Risks of NOT Getting a Vasectomy

If a couple wants to have a child, the risks associated with reversible forms of contraception to delay pregnancy until they are ready, and the risks associated with the ultimate pregnancy and childbirth are worth it.
BUT ...
... if a couple HAS had as many children as they desire, the risks associated with reversible forms of contraception and the risks associated with the  pregnancy and childbirth that may result if those forms of contraception fail, are NOT countered by the benefits of having another child.

The safest thing a man can do for himself is NOT get a vasectomy. BUT, by NOT getting a vasectomy, he transfers to his partner (1) all of the risks associated with use of other forms of contraception and (2) the risks associated with pregnancy and childbirth when those less dependable forms of contraception fail.

The purpose of this page is to explain the risks to one's partner of NOT getting a vasectomy.

FIRST, before deliniating those risks to female partners, a word about condoms. Condoms are safe and effective when used properly. But condoms require self-discipline. ALCOHOL impairs judgment and thereby stifles self-discipline. After a few drinks, the emboldened couple may (1) "conveniently" lose track of where the female is in her cycle, (2) overestimate the effectiveness of early wtihdrawal, or (3) fail to withdraw or use a condom altogether. How many vasectomy couples have I met whose children are 7, 10, 12, and now they are pregnant after feeling frisky following a few drinks at a holiday party?
After a vasectomy, ALCOHOL is no longer a factor.

Risks associated with
the following Contraceptives

Risks of Pregnancy Risks of Childbirth/Post Partum Risks of Tubal Ligation
Birth Control Pills Pregnancy-induced hypertension (PIH) Vaginal and perineal laceration Bleeding
Implants Preeclapmsia/toxemia Puerperal Infection Infection
The Ring Placenta Previa Urinary incontinence Anesthesia-related events
Birth control patch Abruptio Placentae Fecal incontinence Death
The Shot Ectopic pregnancy Post-partum depression Ectopic pregnancy
Mirena Miscarriage Uterine infection Microinsert expulsion
Paragard Gestational diabetes Post-partum hemorrhage Perforation
  Rh incompatibility Vaginal discharge (locia) Pelvic cramping on day of procedure
  Rupture of the uterus Perineal pain Back pain in the first year of microinsert use
  Hyperemesis Gravidarum Kidney infection  
Hyperthyroidism during pregnancy Clogged breast ducts
Stretch marks

Risks of the following Hormonal Contraceptives

Birth Control Pills
    Blood clots - 0.03% per year
    BUT for women a history of clots, the risk substantially increases.

Daily contraceptive pills combine estrogen and progestin to prevent pregnancy. With perfect use, the failure rate is 0.3%; however, the typical use failure rate is 8%. Due to the high rate of misuse/discontinuation of oral contraceptive pills, about 1,000,000 unplanned pregnancies occur each year as a result.

Healthy women who do not smoke cigarettes have almost no chance of having a severe side effect from taking oral contraceptives. For most women, more problems occur because of pregnancy than will occur from taking oral contraceptives. But for some women who have special health problems, oral contraceptives can cause some unwanted effects. Some of these unwanted effects include benign (not cancerous) liver tumors, liver cancer, or blood clots or related problems, such as stroke. Although these effects are very rare, they can be serious enough to cause death.

  Adverse side effects listed below

The most common birthcontrol implant is the 1 rod Implanon. The Implanon, a short rod about an inch long with a width of a spaghetti noodle, is inserted into the arm under the skin and releases progestin. The pros of Implanon (most commonly used implant) are that it is highly effective, long-acting (up to three years), can be used during lactation, and it is discreet, reversible, and does not contain estrogen. The cons are that the implant can cause irregular bleeding, require clinician visits for insertion and removal, and does not protect against STDs. Typical use of the implant results in a 0.05% failure rate.

Some women may have undesirable side effects while using the birth control implant. But many women adjust to it with few or no problems. Women who have had breast cancer cannot use the implant. Irregular bleeding is the most common side effect, espeically in the first 6-12 months of use. After one year, 1 out of 3 women who use the birth control implant will stop having periods completely. Some women have longer heavier periods. Some women have increased spotting and light bleeding between periods. Less common side effects of the Implanon include: change in sex drive, discoloring or scarring of the skin over implant site, headaches, nausea, pain at the insertion site, sore breasts, and weight gain. 
    1% or more: bleeding irregularies, emotional lability, weight increase, headaches, acne, and/or depression
    >5% of users:
headache, vaginitis, weight increase, acne, breast pain, abdominal pain, pharyngitis, leukorrhea, influenza-type symptoms, dizziness, dysmenorrhea, 
    back pain, emotional lability, nausea, pain, nervousness, depression, hypersensitivity, insertion site pain



The Ring
    Common adverse reactions experienced by 2-14% of users

The Nuvaring® is a soft ring about an inch in diameter that is inserted in the vagina 3 weeks out of the month and taken out for the remaining week of the month. The ring releases constant, low hormone levels (a combination of estrogen and progestin) that are systematically absorbed via the vaginal mucosa. Typical use results in a 9% failure rate

Common side effects include: vaginal infections/irritation, vaginal secretion, headaches, weight gain, nausea. Other possible side effects include vomiting, change in appetite, abnormal cramps/bloating, breast tenderness/enlargement, irregular vaginal bleeding/spotting, changes in menstual cycle, temporary infertility after treatment, fluid retention (edema), spotty darkening of the skin (particularly on the face), rashes, weight changes, depression, intolerance to contact lenses,decreased libido, nervousness, dizziness, and loss of scalp hair. Severe risks include blood clots, stroke/heart attack, high blood pressure, heart disease, gallbladder disease, liver tumors, and lipid metabolism and inflammation of the pancreas.

Birth control patch
Unpleasant side effects in over 2.5% of users (See below)

The birth control patch (Generic name: Norelgestromin, Brand name: Ortho Evra®) is applied on the skin three weeks of the month and removed for the remaining week of the month. It releases a combination of estrogen and progestin. With perfect use, the failure rate is 0.3%, while the typical use failure rate is 8%.

Potential side effects include blood clots, heart attack, gallbladder disease, liver tumors, and cancer of the reproductive organs and breasts. Like pregnancy, hormonal birth control methods increase the risk of serious blood clots, especially in women who have other risk factors, such as smoking, obesity, or age greater than 35 years. This increased risk is highest when first starting to use hormonal birth control. Some studies have reported that women who use Ortho Evra® have a higher risk of getting a blood clot. It is possible to die or be permanently disabled from a problem caused by a blood clot, such as a heart attack or a stroke. Women who use hormonal contraceptives, including Ortho Evra®, have a greater risk than nonusers of having gallbladder disease. In rare cases, combination oral contraceptives can cause benign but dangerous liver tumors. These benign tumors can rupture and cause fatal bleeding. In addition, some studies report an increased risk of developing liver cancer; however, liver cancers are rare. Combination hormonal contraceptives, including Ortho Evra®, may slightly increase the changes of having breast cancer diagnosed, particularly using hormonal contraceptives at a younger age.
    Adverse reactions reported by >2.5% of users: breast symptoms, dysmenorrhea, vaginal bleeding/menstrual disorders, nausea, abdonimal pain, vomiting,        
    diarrhea, headaches, dizziness, migraines, application site disorder, fatigue, psychiatric disorders, acne, pruritus, vaginal yeast infections, weight gain

    Adverse reactions reported by <2.5% of users:
Abdominal distention, fluid retention, cholecystitis, blood pressure increase, lipid
    disorders, muscle spasms, insomnia, increased/decreased libido, galactorrhea, genital discharge, premenstrual syndrome, uterine spasms, vulvovaginal
    dryness, pulmonary embolism, chloasma, dermatitis contact, erythema, skin irritation


The Shot
    Unpleasant side effects (below) - 5%

The shot (Brand name: Depo-Provera®) is a form of progesterone, a female hormone, and is a contraceptive that is injected every 13 weeks, or 90 days. The advantages of the shot are that it is a reversible, non-daily, birth control method that does not contain estrogen. Depo-Provera® should not be used as a long-term birth control method (longer than two years). Depo-Provera® may interact wit haminoglutethimide (Cytadren). Other drugs may interact with Depo-Provera®. Typical use of the shot results in a 6% failure rate.

Common side effects include: nausea, stomach cramping/bloating, dizziness, headache, tiredness, breast tenderness, decrease in breast size, acne, hair loss, or irritation/pain at injection site, decreased sex drive, hot flashes, joint pain. Serious side effects include: heavier/longer periods, sudden numbness/weakness, sudden/severe headache/confusion, chest pain, coughing, wheezing, pain/swelling in the legs, fever, nausea, upper stomach pain, swelling in hands/ankles/feet, symptoms of depression.

In two clinical trials with Depo-Provera®, over 3,900 women, who were treated for up to 7 years, reported the following adverse reactions, which may or may not be related to the use of Depo-Provera®. The population studied ranges in age from 15-51 years, of which 46% were White, 50% Non-White, and 4.9% Unknown race. The patients received 150 mg Depo-Provera® every 3 months. The median study duration was 13 months with a range of 1-84 months. Fifty eight percent of patients remained in the study after 13 months and 34% after 24 months.

Adverse reactions that were reported by more than 5% of subjects included: headache (16.5%), abdominal discomfort (11.2%), increased weight >10 lbs at 24 months (37.7%), nervousness (10.8%), dizziness (5.6%), libido decreased (5.5%), menstrual irregularities - bleeding at 12 months (57.3%), bleeding at 24 months (32.1%), amenorrhea at 12 months (55%), amenorrhea at 24 months (68%).

Adverse reactions that were reported between 1-5% of subjects included: Asthenia/fatigue (4.2%), backache (2.2%), dysmenorrhea (1.7%), hot flashes (1.0%), nausea (3.3%), bloating (2.3%), edema (2.2%), leg cramps (3.7%), arthralgia (1.0%), depression (1.5%), insomnia (1.0%), acne (1.2%), no hair growth/alopecia (1.1%), rash (1.1%), leukorrhea (2.9%), breast pain (2.8%), vaginitis (1.2%).

Mirena® IUD
    Perforation of the uterus: 0.1%
    Expulsion sometimes unnoticed and resulting in unplanned pregnancy: 2-10%

The Mirena® IUD, or the Levanorgestrel intrauterine device is inserted into the uterus, contains progestin only, and lasts from 5-7 years. This IUD prevents fertilization by damaging or killing sperm and making the mucus in the cervix thick and sticky, so sperm can't get through to the uterus. It also keeps the lining of the uterus (endometrium) from growing very thick. This makes the lining a poor place for a fertilized egg to implant and grow. The hormones in this IUD also reduce menstrual bleeding and cramping. The benefits of the Mirena® IUD include not having to refill prescriptions and it can be used while breastfeeding. Typical use of the Mirena® IUD results in 0.2% failure rate.

Both IUDs pose the risks of perforation and expulsion. Perforation of the uterus by the IUD occurs in about 1/1000 women. About 2 to 10 out of 100 IUDs are pushed out (expelled) from the uterus into the vagina during the first year. This usually happens during the first few months of use. Expulsion is more likely when the IUD is inserted right after childbirth or in a woman who has not carried a pregnancy. When an IUD is expelled, a woman is no longer protected against pregnancy. Expulsion can occur without detection. Disadvantages associated with the Mirena include the potential of causing benign ovarian cysts, breast tenderness, mood swings, headaches, and acne. Side effects are rare and usually go away after the first few months.

Paragard® IUD
    Perforation of the uterus: 0.1%
    Expulsion sometimes unnoticed and resulting in unplanned pregnancy: 2-10%

The Copper T IUD (Brand name: Paragard®) does not contain hormones and lasts between 10-12 years. It can be used as emergency contraception. Copper is toxic to sperm. It makes the uterus and fallopian tubes produce fluid that kills sperm. This fluid contains white bood cells, copper ions, enzymes, and prostaglandins. Typical use of the Paragard® IUD results in 0.8% failure rate.

Both IUDs pose the risks of perforation and expulsion. Perforation of the uterus by the IUD occurs in about 1/1000 women. The copper IUD may increase menstrual bleeding or cramps. About 2 to 10 out of 100 IUDs are pushed out (expelled) from the uterus into the vagina duringthe first year. This usually happens during the first few months of use. Expulsion is more likely when the IUD is inserted right after childbirth or in a woman who has not carried a pregnancy. When an IUD is expelled, a woman is no longer protected against pregnancy. Expulsion can occur without detection.

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Risks of Pregnancy

Pregnancy-induced hypertension (PIH) (high blood pressure) - 6-8%

3 types: (1) Chronic hypertension: Women who have high blood pressure (over 140/90) before pregnancy, early in pregnancy (before 20 weeks), or carry it on after delivery. (2) Gestational hypertension: High blood pressure that develops after week 20 in pregnancy and goes away after delivery. (3) Preeclampsia: Both chronic and gestational hypertension can lead to this severe condition after week 20 of pregnancy.

Incidence: Hypertension during pregnancy affects about 6-8% of all pregnant women.

Who's at risk? First time mothers, women whose sisters and mothers have PIH, women carrying multiple babies, women younger than age 20 or older than age 40, and women who had high blood pressure or kidney disease prior to pregnancy.

Effects of condition: Hypertension can prevent the placenta from getting enough blood. If the placenta doesn't get enough blood, your baby gets less oxygen and food. This can result in low birth weight. Most women can still deliver a healthy baby if hypertension is detected early and treated with regular prenatal care. If hypertension is severe, it can leave to preeclampsia, which can have much for serious effects on mothers and babies.

Preeclampsia/toxemia - 2-6%

Preecplampsia is a condition that occurs only during pregnancy. Diagnosis is made by the combination of high blood pressure and protein in the urine, occurring after week 20 of pregnancy. Preeclampsia may also be called toxemia and is often precluded by gestational hypertension.

Incidence: Preecplampsia affects about 2-6% of healthy, first time moms.

Who's at risk? The following increases a woman's risk of developing preecplamsia: First-time mom, previous experience with gestational hypertension or preecplampsia, mothers/sisters with who have had preecplampsia, carrying multiple babies, being younger than 20 years old or older than 40 years old, women who had high blood pressure or kidney disease prior to pregnancy, women who are obese or have a BMI of 30 or greater

Symptoms: Mild preecplampsia - high blood pressure, water retention, and protein in the urine. Severe preeclampsia - headaches, blurred vision, inability to tolerate bright light, fatigue, nausea/vomiting, urinating in small amounts, pain in the upper abdomen, shortness of breath, and tendency to bruise easily.

Effects of condition: If preecplampsia is not treated quickly and properly, it can lead to serious complications for the mother such as liver/renal failure, future cadiovascular issues and two other conditions directly related to preeclampsia that could be life threatening. Eclampsia is a severe form of preeclampsia that leads to seizures in the mother. HELLP (hemolysis, elevated liver enzymes, and low platelet count)  is a condition usually occurring in late pregnancy that affects the breakdwon of red blood cells, how the blood clots, and the liver function for the pregnant woman.

Placenta Previa (Placenta obstructing birth canal) - 0.5%

Placenta previa is the attachment (implantation) of the placenta over or near the cervix, in the lower rather than the upper part of the uterus.

Incidence: Placenta previa occurs in 1 of 200 deliveries. As many as 15% of pregnant women have placenta previa during the 2nd trimester. Placenta previa may be visible on ultrasonography. However, it resolves on its own in more than 90% of women before they deliver. If it does not resolve, the placenta may detach from the uterus, depriving the baby of its blood supply. Passage of the baby through the birth canal can also tear the placenta, causing severe bleeding.

Who's at risk? Women having had more than one pregnancy, having cesarean delivery, having had twins, triplets, or other multiple births in a single pregnancy, having a structural abnormality of the uterus (such as fibroids), being of other reproductive age, and female smokers.

Symptoms/effects of condition: Women may have painless, sometimes profuse bleeding late in pregnancy. When bleeding is minor and occurs before about 36 weeks of pregnancy, doctors typically advise bed rest in the hospital until bleeding resolves. If the bleeding stops, women may be allowed to gradually resume light activities. Doctors advise against sexual intercourse, which can trigger bleeding. Delivery, typically cesarean, is usually done when the fetus's lungs are mature enough for delivery (usually after 36 weeks) or when one of the following occur: Bleeding is profuse or does not stop, the fetus's heart rate is abnormal, indicating lack of oxygen, or the woman's blood pressure becomes too low. Women who bleed profusely may require repeated blood transfusions.

Abruptio Placentae (Separation of placenta from the uterus before the baby is delivered) - 0.1%

Placenta abruptio is the separation of the placenta (the organ that nourishes the fetus) from its attachment to the uterus wall before the baby is delivered.

Incidence: Placental abruption, which includes any amount of placental separation before delivery, occurs in about 1 out of 150 deliveries. The severe form, which can cause the baby to die, occurs only in about 1 out of 800 to 1,600 deliveries.

Symptoms: Abdominal pain, back pain, frequent uterine contractions, uterine contractions with no relaxation in between, vaginal bleeding

Who is at risk? Women who smoke, use cocaine, drink more than 14 alcoholic drinks per week during pregnancy, have high blood pressure during pregnancy, have blood clotting disorders (thrombophilias), have a history of placental abruption, have increased uterine distention, have a large number of past deliveries, are of older reproductive age, have uterine fibroids, or endure premature rupture of membranes (bag of water breaks before 37 weeks).

Effects of condition: The mother does not usually die from this condition, but any of the following increases the risk of death for both mother and baby: closed cervix, delayed diagnosis and treatment of placental abruption, excessive blood loss - leading to shock, hidden (concealed) uterine bleeding in pregnancy, no labor. Fetal distress occurs early in the condition in about half of all cases. Infants who live have a 40-50% chance of complications, which range from mild to severe.

Ectopic (outside the uterus) Pregnancy - 2%

Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. With an ectopic pregnancy, the fertilized egg implants somewhere outside the uterus. An ectopic pregnancy typically occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. In some cases; however, an ectopic pregnancy occurs in the abdominal cavity, ovary, or neck of the uterus (cervix). An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue might destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the change for future healthy pregnancies.

Incidence: Up to an estimated 20 in every 1,000 pregnancies are ectopic.

Symptoms: Abdominal/pelvic pain and light vaginal bleeding are often the first warning signs of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. Heavy vaginal bleeding is unlikely, unless the ectopic pregnancy occurs in the cervix. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting, and shock.

Who is at risk? Women who have endured previous ectopic pregnancies, experience inflammation or infection of the fallopian tubes/uterus/ovaries (often caused by gonorrhea or chlamydia), experience fertility issues, have unusual structural concerns (unusually shaped fallopian tubes), are using IUDs, or become pregnant after tubal ligation. Although pregnancy is rare following tubal ligation, it's more likely to be ectopic if pregnancy does result.

Effects of the condition: A fertilized egg cannot develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue must be removed. The cell growth is terminated either through an injection of the drug methotrexate or through laproscopic surgery.

Miscarriage - 10-20%

Miscarriage is the spontaneous loss of a pregnancy before the 20th week. Most miscarriages occur because the fetus isn't developing normally.

Incidence: About 10-20% of known pregnancies end in miscarriage. But the actual number is probably much higher because many miscarriages occur so early in pregnancy that a woman doesn't even know she's pregnant.

Symptoms: Most miscarriages occur before the 12th week of pregnancy. Signs include: vaginal spotting/bleeding, pain/cramping, fluid/tissue passing from the vagina

Who's at risk? Women who are older than 35, have had previous miscarriages, have chronic conditions such as uncontrolled diabetes, have uterine/cervical problems, smoke, drink alcohol, use illicit drugs, are either underweight/overweight, or have had invasive prenatal testing.

Effects of condition/treatment: With ultrasound, it's now much easier to determine whether the embryo has died or was never formed. Either finding means that a miscarriage will definitely occur. In this situation, women may choose let the miscarriage progress naturally, pursue medical intervention with medicine to speed along the expulsion process, or opt for surgical treatment. This can be a very emotionally difficult time.

Gestational Diabetes - 2-10%

Gestational diabetes develops during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how cells use sugar (glucose) - the body's main fuel. Gestational diabetes causes high blood sugar that can affect the pregnancy and baby's health.

Incidence: Reported rates of gestional diabetes range from 2-10% of pregnancies. Immediately after pregnancy, 5-10 percent of women with gestational diabetes are found to have diabetes, typically Type 2. Women who have had gestational diabetes have a 35-60% chance of developing diabetes in the next 10-20 years. New diagnostic criteria for gestational diabetes will increase the proportion of women diagnosed with gestational diabetes. Using these new diagnostic criteria, an international, multicenter study of gestational diabetes found that 18% of pregnancies were affected by gestational diabetes.

Symptoms: For most women, gestational diabetes doesn't cause noticeable signs or symptoms. Rarely, gestational diabetes may cuase excessive thirst or increase urination.

Who's at risk? Women who are older than 25, women who have a family or personal health history of prediabetes, women whose BMI is greater than 30, and women of a nonwhite race

Effects of condition/treatment: Most women who have gestational diabetes deliver healthy babies. However, gestational diabetes that's not carefully managed can lead to uncontrolled blood sugar levels and cause problems for women and babies, including an increased likelihood of needing delivery by C-section. Treatment of the condition involves monitoring blood sugar, regular physical exercise, a healthy diet, medication, a breast-feeding regument, and closely monitoring the baby.

Rh Incompatibility

Rh incompatibility is a condition that develops when a pregnant woman has Rh-negative blood and the baby in her womb has Rh-positive blood.

Incidence: Rh incompatibility develops only when the mother is Rh-negative and the infant is Rh-positive. Thanks to the use of special immune globulins called RhoGHAM, this problem has become uncommon in places that provide access to good prenatal care.

Symptoms: Rh incompatibility can cause symptoms ranging from very mild to deadly. In its mildest form, Rh incompatibility causes the destruction of red blood cells without other effects.

Who is at risk? Rh incompatibility is almost completely preventable. Rh-negative mothers should be followed closely by their obstetricians during pregnancy.

Effects of condition: During pregnancy, red blood cells from the unborn baby can cross into the mother's bloodstream through the placenta. If the mother is Rh-negative, her immune system treats the Rh-positive fetal cells as if they were a foreign substance and makes antibodies against the fetal blood cells. These anti-Rh antibodies may cross back through the placenta into the developing baby and destroy the baby's circulating red blood cells. When red blood cells are broken down, they make bilirubin. This causes an infant to become yellow (jaundiced). The level of bilirubin in the infant's bloodstream may range from mild to dangerously high. After birth, the infant may have: yellowing of skin/eyes, low muscle tone (hypotonia), brain damage due to high levels of bilirubin, fluid buildup and swelling in the baby, problems with mental functioning, movement, hearing, speech, and seizures.  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002567/

Rupture of the uterus - 1-8%

Rupture of the uterus during pregnancy or labor is a serious emergency that can be fatal to both mother and fetus. Uterine rupture results in: bleeding, rupture of the amniotic sac, partial or full delivery of the fetus into the abdominal cavity, and loss of oxygen delivery to the fetus.

Incidence: Uterine rupture is a rare event, occurring in less than 1% of women with a low transverse cesarean section scar. For patients who have had a low vertical scar, the rate of occurrence is approximately 2-4%. Women who have had a previous classical cesarean incision (an incision that is up and down across the whole uterus) have a significantly higher risk of rupture during subsequent pregnancies, approximately 4-8%, and are therefore advised to deliver any future pregnancies by cesarean section.

Symptoms: Pain above and beyond normal labor pain, discontinuation of uterine contractions, signs of fetal heart rate abnormalities, hemorrhage, and shock

Who is at risk? While uterine rupture is uncommon, it is most likely to occur during labor in a patient who has had a certain type of previous cesarean section. The cesarean section scar in the uterus tears open. If severe, the fetus may pass into the mother's abdomen. Other causes of uterine rupture include: history of surgery to remove uterine fibroids or other uterine surgeries, or trauma to the abdomen.

Effects of condition/treatment: If the baby has not been delivered, then an emergency C-section is scheduled. If damage to the uterus is not too severe and the bleeding is easily controlled, a hysterectomy can be avoided. Doctors do their best to repair the uterus. This process generally calls for a blood transfusion for the mother, due to the amount of blood loss, plus antibiotics to prevent infection. Treatment involves removing the baby safely through the following methods: Performance of intrauterine, instrumentation (forceps), and fundal pressure. The mother's uterus must then be repaired.  http://healthline.com/health/pregnancy/complications-uterine-rupture

Hyperemesis Gravidarum (severe vomiting) - 20%

Hyperemesis gravidarum is extremely severe nausea and excessive vomiting during pregnancy. The thyroid gland may become slightly and temporarily overactive (called hyperthyroidism). Rarely, hyperemesis gravidarum continues after 16-18 weeks of pregnancy. If it does, it may severely damage the liver, causing jaundice and degeneration of liver tissue.

Incidence: The majority of pregnant women experience some type of morning sickness (70-80%). Recent studies show that at least 60,000 cases of extreme morning sickness called hyperemesis gravidarum (HG) are reported by those who were treated in a hospital but the numbers are expected to be much higher than this since many women are treated at home or by out patient care with their health care providers. Up to 20% of women require care for hyperemesis gravidarum if symptoms proceed after 14-20 weeks.

Symptoms: Severe nausea/vomiting, food aversions, weight loss of 5% or more of pre-pregnancy weight, decrease in urination, dehydration, headaches, confusion, fainting, jaundice, extreme fatigue, low blood pressure, rapid heart rate, loss of skin elasticity, secondary anxiety/depression

Who is at risk? It is believed that this severe nausea is caused by a rise in hormone levels; however, the absolute cause is still unknown.

Effects of condition/treatment: In some cases, hyperemesis gravidarum requires hospitalization and administration of IV fluids, tube feeding, and medications.

Hyperthyroidism during pregnancy - 2.5%

During pregnancy, the hormone HCG (human chorionic gonadotropin) is produced. HCG is the hormone that "pregnancy tests" detect. HCG increases to a peak at around 12 weeks. It has mild thyroid stimulating effects and, as a result, can cause some symptoms of hyperthyroidism. HCG is in part responsible for the nausea during the first trimester. In situations of multiple pregnancies (twins, triplets), HCG levels are even higher, and symptoms can be more pronounced.

Incidence: The prevalence of hyperthyroidism in pregnancy is about 0.2%. The most common causes is Graves' disease. Maternal, fetal, and neonatal morbidity and mortality may be reduced to a minimum with careful attention to the clinical symptoms and interpretation of thyroid tests. Thyroid disease is particularly common in women of child-bearing age. As a result, it is no surprise that thyroid disease may complicate the course of pregnancy. It is estimated that 2.5% of all pregnant women have some degree of hyperthyroidism. The frequency varies among different populations and different countries.

Symptoms: Patients with hyperthyroidism complain of feeling restless, emotionally hyper, and hot and sweaty. They may experience tremors, trouble concentrating, and weight loss. Frequent bowel movements and diarrhea are common.

Who is at risk? Of the babies born to women with Graves' disease, about 1% will have hyperthyroidism at birth.

Effects of condition/treatment: Women with hyperthyroidism may experience miscarriage, preterm labor, low birth-weight babies, stillborns, complications of pregnancy, including pre-eclampsia (a condition associated with hypertension, low blood platelet count, protein in the urine and mental changes) and heart failure. The treatment of hyperthyroidism in pregnancy is limited because the safety of the baby must also be considered. Usually drugs such as propylthiouracil (PTU) and methimazole (MMI) are administered. While both of these drugs do cross the placenta and can enter the baby's system, treatment is still preferred because of the poor outcomes associated with not treating these women. PTU is preferred because MMI has been associated with a rare scalp condition in the fetus knows as "aplasia cutis."

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Risks of childbirth/post-partum

Vaginal and perineal laceration - Majority

Obstetric vaginal and perineal lacerations are classified as first to fourth degree, depending on their depth.

Incidence: Family physicians who deliver babies must frequently repair perineal lacerations after episiotomy or spontaneous obstetric tears.

Symptoms: Tearing during pregancy as diagnosed by delivering obstetrician/midwife

Who is at risk? Women delivering their first baby, women delivering large babies, women delivering babies that are abnormally positioned, women requiring forceps or vacuum-assisted vaginal delivery.

Effects of condition/treatment: After surgical repair, women are advised to use sitz baths and an analgesic such as ibuprofen. If a woman has excessive pain in the days after a repair, she should be examined immediately because pain is a frequent sign of infection in the perineal area. After repair of a third- or fourth-degree laceration, several weeks of therapy with a stool softener, such a docusate sodium (Colace), should be used to minimize the potential for repair breakdown from straining during defecation. There is no reliable method for preventing vaginal tearing.

Puerperal infection - 1-8%

The term puerperal infection refers to a bacterial infection following childbirth. The infection may also be referred to as puerperal or postpartum fever. The genital tract, particularly the uterus, is the most commonly infected site. In some cases, infection can spread to other points in the body. Widespread infection, or sepsis, is a rare, but potentially fatal complication.

Incidence: Puerperal infection affects an estimated 1-8% of new mothers in the United States. Given modern medical treatment and antibiotics, it very rarely advances to the point of threatening a woman's life. An estimated 2-4% of new mothers who deliver vaginally suffer from a puerperal infection, but for cesarean sections, the figure is 5-10 times higher.

Symptoms: The primary symptom of puerperal infection is a fever at any point between birth and ten days post-partum. A temperature of 100.4° F on any two days during this period, or a fever of 101.6° F in the first 24 hours post-partum, is cause for suspicion. An assortment of bacterial species may cause puerperal infection. Many of these bacteria are normally found in the mother's genital tract, but other bacteria may be introduced from the woman's intestine and skin or from a healthcare provider.

Who is at risk? A woman's susceptibility to developing an infection is related to such factors as cesarean section, extended labor, obesity, anemia, and poor prenatal health.

Effects of condition/treatment: Antibiotics taken together are effective against a wide range of bacteria, but may not be capable of clearing up the infection alone, especially if an abscess or blood clot is present. Heparin is combined with antibiotic therapy in order to break apart blood clots. Heparin is used for 5-7 days, and may be followed by Warfarin for the following month. If the infection is complicated, it may be necessary to surgically drain the infected site. Infected episiotomies can be opened and allowed to drain, but abscesses and blood clots may require surgery.

Urinary incontinence

During pregnancy, many women experience at least some degree of urinary incontinence, which is the involuntary loss of urine. The incontinence may be mild and infrequent for some pregnant women. But it can be more severe for others. Age and body mass index are risk factors for pregnancy incontinence, according to one study. Incontinence can continue after pregnancy and may not be present right after childbirth. Some women do not have bladder problems until they reach their 40s.

Symptoms: After pregnancy, incontinence problems may continue, because childbirth weakens the pelvic floor muscles, which can cause an overactive bladder. Pregnancy and childbirth also may contribute to bladder control problems because of the following conditions: damage to the nerves that control the bladder, movement of the urethra and bladder during pregnancy, or episiotomy, a cut made in the pelvic floor muscle during delivery to allow the fetus to come out more easily.

Treatment: In certain cases, a woman may use a pessary, a device to block the urethra or to strengthen the pelvic muscles. In addition, medications also can be helpful in controlling muscle spasms in the bladder or in strengthening the muscles of the urethra. Some drugs can help to relax an overactive bladder. Kegel exercises are another method that can be used to help control urinary incontinence. These exercises help tighten and strengthen the muscles in the pelvic floor. Strengthening the pelvic floor muscles can improve the function of the urethra and rectal sphincter.

Fecal incontinence - 28%

Problems with anal incontinence following childbirth may linger long after childbirth and hurt women's quality of life and ability to care for their child. Symptoms include involuntary passing of gas and stool.

Incidence: In a study, researchers surveyed 1,247 women in Utah who experienced anal incontinence at least once in the two years following childbirth. The results showed that 68% reported anal incontinence symptoms six months after childbirth, and 45% had symptoms 12 months following childbirth. By two years after childbirth, 28% of women still reported bouts of anal incontinence. The results of the study suggest that about 80,000 women (2% of births) each year in the United States may have persistent long-term anal incontinence related to childbirth. But only 8,000 will report these symptoms to their health care providers.

Post-partum depression - 10-20%

Most women experience a case of the "baby blues" after the birth of their child. Changes in hormone levels, combined with the new responsibility of caring for a newborn, make many new mothers feel anxious, overwhelmed, or angry. For most, this moodiness and mild depression go away within several days or weeks.

Incidence: Longer lasting or more severe depression is classified as postpartum depression (PPD), a condition that affects 10-20% of women who have just given birth. PPD, which usually becomes apparent two weeks to three months after delivery, is characterized by intense feelings of anxiety or despair. Lack of sleep, shifts in hormone levels, and physical pain after childbirth can all contribute to PPD, making it difficult for some women to cope with their new role and overcome their sense of loneliness, fear, or even guilt.

Treatment: The first step in treating post-partum depression is enlisting the support fo family and close friends. Women should share their feelings with them, and get their help in caring for the infant. Women should be sure to discuss any PPD symptoms with their doctors, who can prescribe medication or recommend support groups. If the depression is combined with lack of interest in the baby, suicidal, or violent thoughts, hallucinations, or abnormal behavior, immediate medical attention is required. These symptoms could indicate a more serious condition called postpartum psychosis.

Uterine infections

Normally, the placenta separates from the uterine wall during delivery and is expelled from the vagina within twenty minutes after giving birth. If pieces of the placenta remain in the uterus (called retained placenta), it can lead to infection.

Symptoms/treatment: An infection of the amniotic sac (the bag of water surrounding the baby) during labor may lead to postpartum infection of the uterus. Flu-like symptoms accompanied by a high fever; rapid heart rate, abnormally high white blood-cell count; swollen, tender uterus; and foul-smelling discharge usually indicate uterine infection. When the tissues surrounding the uterus also are infected, pain and fever can be severe. Uterine infections usually can be treated with a course of intravenous antibiotics, which are used to prevent potentially dangerous complications such as toxic shock.

Post-partum hemorrhage - 18%

Postpartum hemorrhage usually happens because the uterus fails to properly contract after the placenta has been delivered, or because of tears in the uterus, cervix, or vagina.

Incidence: "Postpartum hemorrhage, defined as the loss of more than 500 mL of blood after delivery, occurs in up to 18 percent of births. Blood loss exceeding 1,000 mL is considered physiologically significant and can result in hemodynamic instability. Even with appropriate management, approximately 3% of vaginal deliveries will result in severe postpartum hemorrhage. It is the most common maternal morbidity in developed countries and a mjaor cause of death worldwide."

Symptoms: Excessive blood loss after labor

Who is at risk? Women who have endured long labors, multiple births, or an infected uterus

Effects of condition: "Complications of postpartum hemorrhage include orthostatic hypotension, anemia, and fatigue, which may make maternal care of the newborn more difficult. Postpartum anemia increases the risk of postpartum depression. Blood transfusion may be necessary and carries associated risks. In the most severe cases, hemorrhagic shock may lead to anterior pituitary ischemia with delay or failure of lactation (i.e. postpartum pituitary necrosis). Occult myocardial ischemia, dilutional coagulopathy, and death also may occur. Delayed postpartum hemmorhage, bleeding after 24 hours as a result of sloughing of the placental or retained placental fragments, also can occur."

Treatment: If bleeding is severe, the midwife or doctor may massage the uterus to help it contract, or a synthetic hormone called oxytocin may be administered to help stimulate contractions. Most likely, a pelvic exam will be performed to find the cause of the hemorrhage, and blood may be tested for infection and anemia. If the blood loss is excessive, a blood transfusion may be recommended.

Perineal (between the legs) pain

For women who delivered vaginally, pain in the perineum (the area between the rectum and vagina) is quite common. These tender tissues may have stretched or torn during delivery, causing them to feel swollen, bruised and sore. This discomfort may also be aggravated by an episiotomy, an incision sometimes made in the perineum during delivery to keep the vagina from ripping.

Treatment: As the body heals in the weeks following childbirth, the discomfort should lessen. Sitz baths, cold packs, or warm water applied to the  area with a squirt bottle or sponge can help avoid infection and reduce tenderness. It's also important for women to wipe from front to back after a bowel movement to avoid infecting the perineum with germs from the rectum.

Kidney infections

A kidney infection, which can occur if bacteria spreads from the bladder, includes symptoms such as changes in urinary frequency, a strong urge to urinate, high fever, a generally sick feeling, pain in the lower back/side, constipation, and painful urination

Treatment: Once a kidney infection is diagnosed, a course of antibiotics - either intravenous or oral - usually is prescribed. Patients are instructed to drink plenty of fluids, and are asked to give urine samples at the beginning and end of treatment to screen for any remaining bacteria.

Clogged Ducts

Clogged milk ducts, which can cause redness, pain, swelling, or a lump in the breast, can mimic mastitis. However, unlike breast infections, caked, clogged, or plugged ducts are not accompanied by flu-like symptoms.

Treatment: Breast massaging, frequent nursing until the breast is emptied, and warm packs applied to the sore area several times a day may solve the problem. However, if a woman has a lump that does not respond quickly to home treatment, she should consult her doctor.


Mastitis, or breast infection, usually is indicated by a tender, reddened area on the breast (the entire breast may also be involved).

Symptoms: Breast infections, which can be brought on by bacteria and lowered defenses resulting from stress, exhaustion, or cracked nipples - may be accompanied by fever, chills, fatigue, headache, and/or nausea and vomiting. Any of these symptoms should be reported to the doctor, who may recommend treatment with antibiotics.

Treatment: If a woman has a breast infection, she may continue to nurse from both breasts. Mastitis does not affect breast milk. It's also important to rest and drink plenty of fluids. Warm, wet towels applied to the affected area may help alleviate discomfort; and cold compresses applied after nursing can help reduce congestion in breasts. Avoiding constricting bras and clothing is also recommended.

Stretch marks

Stretch marks are the striations that appear on many women's breasts, thighs, hips, and abdomen during pregnancy.

Incidence: About half of women develop stretch marks during pregnancy, regardless of whether or not they have used any topical ointments.

Treatment: These reddish marks, which are caused by hormonal changes and stretching skin, may become more noticeable after delivery. Although they may never disappear completely, they will fade considerably over time. While many women purchase special creams, lotions and oils to help prevent and erase stretch marks, there is little evidence that they work.

Hemorrhoids/constipation - common

Hemorrhoids and constipation, which can be aggravated by the pressure of the enlarged uterus and fetus on the lower abdomen veins, are both quite common in pregnant and postpartum women.

Treatment: Over-the-counter ointments and sprays, accompanied by a diet rich in fiber and fluids, usually can help reduce constipation and the swelling of hemorrhoids. Warm sitz baths followed by a cold compress also can offer some relief. An inflatable, donut-shaped pillow, which can be purchased from any drugstore, can help ease discomfort caused by sitting.

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Risks of tubal ligation

METHODS of tubal ligation include: Female Laparoscopic Sterilization, Postpartum and Interval Minilaparotomy, Cesarean Delivery Tubal, Postabortion Tubal Ligation, and Transcervical Sterilization (Essure®). Methods and risks are described on the following page:

Bleeding - 0.6-1%

Although rare, 0.6 - 1% of women experience minor to major bleeding.

Infection - 1%

Due to the invasive nature of tubal ligation, about 1% of women experience infection.

Anesthesia-related events

About 1-2% of women undergoing tubal ligation experience anesthesia related events. The anesthesia risk, although low, can be reduced further through increased use of local and regional over general anesthesia.

Death - .002%

The most recent estimates on the risk of death from female sterilization suggests rates of 1 to 2 deaths per 100,000 procedures.

Ectopic (outside the uterus) pregnancy

In general, female sterilization is protective against ectopic pregnancy because few pregnancies occur in sterilized women. However, if pregnancy does occur, it is more likely to be an ectopic pregnancy following tubal ligation. The CREST study demonstrated that the 10-year probability of ectopic pregnancy for all tubal sterilization methods studied was 7.3 ectopic pregnancies per 1000 procedures, or one third of all post-tubal sterilization pregnancies. Risk differed by occlusion method employed and age of patient at time of procedure, with bipolar coagulation and age under 30 years associated with the higher risk.

Microinsert expulsion - 2.2%

Transcervical sterilization (Essure®) removes the risks of both invasive laparoscopic incisions and general anesthesia. Although no major complications are associated with transcervical sterilization, short-term complications have been reported. 5% of total patients experience unsuccessful bilateral placement. 2.2% of women experience microinsert expulsion.


Perforation of microinserts as a result of transcervical sterilization occurs in 1.5% of cases.

Pelvic cramping on the day of the procedure

29.6% of women experience cramping the day of transcervical sterilization.

Back pain in the first year of microinsert use

About 9% of women experience back pain in the year following transcervical sterilization.


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