Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I am your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.
Welcome to our “Mailbag” podcast, our 34th “What Does the Fox Say?” Our first question is from Sarah [SP]. “Hi. I’d love to hear your perspective on this. My OB sent my placenta to pathology after the birth of my third child due to a history of some form of adherent placenta with the birth of my second. I have a history of uterine septum repair times two. It came back weeks later showing chorioamnionitis.” For our listeners, that means an infection. “Myself and my baby were totally okay in terms of infection symptoms. Is this typical? Can chorioamnionitis not be a big deal? My water did possibly break a day before delivery, but if it did, it was more like a leak. I did not have a big gush until about six hours prior to delivery.”
All right, Sarah. So, first of all, congratulations. In terms of your question, so, chorioamnionitis is the term that we use clinically for someone who we believe has an infection in the uterus in labor. It’s called that because chorio is one of the…chorion is one of the membranes, amnio or amnion is one of the membranes in the medicine. Itis usually means infection or inflammation.
So, when someone has chorioamnionitis in labor, that essentially means we believe there’s an infection inside the uterine cavity. It does happen in labor, typically the way we know it’s there. The diagnosis is made when the mom has a fever in labor. And usually, it’s accompanied by either a fast heart rate in the baby, what we call tachycardia, or a fast heart rate in the mother, we also call that tachycardia, or sometimes if it’s really bad, we can see the amniotic fluid that’s coming out actually appears infected. It looks more like pus than fluid. That’s a pretty advanced infection. And so, when someone has that, or we suspect someone has that in labor, we typically give them antibiotics. If they have it and they weren’t in labor, we would induce them. Okay. So, that’s sort of how we manage it clinically.
Now, after delivery, after the baby’s born, after the placenta’s born, we have an option to send the placenta to pathology, which means instead of just discarding the placenta, we send it to the hospital pathology laboratory, like you would send any other organ that gets removed during surgery or something like that. And they basically…they look at it as a whole, then they take it and slice it up and look at it under a microscope, and they’ll give you all these various findings in the placenta. And every now and again, it’ll come back with changes that are suggestive of inflammation or infection in the placenta, in the membranes, in the cord. And there’s different sort of grades of it, and there’s different ways that they score it and how severe it is, is one part of it. Also, maybe if it’s something acute versus chronic, meaning do they think this is an infection that happened recently or infection that’s been going on for a long time.
Now, how valuable is that? Well, first of all, sometimes we have a situation, where you’re describing, where there’s no suspicion of clinical chorioamnionitis, meaning the mom does not have a fever, we don’t think she’s infected in labor, and then the placenta comes back and suggests an infection. So, it could mean one of several things. It could mean that there was an actual infection, but it wasn’t bad enough to lead to a fever in the mother or anything in the baby. And in which case, what do we do about that? Well, usually, by the time we find this out, like you, it’s a few weeks later, and if there was an infection, you would know about it. Because mom would have been sick in labor, or after delivery, she would have gotten a fever, the baby would have had a fever, whatever it is.
So, it usually doesn’t have any clinical importance in the circumstance that you’re describing. Doesn’t mean that our diagnosis of…or clinical diagnosis of chorioamnionitis is not sensitive enough. Meaning, maybe there are people who are infected and we don’t know about it and we should know about it, or maybe it means that these “infections” in the placenta aren’t really infections, they’re like pre-infections. And there’s also a lot of debate of how do you define chorioamnionitis? Should it be a clinical diagnosis or should it be a diagnosis made by pathology of the placenta?
So, for example, let’s say the mother had a fever in labor, and we thought she had chorioamnionitis and we gave her antibiotics. And then later, a week or two later, the placenta comes back and has no signs of infection whatsoever. Does that mean she did not have chorioamnionitis? And I think, ultimately, we don’t know the answer to these questions. And it does not make a tremendous difference practically because the findings on the placenta are not received until weeks after the delivery. So, they’re pretty much not going to be used clinically.
I guess the only time it might come up is if, let’s say, there’s sort of a question about something lingering and it’s a week or two after delivery and then the placenta comes back, maybe it could be helpful clinically. But in my experience, it’s rarely helpful clinically, and it just maybe gives some explanation for what was going on, or maybe finding out how severe it was, or maybe finding out how long it was going on. And so, it might have implications for future pregnancies, I would say potentially.
But basically, to answer your question directly, is it typical? Yes, it does happen that we see signs of infection in the placenta that were not present clinically. Can it not be a big deal? Well, if it’s just in the placenta, then yes, it could not be a big deal.
Okay. Next question is from an anonymous listener. “Hi, Dr. Fox. I love listening to your podcast, even on topics that don’t directly relate to me.” All right. Thank you for that. “I appreciate your thoughtful approach, and always learn something new. Anyhow, here’s my question. I’m 35 years old and wanting to start trying to conceive soon. I’ve used a Mirena IUD for the past 15 years — I’m actually on my third Mirena — and have an appointment to have it removed in a couple months. Given how long I’ve been using the Mirena, I expect my endometrium is quite thin. I had an ultrasound a few years ago to check the Mirena placement and it showed my lining was at two millimeters. I also have not been getting periods for this entire 15 years.”
“Given all this, how long should I expect it to take for my lining to build up to a level that can support a pregnancy? And should I plan to use birth control, like condoms, for a while after my Mirena is removed to allow the lining to build up? Or is it fine to go without any birth control since I’m trying to conceive anyway? Asked another way, is there any medical reason I should try to give my body a ‘rest period’ after removing my Mirena? Thank you in advance.”
All right. Great question. For background, there are basically two categories of IUDs. So, IUDs are a form of contraception, a birth control where it’s a little device. It’s typically shaped like the letter T. It’s put inside the uterus, and it is contraception. It prevents pregnancy. There are two sort of broad types. There’s one called the copper IUD, which basically is called that because there’s like a copper lining, and it goes in the uterus, and there’s no hormones in this IUD. It’s just the copper itself acts as essentially a contraception in the uterus. Fine. People who have a copper IUD typically get normal regular periods. Occasionally, they’re a little bit heavier at the beginning, but basically they get their periods. There’s no hormonal changes in the uterus or in the body.
The second kind of IUD, and there’s many sort of brands of this, one of them is the Mirena, which is an IUD that actually has hormones that come out of the IUD slowly over time. So, the reason our listener had her IUD changed every five years is because these IUDs have a shorter expiration, so to speak, because presumably the hormone runs out at a certain point. The hormone that comes out is progesterone and it does multiple things. It’s a contraception, but also since there’s progesterone coming out of the IUD directly to the uterus, progesterone affects the endometrial lining, typically makes it thinner. And for many women, it lowers the amount of their periods or takes them away entirely. So, for example, our listener had the Mirena and did not get her period, which is sort of what happens for most people who have an IUD hormones like a Mirena.
Okay. So, that’s the background. So, the question is, you’ve had a Mirena for 15 years or 3 Mirenas over 15 years. Presumably, the lining has been very thin for a long time. If we take out the Mirena, what happens?
So, I think the short answer is probably it doesn’t make a big difference what you do. Meaning, the lining will typically build up pretty quickly, probably by the next cycle, probably by your next period. And so, it’s not like when people have IUDs taken out, they’re told, oh, you have to wait X amount of months before you can get pregnant. That’s not the case.
Is it possible that if you took out the IUD and you got pregnant sort of right away on the first cycle, might your lining be a little bit thin? Well, it might be, but ultimately, if you’re able to get pregnant, if you’re going to ovulate, an egg’s going to come out, there will be estrogen, your lining will be building up. So, probably, it would be thick enough already. And as far as we know, for most women who do get pregnant who have a thin lining, it tends to go fine because, again, the hormones sort of start shooting up, and that lining does get thick.
And so, we don’t typically recommend, for any IUD that comes out, a washout period, so to speak, or a rest period or anything like that. So, it probably should be fine, is my answer. And if someone would be super cautious, wait one month till your next period, and then it should be fine. And it’s not like we need to do ultrasounds and check the lining or anything like that. It really should be fine.
As a separate note, sometimes people find…if they’ve had any contraception for 15 years that affects their periods, whether it’s a Mirena where your periods go away or whether it’s a pill where you get sort of very regular periods every month or every three months based on how you do it, and they’re on this for 15 years and then they come off, sometimes people find that their periods are a little bit irregular afterwards. And it does not seem to be because they were taking birth control or had an IUD for all the time, but just now they’re 15 years later and we don’t…their periods were not in their state of nature for 15 years. And so, now, you’re sort of fast forwarding 15 years later. So, if you find that your periods are maybe a little bit different, a little bit irregular, whatever it is, I wouldn’t go back and say, oh, it’s because I had the Mirena, I wish I did A, B, or C. It’s almost certainly not that. It’s probably just, hey, now, I’m 35 and maybe my periods are going to be a little different than they were when I was 20 when I first had the Mirena put in.
All right. Next question is from Eliana [SP]. “Hi, Dr. Fox. Love your podcast. Been listening consistently for two years from Jerusalem.” All right, Eliana, thank you for listening from abroad. “I’m curious about episiotomies. They’re very commonplace, especially for first births here in Israel. Two part question. One, why is it so common here and no longer frequently done in the U.S.? Can you speak about the benefits, drawbacks of doing the episiotomy versus letting a woman naturally tear? Two, I had my episiotomy fully open up postpartum and they could not re-stitch it and it is healing naturally. I’m curious if you’ve ever had this happen with the patient and how you’d treat it. Thanks.”
Okay. So, in terms of your question, I cannot answer why it’s done more frequently in Israel versus the U.S. or in any place versus another place. You know, episiotomies, the history of it…and we did a full podcast on episiotomies. You can go back to that for the longer story. But basically, episiotomies used to be not just common, but I would say routine in obstetrics. And this is quite some time ago. I mean, by the time I was even training 20 years ago, it was not done routinely. But prior to that, let’s say, I don’t know, whenever, 20, 30, 40, 50 years ago, they were done pretty much at all deliveries or almost all deliveries.
And the thought was, the reasoning it was done was, okay, when someone’s going to have a baby, pretty much almost always, not always, but almost always, there’s going to be tearing, particularly on a first birth. And that tearing is going to happen. And when it happens, it’s somewhat unpredictable exactly where it’s going to go. Is it going to be one tear? Is it going to be two? Is it going to be on the left, on the right, top, bottom? How long is it going to be? There’s a lot of sort of variation.
And the thought was, all right, if we do one, like a surgical tear with a scalpel or with a scissors, you know, we can guide exactly where it’s going to be, how long it’s going to be. It’s going to be a nice “clean” straight incision. And then after the baby’s born, we can sew it up and it should heal nicely. That was sort of one reason.
Another reason was it would expedite or make the delivery a little bit quicker, which was thought to be helpful, particularly before they were doing fetal monitoring, for example. So, it was done pretty much routinely. And then people started to reconsider that and say, well, maybe we don’t need to do it on everybody. Maybe we should do it on some people or I know people, whatever it was.
And there was some really big studies that were done where they basically did a proper randomized controlled trial, and they took a bunch of women and they randomized them into two groups. One group where a routine episiotomy was done, sort of like everyone else was doing. And the second was where it was done selectively. Selectively, meaning only if the doctor or midwife thought it was specifically going to be beneficial for this woman versus doing it routinely.
And in those studies, there was really…all of the benefits of episiotomy were not found. Meaning, there was not an advantage in terms of healing. There was not an advantage in terms of pain. In fact, it was the opposite. The women who had the selective episiotomies, meaning not in everybody, had less pain, better healing. And so, based on that, pretty much the practice of doing episiotomies routinely on everybody was stopped, and then it was done selectively.
Now, in those studies, the selective episiotomies, it was happening like 20% to 25% of the time. Meaning, it wasn’t 100% of the time, but it was still happening pretty commonly, 20% to 25%. And from that point until now, there has been a gradual push and pull on what is the best number. People sort of believe 25% is still too high. And so, should it be 10%, should it be 5%, should it be 0%, should nobody get episiotomies? And there’s been a lot of discussion about this, and there is no known perfect answer.
People have goals, like hospitals will sometimes say, we want our episiotomy rate to be below X%, below 10%, below 5%. And sometimes you’ll see in sort of what’s called quality metrics in obstetrics, where various organizations put out, this means you’re having high-quality obstetrics and they’ll say the episiotomy rate’s below a certain percent. But that’s really an opinion. So, if someone’s opinion is the overall episiotomy rate should be under 7% or whatever it is, it’s not like we know definitively that that’s the right percentage because, ultimately, it’s an individual decision, and every woman who’s delivering is an episiotomy right for you as opposed to a population.
And so, since there’s some uncertainty on exactly who does and does not benefit from an episiotomy and exactly how often should we be doing them to sort of gauge, am I doing too many, am I not doing enough, there’s going to be a lot of differences from country to country, from hospital to hospital, from doctor to doctor, from midwife to midwife. And you’ll see these varying ranges.
I will say, in my own practice, the way I’ve been trained and the way I’ve been practicing myself is I don’t do episiotomies routinely. Fine. Typically, for me, the times I would do them are essentially three. One is if I’m going to be doing an operative delivery like forceps. Forceps are a situation where the tear tends to be much bigger because you’re putting the forceps on the baby’s head, which sort of effectively makes the baby’s head bigger. And my concern is that there’s going to be a bigger tear. It’s going to go straight down towards the mother’s bottom, which could be like what’s called a third or a fourth degree laceration. And those can be challenging to heal.
And so, often, if I’m doing an operative delivery, I will do an episiotomy and guide the tear away from her bottom, sort of at an angle towards, let’s say, one of the thighs, something like that. So, that’s one instance where I would do potentially an episiotomy.
The second is sometimes there’s situations where you sort of can just see when the head’s starting to come out, that there’s going to be a lot of tearing in a lot of places that’s going to end up hurting. If there’s going to be tearing upwards towards the urethra where people pee, that sometimes is a very painful tear. And if I, in my judgment, feel like if I let this happen naturally, it’s going to be a bunch of tears in places and it’s going to be very difficult to heal and painful, then sometimes in those situations, I’ll cut an episiotomy to sort of guide the tear all into one location.
And the third time is if, let’s say, the head’s really close to coming out and I do have concerns about the baby’s heart rate and I really want to expedite delivery, meaning I’d much rather the baby be born within a minute than waiting another two, three, four minutes, if that circumstance happens, then I would potentially do an episiotomy.
I don’t know my episiotomy rate. It’s definitely less than 10%. Certainly, for situations where I’m not doing forceps, it’s pretty low because those last two circumstances are not that frequent. But in the U.S., I think that’s how a lot of people practice. Again, not exactly like me, but similar to me. And it’s possible that, in Israel, maybe doctors have a slightly different take on this. I would guess it’s not 100% in Israel. I would guess, if it’s high, high is probably in the range of 20% to 25%. I don’t know the numbers there. So, I’m totally making these up. I don’t know what their numbers are. But if you’re sort of experienced, you know, you, your friends, whoever, I highly doubt it’s 100%, but maybe there’s…the way they do it is higher than we do it. And again, it’s not known which is better within that, let’s call it, less than 25% range. Is it better to be doing it more or less within those range? We really don’t know for certain. All right. Great question. Great topic.
Next question is from Megan [SP]. “Hi, Dr. Fox. I love your podcast. You’re so great at delivering the facts in a calm and encouraging manner.” All right. Thanks, Megan. I appreciate that. “I’m planning a VBAC for my second birth. Besides being VBAC, I am not a high-risk pregnancy. I live in a populated metro area with a lot of hospitals in close proximity. Do you think it matters that I pick a hospital with a high-level NICU, or is it safe to go with a level 2 NICU? All hospitals I’m looking at are staffed with 24/7 anesthesia.”
All right. So, there’s sort of two aspects of that question. The first is for you specifically, and the second is sort of in general. So, I’m going to start with in general. In general, there are designations for NICU in the U.S., level 1, level 2, level 3. And basically, the higher it is, the sicker the baby they can handle or the more premature baby they can handle. So, a level 3 NICU is sort of more equipped and more staffed for “sicker” babies or younger babies than a level 2, more so than a level 1.
And should anyone really care about this? I think, potentially. Certainly, if you know you’re having a baby that’s going to need extra care after delivery, that’s something that comes into play, and that’s something that will probably be discussed if you’re in that situation. Frequently, the level of NICU is parallel to sort of how busy the labor floor is. So, if you’re delivering in a smaller community hospital that has two or three labor rooms, they’re going to have, if any NICU at all, it’s going to be very, very low level. Whereas, if you’re going to any big hospital that has 10, 12, 14, 15 labor rooms and does a ton of deliveries, they’re probably going to have a higher level NICU.
And so, for most people, they sort of know what the deal is when they’re going. And those decisions are made based on who their doctor or midwife is, where do they live, what are the options, what are they looking for. And there are so many things that go into that decision. So, for most people planning a pregnancy where everything is healthy and the baby is fine and there’s no concerns, they’re making decisions about the entire experience of birth. Do I want to deliver at a birthing center, at a community hospital, at an academic hospital? Do I want there to be residents and medical students running around? Do I not want them? Where’s my doctor [inaudible 00:21:38]? Where do I live? How far is it? And there’s all this calculus that goes into it, but it’s part of it.
And so, if someone were, let’s say, planning delivery in a smaller hospital without a high-level NICU, and then they realize, oh, we found A, B, and C with the baby and there’s a higher chance that he or she’s going to need something after birth, then it’s a discussion, all right, do I have to deliver at a different hospital because of all these things, including the NICU? Fine.
So, for you, Megan, specifically, from what I understand, you’re healthy, low risk pregnancy, except the fact that you’re going to have a VBAC and you correctly noted that it’s important to have 24/7 anesthesia because a lot of hospitals, if they don’t have 24/7 anesthesia, either won’t allow VBACs or maybe it’s not a great idea to do a VBAC. Okay.
The likelihood that it’s going to matter to you whether the NICU is level 2 or level 3 is pretty low, particularly if you’re delivering full-term. Meaning, if there is a NICU, if there is level 2, and let’s say your delivery is not a successful VBAC and you have an emergency C-section or something’s going on and you need NICU staff or the pediatricians at birth, they’re going to have that. That’s available, basically. The only, I would say, big distinction is if you were delivering extremely preterm. If you’re 24 weeks in in labor, that’s a different situation.
And so, typically, if there is a NICU and it’s level 2, for a full-term baby, they’re going to have all the services that your baby might need. And this is with the caveat that always there’s the potential for something unexpected coming up where a baby would need to be transferred. That’s true for everybody, for every birth who delivers, you know, that you or the baby may need to be transferred. It’s not likely, but it’s certainly a possibility. But whether VBAC really increases that by a lot, I would say, you know, very, very low chance that it’s going to impact your need for a higher-level NICU, again, assuming you’re delivering full-term.
All right. Our last question today is from Cassie [SP]. “Hi, Dr. Fox. I so appreciate the information and education you’re providing with your podcast.” Everyone’s just, you know, throwing flowers at me today. I love it. Thank you. “I was wondering if you could provide a little insight on Asherman’s syndrome and return of fertility. I had an early miscarriage that we found at seven weeks, ended up with me having an MVA,” not motor vehicle accident, listeners. That’s mechanical vacuum aspiration. It’s like a D&C done in the office.
“Nine months later and I still haven’t gotten pregnant. I just had a fertility workup and my HSG showed filling defects that they’re currently presuming to be Asherman’s from my miscarriage, and are going to schedule my hysteroscopy to clear up the scar tissue. I’m wondering if you have experience seeing these types of patients and if you have any advice or thoughts on the ability to get pregnant or any complications that could result from this. I’m 34, otherwise healthy. My fertility workup was unremarkable aside from the HSG. Thank you so much.”
All right. So, I definitely have experience taking care of people with Asherman’s. I do not myself treat Asherman’s. I’m not the one who does the hysteroscopy in this, but that’s okay.
So, as background, Asherman’s is a diagnosis that was coined by Dr. Asherman, I think, of the 1940s, if I’m correct. It’s been a while. But basically, it was a clinical diagnosis where a woman after a miscarriage or after a C-section or after a delivery, she would stop getting her periods. And the reason she would stop getting her periods is that the inner lining of the uterus, the endometrium, basically, was stuck together like glue, as if you put like glue or cement inside the uterus. So, it was all stuck together. And so, the lining would not grow and shed as it normally would, or sometimes it would, but the scar tissue would prevent the blood from coming out.
So, the way it was diagnosed was, women, number one, would not get their periods or get very, very light periods after this. Number two, they would sometimes, though not always, have pain. Because sometimes if there’s blood trapped inside the uterus, they would have pain. And number three, they would have infertility. They would not be able to get pregnant because, again, there’s nowhere for this embryo to implant and there’s all the scar tissue.
So, that was sort of the classic Asherman’s syndrome. And it was more common after a delivery or miscarriage that required scraping of the endometrial lining. So, when we see the term D and C, D stands for dilation because we have to dilate the cervix to go in, and C stands for something called curettage, which is what used to be done for a lot of procedures regarding uterus, which is basically like this little device that would essentially scrape the inner lining of the uterus to remove whether a pregnancy or whether it was abnormal tissue or whatever it was.
The thought was people had this procedure done. You’re scraping this nice, soft, fluffy lining of the uterus, and now, it’s gritty. And when it heals, it sort of sticks together and has a lot of scar tissue. As a side note, nowadays, curettage is done much, much less frequently. Like when people have a miscarriage or a termination, we don’t use that curette anymore. We typically would use a little tube that just uses suction. So, what you, Cassie, had was a vacuum aspiration, which is, again, a little device that uses suction. And that’s what’s typically done.
So, the likelihood of the full-blown condition, Asherman’s, I believe, has gone down over the years. But what we’ve now been able to diagnose using either ultrasound or saline sonohysterogram, or HSGs, is that there’s a lot of women who, after delivery or after a miscarriage or after a C-section, will have some scar tissue in the uterus, but not the full-blown syndrome. Meaning, they will still get their periods. Maybe they’re slightly lighter, maybe they’re normal. They may not have any pain. Maybe there’s slightly pain, but usually they won’t. And they may or may not have fertility issues.
It sort of depends. Sometimes these things are found by fertility specialists. So, all the people going to them are having fertility issues. And then you’re like, well, is it because of the scar tissue or not? So, it’s frequently called Asherman’s syndrome, even if there’s just a tiny amount of scar tissue inside the uterus, but it’s not the full-blown Asherman’s syndrome.
And then there’s, what do you do about that? What do you do if there’s scar tissue in the uterus? And again, it really has to be individualized. So, on one end of the spectrum, Asherman’s is not itself dangerous. It’s typically not a danger to the woman to walk around with scar tissue in the uterus. So, whether she has slight amount of scar tissue or a lot of scar tissue, whether she is not getting her period or is getting her period, if she has no pain and she’s not planning any more pregnancies, frequently, you don’t have to do anything about it. Because it’s really not causing her any symptoms. It’s not dangerous to walk around like that. And she’s not trying to get pregnant.
Versus if she has symptoms or if she’s trying to get pregnant and there’s a thought that the scar tissue is affecting that, then typically, it will be treated. And the treatment is typically a form of a hysteroscopy where you go inside the uterus through the cervix from below with a camera, sort of try to remove those adhesions, first of all. And then the second is try to prevent them from re-forming. And there’s different ways to do that.
Again, this is not a procedure that I do. I refer to people to do this, but sort of on a broad level, they’ll go in, they’ll use the hysteroscope to sort of remove the scar tissue, to cut it, to try to remove it, and then do something afterwards to try to prevent it from happening again. Sometimes, people get placed on extra hormones, which sort of makes the lining sort of fluffy again, or sometimes they’ll put a little balloon inside the uterus to keep the walls apart from each other so they don’t touch each other and stick.
But there are many, many women who have this, get treated for it and then have successful pregnancies. A lot of that will depend on how severe it was. Is it done in one operation? Is it done in multiple operations? Is it going to be successful right away? Again, there’s a lot of nuance with this, based on the circumstance.
There is a potential risk afterwards of if someone does get pregnant, that the placenta can stick to where the scar tissue was, and can lead to portions of the placenta not coming out of delivery, or in a more pronounced form, something like a placenta accreta where the entire placenta gets stuck.
So, there’s a lot to talk about when someone has scar tissue in the uterus. And what we’ll try to do is figure out how much is it, does it need to be removed, does it not need to be removed, if it is, who’s going to do it, how are they going to do it, what are they going to do afterwards, how are we going to monitor afterwards? And then, similarly, if there’s a pregnancy in someone with a history of Asherman’s syndrome, how are we going to follow them, how are we going to figure out, at the time of delivery, is the whole placenta out? And there’s a lot of stuff that goes into it.
But for you, assuming the scar tissue is not a lot, able to be removed, and you do find afterwards, hopefully, you should go on to have a uncomplicated pregnancy.
All right. Thanks, everyone. We’ll see you all next week.
Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.
The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health, and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.
