 300 more calories per day.

Monika Hearne, M.D. :

We commonly encounter scar tissue. You can verify with your doctor that your surgery did not leave any concern with future pregnancies. He/she can review their operation note dictated after your surgery.

Monika Hearne, M.D. :

I would recommend you wait and decide on pregnancy termination after first trimester screening. This is typically done at 11-13 weeks. If abnormalities are found, you may always choose to terminate at that time.

Customer:

In addition to the increased risk of chromosomal abnormalities, can you tell me about the increased risk for requiring a hysterectomy due to delivery complications?

Monika Hearne, M.D. :

Less than 1%.

Monika Hearne, M.D. :

Because you're having a c-section.

Customer:

Very good to know that I can terminate after screening. This is a huge concern as I never thought I would ever consider terminating and feel very anxious about not being able to due to state laws which I know change by state and each year.

Customer:

Very good to see the 1% on hysterectomy risk. Thank you for that info.

Monika Hearne, M.D. :

True, but usually its about 22 weeks everywhere, sometimes later depending on the state. So, you have plenty of time. However, I would not recommend waiting that long.

Monika Hearne, M.D. :

You're so welcome. Most of the time things turn out just fine.

Customer:

Thank you. The anxiety disorder makes anything as life-changing as this very difficult to manage as an unplanned event. But your information has been quite helpful.

Customer:

One last question. I have Folic Acid on hand in a 1,000 mcg dose. Can you help me translate that into mg?

Monika Hearne, M.D. :

I'm glad to have been able to help. Keep in mind may women will conceive and not know it while taking these medications or others. The vast majority of the time, everything is fine. Yes, that dose is 1mg.

Customer:

Wonderful. I so appreciate your assistance and availability at this late hour!

Monika Hearne, M.D. :

You are so welcome. I was about to turn in and saw your question. I'm glad I could help. :)

Monika Hearne, M.D. :

I wish you the best. If you have no further questions, please rate my answer. Thank you.

Monika Hearne, M.D., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 5827
Experience: With experience and compassion, I treat my patients like family.
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