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This blog post is based on a Healthful Woman podcast episode titled Mailbag #10: With Dr. Helen Feltovich, in which Dr. Nathan Fox and Dr. Helen Feltovich, both Maternal Fetal Medicine Specialists, address questions regarding bilobed placenta, appropriate activity levels for someone with a history of PPROM, whether an MFM doctor is needed following IVF, and more.

Bilobed Placenta with Marginal Cord Insertion

This episode begins with a listener’s questions regarding being diagnosed with a bilobed placenta with a marginal cord insertion and whether or not there is anything to be worried about. She states that her OB is not concerned and that searching on Google for answers has been unhelpful.

Dr. Fox and Dr. Feltovich begin by explaining what a bilobed placenta and a marginal cord insertion are. “Bilobed just means that instead of your placenta being together in one half-moon shaped mound, you have two separate parts of it that are connected by membranes in the middle. And sometimes, the cord can come out of the membranes in the middle. That’s rare,” said Dr. Feltovich. “The marginal cord insert just means that the cord isn’t coming out pretty much smack in the middle or around that area.”

They agree that that these conditions are not something to become distressed over, as the listener’s obstetrician had originally stated.

The listener also asks a second part of the question regarding whether or not her past vanishing pregnancy had anything to do with the smaller attached lobe on her placenta. Dr. Fox and Dr. Feltovich first acknowledge that pregnancy loss is hard and that there are many emotions surrounding it. They both also agree that there is no pathophysiological path to having a bilobed placenta because of a vanishing pregnancy.

 McDonald Cerclage due to PPROM in a Prior Pregnancy

The second question comes from a listener who is currently 22 weeks pregnant with a history of indicated McDonald cerclage due to 22-week PPROM in her last pregnancy. She asks what type of activity and exercise is safe during her pregnancy.

Dr. Fox and Dr. Feltovich explain that newer evidence shows that activity and exercise during pregnancy are generally healthy. It is generally agreed upon that whatever activity level helps the mother to feel less anxious and healthy is OK to do, as long as it is safe.

Seeing an MFM Following IVF

The third question of this podcast is asked by a listener who went through IVF. She asks if she should see an MFM just because she became pregnant through IVF or if it is OK to see a general obstetrician if everything is going well in her pregnancy.

Because people who have undergone IVF have a small risk of having a birth defect, Dr. Feltovich and Dr. Fox recommend undergoing a full, detailed ultrasound with an MFM. However, beyond that, they agree that the answer is ultimately up to the mother-to-be. “How do you feel?” asked Dr. Feltovich. “And how much do you like the person?” Patients who feel comfortable with their MFM doctor can feel free to keep seeing them, while others may choose to switch to a regular obstetrician.

Miscarriage

For the fourth question of the podcast, a listener asks a question regarding miscarriage. She states that in a former podcast, it was noted that if a heartbeat is seen in an ultrasound, the risk of miscarriage reduces drastically. She then goes on to state that she went in for an ultrasound due to light bleeding at seven weeks, and the ultrasound and blood test confirmed that everything was normal. However, the next day, she miscarried. She wonders where the bleeding was coming from if there was a heartbeat.

The doctors responded that, unfortunately, pregnancy loss is fairly normal in that it occurs for many women. Dr. Fox stated, “It is true that the risk of miscarriage is much lower if we see a heartbeat on ultrasound, but it’s not zero.” He goes on to explain, “In the first trimester, the overwhelming majority of miscarriages are due to something that’s abnormal in the embryo from day one. You just don’t know it.” They also agree that, in many cases, the exact reason why a miscarriage occurs is unknown.

PP Cardiomyopathy

The last question of this episode comes from a 32-year-old listener with five healthy children. She stated that her pregnancies were uneventful, other than being diagnosed with gestational diabetes during her last pregnancy, which remained under control. She shared that about a week following her last delivery, she was diagnosed with PP cardiomyopathy. She wonders if it’s possible for her to be totally cured and if this will impact future pregnancies.

Dr. Fox and Dr. Feltovich agree that these answers rely heavily on the listener’s specific situation, including how long it takes her to recover, what her function is like, and what the risks will be with the next pregnancy if she chooses to have one. They share that the treatment for heart failure is more advanced now than in the past, so it is possible for people to recover and become pregnant again.

Learn More

Listen to the complete episode, Mailbag #10: With Dr. Helen Feltovich, on the Healthful Woman podcast to learn more about these topics. To schedule an imaging appointment, contact Carnegie Hill Imaging for Women in New York today through the online contact form.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!