Does erosion of the cervix prevent conception. Conception with erosion and concomitant diseases. Planning for pregnancy after treatment
When diagnosing erosion, women are most concerned about the question of how the pathological condition affects reproductive functions. Gynecologists reassure in this regard: it is possible to become pregnant with cervical erosion, and this happens very often.
An unpleasant, but possible combination of conditions is acceptable, however, it is considered safe only in cases where there is no suspicion of oncology and the development of serious infectious diseases. The disease does not interfere with conception and does not deprive a woman of the ability to bear children, but, like any gynecological ailment, this pathology requires timely treatment.
The cervix is the connecting organ between the vagina and the uterus. If the epithelium of the uterine neck is damaged, erosion is formed. It is this term in gynecology that is commonly called any ulcerative defects of the mucosa. Violation of the integrity of the shell can be caused by a variety of reasons:
- abnormal development of the epithelium;
- early sexual life;
- viral, infectious and fungal diseases;
- hormonal imbalance;
- cervical injury;
- weak immunity.
Put women who already have children, nulliparous women, pregnant and infertile. The disease is very common and dangerous with an asymptomatic course. For a long time, the pathology does not manifest itself and does not cause discomfort. A bright red erosive spot is detected only during a gynecological examination. If a woman does not visit a doctor, she may not know about the disease. Painful symptoms and inflammation characterize the chronic stage. Advanced forms of the disease are treated longer and lead to complications during pregnancy.
Erosion influence
With erosion of the cervix, you can get pregnant. These two conditions are compatible and do not always pose a threat to the health of the expectant mother and child. Moreover, this pathology can eliminate itself. Often this happens during the first pregnancy, during gestation and immediately after the baby is born, but not all women have such a favorable outcome.
It is desirable to treat cervical erosion at the stage of pregnancy planning. With a progressive pathology that occurs in a chronic form, the risk of complications is very high. The fetus develops in the uterus, and the epithelial layer performs a protective function. It protects the cavity from the penetration of harmful microorganisms. When the integrity of the epithelium is broken, its protective abilities are lost. This causes infections and bacterial growth.
Inflammatory processes developing in the body of a pregnant woman negatively affect the health of the unborn baby and the mother herself.
Conception
The presence of erosion does not affect conception. Damaged mucosal tissues do not prevent the advancement of the spermatozoon and the fertilization of the egg, but for the sake of their own safety and the health of the unborn baby, doctors recommend treating the disease before pregnancy.
Surgical intervention with cervical erosion is rarely resorted to. Modern procedures are carried out using liquid nitrogen, radio waves, laser, cauterization. The latter method is considered a classic and is still used, but if a woman plans to give birth, it is better to refuse such a procedure. Cauterization before pregnancy is accompanied by deep tissue damage and provokes deformation of the cervix, which in the future can cause problems with childbearing and childbirth.
Pregnancy
Erosion of the cervix is not able to prevent pregnancy. If conception has taken place or is only planned, the woman should be constantly monitored by a gynecologist and undergo examinations. Small erosive lesions do not manifest themselves and are not dangerous. Another thing is when the cervix is complicated by the appearance of large lesions and atypical symptoms:
- pain during sex;
- ichor between menstruation;
- leucorrhea, pus;
- profuse mucous discharge.
Such symptoms indicate an advanced (chronic) stage of the disease, which can develop into a cancerous tumor.
To avoid the transformation of erosion into a malignant neoplasm, a woman should regularly take an analysis of epithelial secretions. The smear reveals atypical cells, which may indicate the onset of negative changes.
The need for treatment during childbearing arises only when inflammatory processes have begun and a tumor is suspected to develop. If the test results do not confirm pathological conditions, the treatment of a pregnant woman with erosion is transferred to the postpartum period. In order to avoid exacerbation of diseases, doctors prescribe preventive therapy.
childbirth
With cervical erosion, natural childbirth is allowed, but there are complications, most of which are associated with a violation of the integrity of the epithelium. Fragile, eroded areas of the mucosa are very easily damaged. During childbirth, ruptures often occur in these places. If serious violations of the elasticity of epithelial tissues are detected, the doctor may prescribe a caesarean section.
Another trouble that a woman may encounter is. Pathology arises and worsens after any operation. If the erosion was cauterized, the weakened body is not able to protect itself from Candida yeast. They freely penetrate the uterine cavity. Natural childbirth with thrush is dangerous, first of all, for the child. There is a risk of infection during passage through the birth canal.
Erosion often recurs, that is, it returns after treatment. If this condition recurs regularly, it is recommended to give birth between relapses.
Pregnancy planning
The presence of cervical erosion does not affect conception. In most cases, the disease does not harm the pregnancy and fetus. Minor lesions are not able to provoke a miscarriage, premature birth and lead to infertility. However, when planning a pregnancy, a woman needs to eliminate all risks and be as healthy as possible. Thanks to modern means and methods of erosion treatment, this is possible.
After an examination and a thorough examination with mandatory testing, the gynecologist determines the cause of erosion and the stage of the disease. After the diagnosis, the doctor proposes the best treatment method for a particular case. It could be:
- (treatment of the cervix with a special substance);
- radio wave therapy (non-contact therapeutic method of treatment that does not injure healthy tissues);
- cauterization (exposure to the affected area with electric current);
- cryodestruction (freezing using liquid nitrogen);
- (exposure to a laser beam).
After any procedure, it is recommended to delay conception. The body must recover. When planning a pregnancy after laser and radio wave therapy, you must wait a month. After cryodestruction, rehabilitation takes at least a year. Doctors make more precise prescriptions and recommendations.
Erosion of the cervix cannot interfere with pregnancy. When diagnosing a disease, you should not give up the desire to have a baby and constantly think about possible complications. Planning pregnancy and timely treatment of erosion with the participation of a good specialist will help to avoid unpleasant consequences.
Is it possible to get pregnant with erosion of the cervix - the question is not uncommon in the offices of gynecologists, since erosion overtakes women very often and is one of the most common gynecological diseases. It can appear both in nulliparous women and in those who already have children. What is a disease? Is it possible to get pregnant with cervical erosion? What danger can it carry for the expectant mother and child? Consider 6 important tips from gynecologists.
Understand the essence of the disease
Cervical erosion is any damage to the mucous membranes of the cervix. Outwardly, it looks like a wound or a red spot on the epithelium. Damage can be caused by:
- mechanical impact, including mucosal disorders during childbirth and abortion;
- chemical impact;
- developmental anomalies;
- hormonal disorders;
- decreased immunity;
- sexual infections and inflammation;
- promiscuous sex life.
As a rule, if the erosion is small, then it does not manifest itself in any way and is diagnosed by chance at a gynecologist's appointment. With erosion of a large size, a woman can observe:
- Pain during sexual intercourse.
- Small bloody discharge between periods or after intercourse.
- Other copious discharge (leucorrhea, mucus or pus).
Get rid of the factors that provoke erosion
Erosion itself for a healthy woman does not pose any danger. However, it is believed that erosion of large sizes can develop into a cancerous tumor. Therefore, it is highly desirable to treat it. As for the question of whether it is possible to become pregnant with cervical erosion, the doctors unequivocally answer that it is possible. Erosion has no effect on the process of conception, the advancement of the sperm to the egg and its fertilization.
But there is a reverse side of the coin. If erosion is a consequence of any diseases or disorders in the body, then these diseases will serve as an obstacle to conception. Those. the possibility of conception is not affected by the damage to the mucosa itself, but by infections or inflammations that led to erosion. For example, if it is an infection in the vagina, then it can rise to the uterus and appendages and not only complicate conception, but also lead to infertility.
Treat erosion before pregnancy
First of all, it is necessary to eliminate the cause that caused erosion. Only then can therapy begin to eliminate the wound itself. Treatment of erosion by cauterization is undesirable for nulliparous women, because after the procedure scars remain on the cervix, due to which it loses elasticity, which leads to ruptures. Nulliparous women can remove erosion by other modern gentle treatments that do not leave scars (freezing, laser removal).
In cases where erosion does not progress, and pregnancy is not planned in the near future, there is no need to remove it at all. If the cause of erosion is eliminated, there is no inflammation and infection, then erosion can even resolve itself. Operations are prescribed only for severe cervical dysplasia. In this case, the affected tissue must be removed.
But for women who want to get pregnant, it is highly recommended to treat erosion, especially with a large affected surface, because. a damaged cervix is an open gate for the penetration of bacteria and the settlement of harmful microorganisms, and thus a threat to the fetus. Those. wondering if it is possible to get pregnant with cervical erosion, if it is large, you should definitely ask about what effect it can have on the fetus. After cauterization, women planning a pregnancy are advised to wait 1 year to conceive.
Watch for erosion during pregnancy
Often, erosion occurs during pregnancy due to hormonal imbalance or a decrease in immunity. During pregnancy, it is not only not necessary to treat erosion, but it is also extremely dangerous. Erosion does not affect the course of pregnancy if it is not supported by an infection, and surgical intervention is generally prohibited.
However, due to erosion, the cervix becomes less elastic, and therefore prone to rupture during childbirth. If a woman becomes pregnant with untreated erosion, then it is necessary to find out its cause. In the case when an infection “walks” through the body, the result of which is erosion, there is the possibility of infection of the fetus with it. Pregnant women with erosion should be constantly observed by a gynecologist and undergo regular examinations.
As a result, to the question of whether it is possible to become pregnant with cervical erosion, the answer is yes. But is it possible to bear a healthy baby at the same time, no one gives an affirmative answer.
Treat erosion after childbirth
For treatment, doctors recommend waiting until the end of childbearing, and sometimes the completion of the breastfeeding process, since not all medications are allowed during breastfeeding. After that, you can destroy all factors that provoke damage to the cervical mucosa, and remove damaged tissues.
Sometimes erosion occurs during labor as a result of mechanical damage. This phenomenon is not dangerous and after childbirth may disappear on its own. Is it possible to get pregnant with cervical erosion a second time? By removing all concomitant diseases, if any, definitely - yes!
Thrush with erosion must be treated without fail
Many women do not know if it is possible to get pregnant with cervical erosion and thrush. Thrush can affect the possibility of conception. By itself, the fungus does not affect reproductive function. But with thrush, a special acid-base environment is formed in the vagina, in which the survival rate and permeability of spermatozoa is very low. Once in the vagina, spermatozoa die there. But since the level of sperm destruction is high, but not absolute, there is still the possibility of becoming pregnant. However, in order for the likelihood of conception to increase, thrush must be treated.
In addition, if an already pregnant woman has cervical erosion and thrush, this increases the likelihood of infection of the fetus and the threat of termination of pregnancy. There is also a risk of infection with thrush of the child during childbirth. Therefore, before pregnancy, you need to recover from thrush, and then from erosion.
The cyst must be treated without fail
Is it possible to get pregnant with cervical erosion and cyst? A cyst on the ovaries, like thrush, reduces the possibility of conception. She definitely needs to be treated. A cyst can provoke such a phenomenon in women as pathological amenorrhea, i.e. lack of ovulation and, as a result, the possibility of conception. But there are such types of these neoplasms that do not interfere with the process of ovulation. In this case, nothing interferes with conception.
A gynecologist will help determine what type of cyst has formed in a woman. The danger of a cyst on the ovary during pregnancy is determined by the fact that if the neoplasm progresses and increases, then this threatens with deformation of the cervix, miscarriage or premature birth.
If we are talking about a cyst on the cervix, then it does not affect the ability to become pregnant and bear a child. Such cysts can be provoked by erosion and, as a rule, do not progress.
Conclusion
When looking for information about whether it is possible to get pregnant with cervical erosion, reviews of women who have given birth will help to gain confidence in this. But if a woman plans a pregnancy in advance, then the right decision would be to get rid of all diseases before pregnancy, including erosion. After completing a full course of treatment for all diseases, the expectant mother will not be able to worry about the health of her baby and will gain confidence that the baby will develop and grow normally.
Among women of childbearing age, there are many myths about cervical erosion. Most believe that erosion should be treated only after the birth of children. Undoubtedly, many are interested in whether it is possible to get pregnant with erosion at all, will there be problems with bearing a baby due to this disease? Let's try together to find answers to all these questions and at the same time find out what is true and what is a lie, and is there a chance for women with erosion to become pregnant.
What is cervical erosion?
The cervix is the organ that connects a woman's vagina to the uterus. In the event that the epithelium that covers the neck is damaged, erosion forms. There are a lot of reasons that can provoke the appearance of erosion, among them are mechanical damage to the epithelium, and a violation of the hormonal background of a woman, and infections, and past inflammatory processes.
As a rule, erosion is detected during examination by a doctor, but there are certain symptoms that may indicate the presence of this disease. It is worth worrying if you are worried about spotting after sex, the amount of whiteness has increased, or pain in the lower abdomen is tormenting - this may indicate the presence of this disease.
Is it possible to get pregnant with cervical erosion?
Fortunately, women with erosion can become pregnant, since its presence does not affect the conception process. But during pregnancy, erosion can manifest itself and affect the process of bearing a baby.
Due to violation of the integrity of the epithelium of the cervix penetration of infections most likely to affect the health of the unborn child. It is also worth noting that places where there is erosion are subject to breaks during childbirth. That is why, before planning a pregnancy, it is better to undergo special treatment. Sometimes doctors recommend treating this disease after childbirth, if the erosion is small.
It is worth noting that in most cases, cervical erosion does not bring any harm to either the pregnant woman or the fetus. The presence of erosion cannot lead to infertility, premature birth or provoke a miscarriage.
Definitely, with erosion, you can get pregnant. Note that in some cases there is a need to treat erosion during pregnancy. During pregnancy, erosion is treated if an inflammatory process occurs or if oncology is suspected. In other cases, erosion is treated after childbirth.
Treatment methods for cervical erosion
If you are planning a pregnancy, and the doctor has identified erosion in you, then do not be upset. A few years ago, the uterus was carried out only by cauterization, after which scars formed on the necks. They negatively affected the process of stretching and opening the cervix during delivery, which is why, earlier, erosion was not treated before childbirth.
Currently, there are many alternative methods of erosion treatment that allow you to restore the integrity of the epithelium in more gentle ways. Therefore, if erosion is detected, it is best to undergo treatment before pregnancy.
So, we found out that with erosion you can get pregnant without any problems. The method and time of treatment of erosion (before or after childbirth) should be consulted with your gynecologist. Only a doctor is able to give correct recommendations regarding the treatment of this disease based on tests and a gynecological examination. Do not be too careless with this disease. It requires specialist supervision and proper timely treatment.
How is erosion treated (video)
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Gynecologists often diagnose young patients with cervical erosion. But what if a woman is planning a pregnancy? Will this pathology affect the conception and bearing of the baby? Does it interfere with normal fertilization? What method of treatment is better to choose so as not to harm yourself and not provoke possible infertility? Is it possible to get pregnant after cauterization of erosion? Modern medicine looks at these problems a little differently than one or two decades ago.
The cervix plays a key role in the process of conceiving a child. After all, this is a kind of gateway to the uterus.
It performs important functions:
- produces mucus, which affects the ability of sperm to move freely towards the fallopian tube, where the fertilization of the egg should occur;
- affects the process of gestation, preventing the premature onset of labor;
- prevents rapid labor activity.
Ectopia is a normal physiological condition that occurs in every third woman. Redness with ectopia goes away on its own and does not need treatment. Ectopia also has no effect on conception.
However, some doctors of the "old school" do not differentiate between erosion and ectopia, sending the patient for cauterization "without trial or investigation." Although true erosion is much less common than ectopia.
Remember: before making such a serious diagnosis, the doctor must do a colposcopy - an examination of the vaginal mucosa using a special device.
Colposcopy is done on a gynecological chair. If the diagnosis of "true erosion" is confirmed during colposcopy, sometimes a biopsy (examination of a piece of tissue under a microscope) is sometimes necessary to rule out a malignant process.
Why does it occur
Women planning a pregnancy are often interested in how an erosive formation on the cervix will affect conception.
True erosion of the cervix affects its condition and functionality, therefore, to some extent, reduces the likelihood of successful conception. This does not mean that having an erosive formation at the outer end of the cervical canal, a woman will not be able to become pregnant.
Cervical erosion is not an obstacle to pregnancy, but it is still better to plan the conception of a child after it has been eliminated. After all, it is important not only how cervical erosion affects conception. But also the reasons why it arose. After all, some of them in themselves are unsafe pathologies and can harm the unborn child.
So, the possible causes of pathology:
- hormonal changes in a woman's body, menstrual irregularities;
- regular and long-term use of oral contraceptives;
- infections that are sexually transmitted and are a risk factor for the development of inflammation;
- physical and mechanical injuries of the cervix;
- genetic predisposition;
- bad ecology;
- depletion of the body;
- non-observance of elementary rules of intimate hygiene.
With erosion of the cervix, it is possible to become pregnant, but it is better to be cured first. Most experts recommend that you first get rid of the disease, and only then plan to conceive a child.
infection and conception
By itself, erosion is not an obstacle to getting pregnant. What can not be said about an infection that likes to join it, provoking the development of an inflammatory process, a modification of the epithelial covering tissue, and a dysfunction of the cervix.
Is it possible to get pregnant with cervical erosion, which has become inflamed as a result of an infection?
As you know, an active infectious process changes the structure of epithelial cells, can interfere with the formation of normal mucus, which is necessary to protect the internal cavity of the uterus from the spread of microbial agents. This can lead to infection of the fetus. In addition, inflamed and thinned epithelium in the area of erosion can lead to premature birth. And also during childbirth, it can be damaged and torn.
The attending physician always warns his patients about the possible dangers posed by an erosive formation on the cervix and strongly recommends pregnancy planning only after erosion treatment.
Treatment
To get rid of the pathology of the cervix, a woman needs to undergo several studies and only after that the doctor will decide on the advisability of using one or another type of treatment.
The choice of therapeutic tactics is influenced by several factors at once: the cause of the development of the pathological process, the presence of infection, the features and main characteristics of erosion, and the like.
In modern medical practice, doctors use the following techniques to heal erosion in order to get pregnant later:
- local treatment with antibacterial agents. They allow you to get rid of the infection, and thereby reduce the manifestations of erosion and promote healing;
- cauterization with chemicals (a mixture of acids);
- defect destruction by laser. The laser beam acts on the affected tissues without subsequent scarring;
- cryodestruction of erosive formation with liquid nitrogen;
- diathermocoagulation is a method of cauterization by electric current. This method gives good results, but scarring may occur after it, and this is undesirable for those planning a pregnancy;
- excision of an erosive defect using radio waves, which bears the working name "radio knife";
- alternative treatment, the effectiveness of which has not been fully proven. Therefore, practitioners are wary of him, not believing that with the help of traditional medicine recipes, the disease can be eliminated.
Moxibustion and infertility
After successful treatment of cervical erosion, when we can talk about the complete recovery of the patient, we can safely proceed to pregnancy planning. Naturally, women who want to experience all the joys of motherhood have questions.
When can I get pregnant after cauterization of erosion? Is it possible to get pregnant at all after cervical erosion, if scars have formed due to intensive treatment? In the vast majority of cases, it is possible to get pregnant, although there are exceptions.
Does moxibustion affect the reproduction of women and can it lead to infertility? Usually, pregnancy after cauterization of cervical erosion does not differ from the usual process of bearing a child. After all, most modern methods do not leave scars.
If there are scars, then among such women the percentage of miscarriages is somewhat higher. After all, scars make the neck less elastic, and it performs its functions worse.
Very rarely, cauterization of the cervix causes the formation of multiple scars, which leads to a sharp narrowing of the cervical canal, and the woman becomes infertile. But do not despair: there are techniques that eliminate such scars.
When to plan pregnancy
How long can you get pregnant after cauterization, cryodestruction, diathermocoagulation and other procedures?
It all depends on the specific patient: on the processes of tissue regeneration, scar formation, immune reactivity, and the duration of the rehabilitation period.
How much time it takes to prepare for pregnancy depends on the woman herself, her desire to be cured, and the strict implementation of all the recommendations of a specialist.
An erosive defect on the cervix is a very aggressive pathological formation, which, without treatment, can cause a number of complications, including cancer. Therefore, women who are planning a pregnancy should regularly visit a gynecologist and, when diagnosing erosion, immediately begin its treatment.
Competently: gynecologist's comment
Obstetrician-gynecologist Elena Artemyeva answers questions from patients
- The doctor found erosion in me and sent me for cauterization. Is it necessary to do it?
Get tested for sexually transmitted infections first. I also advise you to undergo a colposcopy and a cytological examination of the cervix. These studies will help determine if your doctor has indeed made the correct diagnosis. Often, doctors interpret pseudo-erosion (ectopia) as true erosion. The latter is very rare and must be treated (for example, by cauterization). Ectopia does not need treatment.
I am 32 years old and have given birth twice. After the second birth, erosion formed (0.5 cm, Y-negative epithelium). Is it possible to get pregnant with cervical erosion? Should I burn it?
- It is necessary to pass an analysis for the human papillomavirus, it sometimes causes changes in the epithelium in the female organs. Often it is because of HPV that the Y-negative zone occurs. You also need to do a colposcopy and a smear for atypical cells. Treatment is based on results. It is possible that you have ectopia, but it does not require treatment at all.
- During pregnancy, they found a small erosion. I am planning to have a child again. When is it better to be treated - now or after the second birth? Will the treatment affect the ability to get pregnant?
- First, you need to be examined to find out if erosion remains. Often she heals herself after childbirth. Do a general smear, cytology, colposcopy. If necessary, get treated. Proper treatment will not affect subsequent conception.
Is it dangerous to get pregnant with erosion? Maybe you should give birth and only then be treated?
- By itself, this pathology does not affect the fetus. But if it arose due to an infection, then this can lead to intrauterine infection, and this is very dangerous. I advise you to take a sowing from the vagina, PCR for sexually transmitted diseases.
Every woman who is preparing to become a mother takes care of her health. Having any diseases, she is very worried about whether this will affect conception and future pregnancy. Unfortunately, in our country, every third woman of childbearing age is familiar with such a pathology as erosion. Why is erosion dangerous? How does it affect conception? Is it possible to get pregnant with cervical erosion? These and many other questions will be answered in our article.
Causes
Erosion is a superficial damage to the mucous layer of the cervix. In other words, erosion is a small wound in the vagina, and differs from a healthy mucous membrane in a more red tint. The most common causes of erosion are:
- Hormonal disbalance.
- Sexually transmitted infections.
- Injuries and injuries of the vagina.
- Early sexual life and frequent change of partners.
- Inflammatory processes in the body.
Symptoms of cervical erosion
Erosion usually does not bother a woman and does not manifest itself in any way, and she often finds out about her disease at a scheduled examination by a gynecologist.
Usually, cervical erosion is asymptomatic, in rare cases there may be spotting or pain during intercourse.
Most doctors agree that erosion cannot be an obstacle to conception and does not affect this process, if you do not start this pathology and do not let everything take its course. After all, one should not forget that erosion is still the very initial stage of precancerous diseases. But often women do not even know if it is possible to get pregnant with erosion and what it threatens.
To prevent unwanted serious consequences, many doctors recommend that women planning a child cure erosion before conception, despite the fact that it is possible to become pregnant and give birth to a healthy baby without problems. But there are cases when erosion can adversely affect the fetus.
Treatment of the disease
There are several ways to eliminate erosion, but the most effective is, of course, surgery. Unfortunately, drug treatment of cervical erosion is practically not amenable to. If treated with folk remedies, this can lead to completely undesirable consequences.
Previously, the method of cauterization of erosion was most often used. But progress does not stand still, treatment methods have improved, and at the moment radio wave and laser surgery are widely used. Also common is the method of cryodestruction - destruction by cold.
It is very desirable to cure erosion before childbirth, or after childbirth, but if inflammation occurs or there is a suspicion of the development of oncology, erosion will be treated even during pregnancy.
We found out that you can get pregnant with erosion. The question arises: how will erosion affect pregnancy, and can there be any complications during pregnancy. After all, there are 9 months of gestation ahead, and every expectant mother wants no problems throughout the entire time, since the correct development of the fetus and the health of the desired child come first.
Risks during pregnancy with erosion:
- Cervical erosion is a risk factor for miscarriage.
- Due to the violation of the integrity of the vagina, infections are likely to occur.
- Places on the cervix that are prone to erosion can lead to ruptures during childbirth.
The risks listed above are rare, but, alas, very dangerous. And at such an important stage of life as pregnancy, you should treat your health very responsibly.
Mandatory diagnostic measures during pregnancy:
- Periodic examinations by an obstetrician-gynecologist using mirrors.
- Human papillomavirus analysis.
- Taking vaginal swabs to examine the composition of the cervix under a microscope to look for cancer cells.
- Colposcopy, which examines the cervix using special equipment.
It became clear from the article that it is possible to become pregnant with erosion, but if there is an opportunity to be treated before the desired pregnancy, be sure to use this opportunity so as not to put yourself and your child at risk. Timely treatment will protect you from many unforeseen problems. Listen carefully to your doctor, follow his instructions, and be healthy.
