Allergies and Intolerances during Pregnancy – How to avoid them?

Pregnancy is one of the most beautiful stages of a woman’s life. But being pregnant doesn’t only mean taking care of the baby, but taking care of self, as well. Taking care of self is one of the vital things during pregnancy. And, if you have allergies, you should consult your doctor regarding the same. Because when you stay fit and healthy, only then will the baby receive all the vital nutrients required for proper development.

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What is an allergy?

An allergy is a response by the body’s immune system to allergen, which may not be very harmful. Some people are sensitive to the allergens and get affected when exposed to them. Though most of the allergies are mild and don’t do much harm, some are severe and life-threatening. The life-threatening ones are known as Anaphylaxis. Food allergies are the most common form of allergy which occur during pregnancy.

Food Allergies and Food Intolerances

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Food allergies are not to be mistaken with food intolerances. Though seemingly similar, each has different signs and symptoms. But it is very difficult to differentiate between the two. The following will help you know the difference:

  • Food allergies occur when the immune system of the body reacts abnormally to certain foods. Food intolerances, however, don’t have an allergic reaction.
  • Allergic reactions happen quickly while the symptoms of food intolerance usually manifest a few hours after having food.
  • In case of food allergy, even a small amount of the food can cause allergic reaction. But the case is not same for food intolerance.

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Symptoms of Food Allergy:

  • Vomiting
  • Itching and tingling
  • Swelling of mouth, lips and throat
  • Constipation
  • Atopic eczema
  • Loose motion
  • Blood or mucus in stool
  • Tiredness
  • Poor growth


Symptoms of Food Intolerance:

  • Diarrhoea or loose stool
  • Bloating and tummy pain
  • Skin rashes and itching

How to Avoid Allergies and Intolerances?

Change in the hormonal level during pregnancy leads to change in allergy symptoms. Pregnant women should note the following to help avoid allergies and intolerances.

  • Avoid food that causes allergy and intolerance
  • Consult your doctor if you are allergic to certain foods
  • Take medications for allergy and intolerance as per your doctor’s advice
  • Check the medication information if it is suitable for use or not during pregnancy
  • Make a list of your allergic and intolerance factors
  • Inform emergency staff about your allergies
  • Ensure all your medicines are easily accessible
  • Avoid alcohol and smoking

Remember, it is very essential for pregnant women to take care of their own health along with the baby in the womb.

References:

http://patient.info/health/food-allergy-and-intolerance

http://www.babble.com/pregnancy/food-allergies-2/

http://www.allergyuk.org/causes-and-risks-of-allergy/allergies-during-pregnancy?cookieaccept=true

 

Urinary Problems During Pregnancy

Many women experience some unpleasant conditions during pregnancy like urine infection, urinating more frequently, constipation, haemorrhoids etc.

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Urinary Tract Infection

Generally, urine infections are caused by bacteria from the skin, rectum or vagina which enters the urethra. There are different types of urinary tract infection, commonly known as UTI. Below are some of the urinary tract infections which occur during the time of pregnancy.

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Kidney Infection: Also known as pyelonephritis, kidney infection is one of the most serious complications during pregnancy period. Germs in the form of bacteria travel from the bladder up through the urethras which infect the kidneys. If not treated on time, the infection may spread on the bloodstream which becomes life-threatening at times.

Asymptomatic Bacteriuria: Sometimes, bacteria reach the urinary tract without showing any type of symptoms in pregnant women. This type of bacteria is known as asymptomatic bacteriuria. If such bacteria form in non-pregnant women then there is no problem at all. But in case of pregnant women, it needs to be treated. If asymptomatic bacteriuria is left untreated, it increases the risk of kidney infection. So, during your pregnancy, get your urine tested regularly. And if you are tested positive, you will be given oral antibiotics which are safe to consume during pregnancy period.
Cystitis or Bladder Infection: Cystitis or bladder infection is most common among women between the ages of twenty to fifty who are sexually active. In such case, bacteria form in the bladder where it multiplies which causes inflammation and other symptoms of bladder infection.

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Symptoms of urinary tract infection

In some cases, there are no symptoms of urinary tract infection. But during your first pre-natal examination, your doctor will test for asymptomatic urine infection. And if the below mentioned symptoms arise in your pregnancy period, consult your doctor.

  • Sudden and quick urge to pee, also known as urinary urgency
  • Burning sensation or pain while urinating
  • Bloody urine
  • Foul smelling urine
  • Feeling pain in the area of pubic bone

How to avoid urinary tract infection?

If you are a pregnant woman, you can minimise the chance of getting affected with urinary tract infection by taking the following measures.

  • Drink lots of water every day to keep hydrated
  • Empty your bladder fully when you urinate. And don’t stop your urge to pee as this may lead to urine infection
  • To prevent bacteria in the stool getting near the urethra, wipe yourself from front to back after the bowel movement
  • Always keep your genital area hygienic and clean by cleaning with water and mild soap
  • During your pregnancy avoid using sprays, powders and strong hygienic wash in the genital area as it can irritate your genitals and urethra. It makes a better place for the bacteria to breed
  • To eliminate genital bacteria, urinate before and after sex
  • You can drink cranberry juice during your pregnancy as it helps in reducing the level of bacteria and stops breeding in the urinary tract
  • Stay away from having chocolate and caffeine during your pregnancy as it can irritate the bladder

Treatment of urine infection during pregnancy

There are different types of antibiotic which help to stop urine infection during pregnancy. Usually seven days course is prescribed by the doctor to treat urine infection. The antibiotic given by the doctors during the time of pregnancy are safe to consume and doesn’t have any adverse effect. So, consult your doctor and get urine test done from time to time to keep a check on urinary tract infection and get treated accordingly.

For those infecting with cystitis can drink plenty of water and flush out the bladder time to time. But it is advisable to consult your doctor if such infection occurs. However, drinking lots of water helps you keep hydrated if you have fever during your pregnancy.

Role of Each Vitamin During Pregnancy

It is very essential that your food contains different types of vitamins, minerals and other nutrients for you to stay fit and healthy. It is even more necessary in the case of pregnant women. During pregnancy, not only does the mother need different types of nutrients but you must remember the baby also receives its food from the mother. So, during pregnancy, you need to have more vitamin rich food than you did normally. At times, you have to take supplements if you don’t meet your bodily demands through food.

Different types of vitamins have varied roles in the growth of the baby. So, always consult your doctor before taking any type of vitamin supplements.

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 Vitamin A

Vitamin A is one of the main requirements for foetal development, proper functioning of the immune system and visual health. Deficiency of vitamin A can cause night blindness etc. During pregnancy, it is advisable not to consume vitamin A supplements like retinol which is a compound of vitamin A as too much of it can harm the baby. Take your doctor’s advice before taking supplements of vitamin A. Some of the best dietary sources of vitamin A are:

  • Vegetables like carrots, potatoes, pumpkin, broccoli etc
  • Milk
  • Eggs
  • Liver


Vitamin D

You need vitamin D to keep your bones and teeth healthy. But during pregnancy, the baby also needs vitamin D during its first phase of development.  Vitamin D helps your child’s teeth and bones grow. It also helps in regulating the immune system, nerves and muscles of the body. As we all know, the best source of vitamin D is sunlight, but too much of sunlight can lead to skin ageing etc. So, it is better to have vitamin D rich food and vitamin supplements during pregnancy.

Deficiency of vitamin D can soften the bones of your child and make it suffer from diseases like rickets. Some of the best sources of vitamin D are:

  • Cereal
  • Milk
  • Fatty fish


Vitamin C

Vitamin C is one of the essential vitamins during pregnancy. Vitamin C helps to form collagen in the blood vessels and during pregnancy the requirement of blood volume increases. So, a pregnant woman needs more vitamin C for the growth of the unborn baby.

During pregnancy, the average requirement of vitamin C is around 40 mg/day. But in some cases, the necessity is around 60 mg/day or more. Some best dietary sources of vitamin C are:

  • Vegetables like green bean, potato, broccoli, papaya, tomato, bell pepper etc
  • Citrus fruits
  • Strawberries


Folic Acid

Folic acid helps in the growth of the cells and prevents neural tube defects. During pregnancy, a woman needs around 600 mcg of folic acid. Some dietary sources of folic acid are:

  • Green leafy vegetables
  • Vegetables like spinach, beans, broccoli and beet
  • Fruits like strawberries and oranges
  • Fortified cereals and pastas


Vitamin E

Vitamin E helps to form red blood cells and muscles. During pregnancy, you need to have vitamin E either through dietary source or through supplements. Some of the excellent dietary sources of vitamin E are:

  • Fortified cereals
  • Vegetable oils
  • Spinach
  • Nuts


Vitamin B1 or Thiamin

Vitamin B1 or Thiamin helps in raising the energy level and regulates the nervous system, as well. It also helps in maintaining appetite and growth. Deficiency of vitamin B1 can cause diseases like beriberi. So, it is advisable to have around 1.4 mg of vitamin B1 per day when you are pregnant.

You can find good source of vitamin B1 in the following:

  • Fortified cereals
  • Wheat germ
  • Whole grain
  • Pasta
  • Eggs
  • Legumes
  • Organ meat


Vitamin B2 or Riboflavin

For better energy, good eyesight and healthy skin, vitamin B2 or riboflavin is very essential. So, during pregnancy, your body should get around 1.4 mg of vitamin B2 daily. Some dietary sources of vitamin B2 are:

  • Fortified cereals
  • Dairy products
  • Egg
  • Fish
  • Meat

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 Vitamin B3 or Niacin

Vitamin B3 or Niacin is essential for the normal functioning of the gastrointestinal tract and nervous system. It also promotes healthy skin. A pregnant woman needs 18 mg of vitamin B3 on a daily basis either through dietary source or supplements. Some sources of vitamin B3 are:

  • Fortified cereals and bread
  • High-protein food
  • Peanuts
  • Milk
  • Fish
  • Egg


Vitamin B6 or Pyridoxine

Vitamin B6 helps in forming red blood cells and getting rid of morning sickness during pregnancy. During pregnancy, a woman requires around 1.9 mg of vitamin B6 daily in any form. Some of the good dietary sources of vitamin B6 are:

  • Vegetables like cabbage, spinach, bean, broccoli and peas
  • Nuts like walnut and peanut
  • Brown rice
  • Wheat germ
  • Oats
  • Sunflower seeds
  • Chicken
  • Fish
  • Egg

It is essential to have a healthy diet during pregnancy for the proper growth of the baby. So, consult your doctor from time to time and take supplements when prescribed.

 

Fatigue Problems During Pregnancy

During pregnancy, most women experience extreme tiredness and fatigue. It is quite normal to feel tired during pregnancy as your body undergoes different types of changes,  and pains, aches, tender nipples etc occur. During the early and later stages of pregnancy, fatigue becomes very common. Some pregnant women experience fatigue throughout the whole pregnancy yet some don’t feel tired at all.

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Reasons for fatigue

Though the actual reasons for fatigue during early pregnancy are not known, it is assumed that  hormonal changes are the main reason. As progesterone is known to make one tired and sluggish, rapid rise of this hormone in pregnant women make them feel more tired. The hormonal changes results in a mess of stress level with the mental state taking a toll on the rest of the body making you feel tired. At the end of the first trimester, all these symptoms reduce to a great extent. If they still continue in the second trimester, it is advisable to consult your doctor.

Moreover, most pregnant women get affected with anaemic problems. The symptom of anaemia during pregnancy is fatigue. An expectant woman needs greater amount of iron for the baby and for the blood loss during the delivery.

Some other causes of fatigue may include the stress of becoming a mother, carrying twins, vitamin D deficiency etc.

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How long does fatigue last?

Fatigue is common in the first and third trimester, but in some cases it may occur in the second trimester, as well. You will gain more weight during the last months of pregnancy resulting in  trouble while sleeping, backache, leg cramps, heartburn etc. So, it is very natural to get tired and restless during the first three months and the last months of pregnancy.

How to reduce fatigue during pregnancy?

Though there is no prescription to reduce fatigue, doctors advise pregnant women to rest and relax.  The following tips may help you to prevent and manage fatigue during pregnancy.

  • Take rest as much as possible
  • Drink lots of fluids in order to keep hydrated
  • Take power naps in the afternoon to compensate loss of sleep at night
  • Eat small but healthy meals throughout the day which will help you gain energy
  • Do some deep-breathing exercises, some stretches or take a short walk every day
  • Include protein and iron rich food like whole grain bread, red meat, sea food, leafy vegetables
  • Go to bed early and try to get a good night’s sleep
  • Adjust your work schedule and be less busy during your pregnancy. You can ask your family to help you in household activities.

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Consult your doctor if the following occur:

  • Fatigue due to extreme thirst and hunger
  • Fatigue due to sore throat, swollen glands or fever
  • Excessive fatigue along with vomiting, nausea, increased urination etc
  • Fatigue due to depression or stress
  • Fatigue even after proper rest

Though it is pretty normal to be tired during the first and last trimester of pregnancy, at times it is advisable to consult your doctor. Taking proper rest is one of the best ways to get relief from stress and tiredness during pregnancy.

All You Wanted to Know About Pelvic Exercises During Pregnancy

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While pregnancy is physically demanding, exercise becomes necessary to cope with the physical as well as biological changes that affect specific areas such as muscles, joints, backbone and especially the pelvic floor. In this post, we are going to share how pelvic floor exercises during pregnancy are important since they not only help reduce pelvic pain but also ease the childbirth procedure.

Your takeaway from this blog post on pelvic floor exercises during pregnancy

  • Where are pelvic floor muscles located
  • How to locate pelvic floor muscles
  • Why is pelvic floor exercise so important
  • How does pregnancy affect pelvic floor
  • Benefits of pelvic floor exercises
  • Types of pelvic floor muscle exercises
  • What else you should know about pelvic floor exercises

Before we jump into the workout section, let’s have a quick intro on pelvic floor –

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 Where are pelvic floor muscles located?

As the name suggests, the pelvic floor muscles form the base of the pelvis.

Pelvic floor is a group of muscles, ligaments and sheet-like tissues that stretch from the front side to the back side i.e. base of your spine. These muscles are attached to the pelvis sides (the bones that we sit upon). They are also attached to the pubic bone and the coccyx i.e. tailbone. These muscles pass through the vagina, anus and urethra, as shown in the image.

What do pelvic floor muscles do?

  • They help in supporting the bladder, uterus and intestines.
  • They help in controlling bowel and bladder movement.
  • They help in sneezing, coughing and lifting heavy objects.
  • They support the spine and help during sex.

How to locate pelvic floor muscles?

Try to control your flow while urinating, and you can soon identify the muscles which help you stop the flow in the middle of urinating. However, it is not ideal to do this as an exercise as stopping the flow can affect your bladder.

Another way of identifying these muscles is by inserting two fingers into your vagina and try squeezing them. You will soon understand the mechanism.

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Why is pelvic floor exercise so important?

  • As already discussed above, the pelvic floor muscles support the uterus and help in bowel as well as bladder movement, so if the pelvic floor is weakened then the muscles become harder to be squeezed which affects urinating and bowel movement.
  • Weak pelvic muscles may also put you in an embarrassing situation as you may pee a little while coughing or sneezing. This further leads to a heavy dragging-like feeling because of improper bladder and womb movement.
  • Weak pelvic muscles also affect vaginal muscles.
  • Not only during pregnancy but pelvic muscles should be well maintained as post menopause hormonal changes worsen the abovementioned problems, thereby causing sagging of the uterus and bladder towards the walls of the vagina.

By regularly doing a few pelvic floor exercises, bladder weakness or prolapse symptoms are kept at bay, while reducing the pelvic pain during pregnancy and labour pain as well. 

How does pregnancy affect the pelvic floor?

The extra pounds that you put on following pregnancy exert pressure on your pelvic floor muscles, thereby leading to weakness that persists even after the childbirth. The pelvic floor tends to become weak as early as 12 weeks into your pregnancy.

As constipation is one of the common health problems for expecting moms, it can put more strain on your pelvic floor thus increasing the pelvic pain.

Benefits of doing pelvic floor exercises

  • They help in toning up the pelvic floor.
  • They help in reducing the risk of uterine/bladder prolapse.
  • They help during labour, while improving the recovery time.
  • They help in reducing post-partum discomforts such as perineal swelling and hemorrhoids.
  • They help in healing the area between anus and vagina i.e. perineum post-partum, by improving the blood circulation.
  • They help in reducing perineal tearing and the likelihood of episiotomy.
  • They help in the complete emptying of the bladder and bowel.
  • They help in maintaining the muscle tone of the vagina thereby easing the delivery process.
  • They help in preventing urinary leakage during pregnancy.

Types of pelvic floor exercises

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Since your pelvic floor muscles comprise two types of fibres — fast fibres that render strength and slow fibres that render stamina; we offer you two types of pelvic exercises during pregnancy for best results.

Short squeezes in pelvic floor exercise –

  1. Sit down comfortably by slightly stretching your knees. Stretch the muscles around the back passage just as you would do to stop your bowel movement.
  2. Now do the same thing at the front, as if you are squeezing your vagina to stop urinating.
  3. Make sure the squeezes are strongly executed in as much that you feel a definite ‘let go’.
  4. These types of short squeezes should not last for more than a few seconds.
  5. Try to do three sets per day in different positions.

Long squeezes in pelvic exercises during pregnancy

  1. Sit down in the same position as you had done for short squeezes and repeat the above step. The only difference is you need to hold it for a longer time i.e. a few extra seconds. But always remember to breathe normally.
  2. Make sure in the process you’re not constricting your buttock muscles. You can stress your lower abdominal muscles a bit but don’t squeeze out your anus.
  3. Take a break of few seconds before repeating the above step. However, you should stop immediately if you feel your muscles are tired.
  4. Try to find out how long you can hold on to the squeezing, say 4 seconds. This will help you do the long squeezes better.
  5. Now when you become comfortable with the 4-second long squeeze, try to increase it to say 10 seconds. You can gradually increase the counts with each workout.

Bonus points — What else you should know about pelvic floor exercises?

It is equally important to relax pelvic floor muscles as it is to tighten and squeeze them. It is especially important when the baby starts crowning its head during second stage of labour. The pelvic muscles need to be relaxed during this stage, so as to avoid episiotomy.

Make sure you drink a lot of fluid and that you urinate only when you feel your bladder is completely full. Since the frequency of urinating increases during pregnancy, do not try to hold on for too long as it affects the bladder.

Hysterosalpingogram

What is Hysterosalpingogram ?

Hysterosalpingogram (HSG) is an X-ray test done to know about the patency of the fallopian tubes, which help in the transport of the egg and the fertilized embryo. It is usually done on 7th or 8th day of the menstrual cycle.

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Procedure and Instructions to be Followed for the Investigation

  1. In this test, a small amount of liquid (dye) is pushed into the uterus through a small instrument (speculum) placed in the vagina and an abdominal X-ray is taken. There can be period-like crampy pain during the procedure.
  1. To prevent pain, we advise Tab. Meftal spas to be taken with food, 1 hour before HSG and to continue it 8th hourly depending on the pain for the next two to three days.
  1. This test delineates the uterine cavity and the tubes. If the tubes are open, the dye flows out of the tubes and can be seen on the X-ray film.
  1. As this test involves pushing some liquid into the uterus, there can be a small risk of infection. In order to avoid this, we advise antibiotic Tab. Doxycycline 100 mg two times a day after food, starting from the day of HSG which has to be continued for a total of five days.
  1. Once HSG test is done, a gynaecology consultation (by appointment) with the report is advised.

Medical Ectopic Pregnancy

Ectopic pregnancy (EP) is a pregnancy situated outside the uterine cavity (normal location). Early diagnosis of EP is possible with the advent of high resolution ultrasound and judicious use of serum Beta hCG levels (blood test), which in turn allow medical management in most cases. The choice of treatment should be guided by eligibility criteria and patient’s choice after discussing risks and benefits. Methotrexate (MTX) is the drug used for medical management of EP, sometimes in combination with mifepristone.

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Prerequisites for Medical Management

  • Asymptomatic women with unruptured EP who are clinically stable, have normal baseline blood investigations (blood counts, liver and kidney function tests) and are willing for regular follow-up for 4-6 weeks, can be offered medical management.
  • High serum Beta hCG levels (> 3500 mIU / ml), ectopic mass size > 3.5 cm and / or presence of cardiac activity in EP are relative contra indications to medical management.
  • It should not be offered to those with significant bleeding into the abdomen or those with a coexisting viable intrauterine pregnancy.

Methotrexate Administration

Two protocols are currently used for medical treatment of EP : “Single Dose” MTX therapy at a dose of 50mg/m2 of body surface area and “Multidose” regimen consisting of 1mg / kg of MTX alternating with 0.1mg / kg of leucovorin for upto 4 doses of each agent. Both regimens are found to be effective.

  • MTX can be given on Out Patient basis and intramuscular administration is the preferred route.
  • Multidose regimen is preferred in women with high serum Beta hCG levels or those with presence of cardiac activity on ultrasound. In the single dose regimen, further doses of MTX may be repeated (upto a maximum of 3) if there is an inadequate response (<15% drop in serum Beta hCG).
  • In the single dose regimen, further doses of MTX may be repeated (upto a maximum of 3) if there is an inadequate response (<15% drop in serum Beta hCG).

Laparoscopy is indicated if :

  • Severe abdominal pain or signs suggestive of tubal rupture develop.
  • There is no satisfactory drop in serum Beta hCG levels even after 3 doses in the single dose regimen or 4 doses in multidose regimen.

Anti D:

Regardless of the method of treatment Anti D should be given to all Rh negative women who have an EP.

Patient Should Be Advised To

  • Avoid sexual intercourse until Beta hCG is <10 mIU / ml.
  • Avoid pregnancy for three months after MTX injection, due to the theoretical risk of birth defects with MTX.
  • Avoid sun exposure to limit risk of MTX dermatitis.
  • Avoid foods and vitamins containing folic acid.

Post Treatment Management

Beta hCG   Serial serum Beta hCG levels need to be checked on days 4 and 7 after MTX.

  • If there is >15% decrease between days 4 and 7, weekly follow up is advised until Beta hCG is <10 mIU / mL.
  • If <15% decrease is noted by day 7, 2nd dose of MTX is advised.
  • In multidose regimen, serum Beta hCG levels are checked every 48 hours till significant decrease is noted and weekly thereafter.

Ultrasound It is generally not repeated except to evaluate severe pain or suspected rupture or for patients with cardiac activity in the EP.

After completion of treatment, an ultrasound is advised to check for resolution of the EP which may take upto 3 months at times.

Efficacy

  • Overall success of medical management is 88 – 90%.
  • Around 14% of patients require a 2nd dose and less than 1% of women require more than 2 doses of MTX.

Side Effects

Drug related

Adverse reactions to MTX are usually mild and self-limited. Approximately 30% of patients in the single dose protocol will experience side effects, the most common are mouth ulcers and conjunctivitis.

Separation pain

Up to 75% of patients may complain of pain between days 2-7 after receiving the medication. This pain is usually mild and can be managed with paracetamol. Women with severe pain require further evaluation to rule out rupture of EP and the need for surgery.

Subsequent Reproductive Performance

  • There is no evidence of adverse effects of MTX treatment on future pregnancies.
  • Studies have shown a subsequent intra uterine pregnancy rate of 60-90%.
  • The incidence of recurrent EP is approximately 7-15%.
  • Women should be instructed to undergo an early ultrasound evaluation in subsequent pregnancies to confirm normal intrauterine location.