Is it OK for me to get pregnant again?
Dear Dr Mitchell,I am 38 years old. I had my daughter when I was 33 years old by Caesarean section. I also had an ectopic pregnancy before my daughter. Is it OK for me to get pregnant again?
It is perfectly safe for you to become pregnant after having an ectopic pregnancy and a subsequent delivery by Caesarean section. The fact that you had an ectopic pregnancy is significant. There is a risk that you could also have another ectopic pregnancy so it is important for you to do a pelvic ultrasound within a week or two of missing your menstrual period once the pregnancy is confirmed. This is important to localise the gestational sac within the uterus and to rule out a pregnancy in the Fallopian tube. It is very reassuring that you had a normal pregnancy after having the ectopic pregnancy since this definitely means that the Fallopian tube that is left back is functional.
It has been five years since your last pregnancy so it would definitely be a safe thing to do an X-ray of the Fallopian tube to establish that it is still functional before trying to become pregnant. This would be even more important if you have been trying to conceive without any success since then. This will help to guide you as to the way forward and reduce your risk of having another ectopic pregnancy which can be life threatening. If the remaining Fallopian tube is blocked, then you should consider doing invitro fertilisation so that pregnancy can be achieved by bypassing the Fallopian tube. This procedure is available at the Hugh Wynter Fertility Management Unit and is relatively affordable.
The fact that you are over 35 is significant. Older women are at an increased risk for birth defects and chromosomal abnormalities. The risk of developing pregnancy induced hypertension and diabetes mellitus also increases as you get older.
It is important for you to exercise and eat a healthy diet so that you can achieve your ideal weight for height before pregnancy. If you are already diabetic or hypertensive then you should try to achieve good control of these medical conditions before becoming pregnant. It is important to take folic acid supplements daily to reduce the risk of birth defects in the brain and spinal cord of your baby. Screening for birth defects and chromosomal abnormalities can be done in early pregnancy and is now recommended in all pregnant mothers, especially if you are over 35.
You will definitely be considered for delivery by another Caesarean section so it is important to book antenatal care and delivery in a hospital that has ready access to an operating theatre and with trained doctors and staff readily available.
Consult your doctor who will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025.
