Подпись: ReviewQuestionПодпись:Подпись:Подпись:In some cultures, sex during pregnancy is strongly recommended because it is believed that the father’s semen is necessary for proper development of the fetus (Dunham et al.,

1992) . In the United States, many women continue to have satisfying sexual relations during pregnancy. In an uncomplicated pregnancy, sexual intercourse during pregnancy is safe for most mothers and the developing child up until the last several weeks of preg­nancy. During a woman’s first pregnancy, sexual interest is often decreased because of physical changes, including nausea and fatigue. Fluctuations in men’s sexual interest during the pregnancy are very normal as well. Some men fear injury to the fetus during

sexual activity. Others report increases in sexual desire and find their pregnant partner particularly sexy and attractive.

Orgasm during pregnancy is also safe in an uncomplicated pregnancy, but occasionally it may cause painful uterine contractions. Cunnilingus can also be safely engaged in during pregnancy, although changes in vagi­nal aroma and discharge may make couples uncomfortable. As we dis­cussed in Chapter 10, air should never be blown into the vagina of a preg­nant woman because it could cause an air embolism, which could be fatal.

Sexual interest and satisfaction usually begins to subside as the woman and fetus grow during the third trimester (Gokyildiz & Beji, 2005). The increasing size of the abdomen puts pressure on many of the internal organs and also makes certain sexual positions difficult. During the first and part of the second trimester, the male-on-top po­sition is used most often during sexual intercourse. However, later in pregnancy, the side-by-side, rear-entry, and female-on-top positions are used more frequently because they take the weight and pressure off the uterus. The main reasons that the frequency of sexual activity de­clines are physical discomfort, fear of fetal injury, awkwardness, or physician recommendation.

Ok PROBLEMS IN THE PREGNANCY————————————————- 1

The majority of women go through their pregnancy without any problems. However, un­derstanding how complex the process of pregnancy is, it should not come as a surprise that occasionally something goes wrong. We will now discuss some of these problems.

Ectopic Pregnancy

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Подпись: Figure 12.4 In an ectopic pregnancy, the fertilized ovum implants outside the uterus. In most cases, it remains inside the Fallopian tube. Подпись: Ovary Подпись: Fallopian tube

Most zygotes travel through the Fallopian tubes and end up in the uterus. In an ectopic pregnancy, the zygote implants outside of the uterus (see Figure 12.4). Ninety-seven per­cent of ectopic pregnancies occur when the fertilized ovum implants in the Fallopian

tube. These are called tubal pregnancies. The remaining 3% occur in the abdomen, cervix, or ovaries. Approximately 2% (1 in 50) of all U. S. pregnancies are ectopic, and this number has been steadily increasing in the past 2 decades. This is primarily due to increases in the incidence of pelvic inflammatory disease caused by chlamydia infections (Tay et al., 2000).

Prior to the 19 th century, half of all women with an ectopic pregnancy died. But then doctors began surgical intervention and as a result, by the end of the 20th century only 5% of women with ectopic pregnancy died (Sepilian & Wood, 2004). Today the survival rate is increasing, even though the rates of ectopic pregnancy are increasing as well.

What contributes to the likelihood of an ectopic pregnancy? Research indicates that smokers may be at increased risk for ectopic pregnancies. Nicotine has been found to change the tubal contractions and muscular tone of the Fallopian tubes, which may lead to tubal inactivity, delayed ovum entry into the uterus, and changes in the tubes’ ability to transport the ovum (Handler et al., 1989). Sexually transmitted infections may also cause ectopic pregnancies (Ankum et al., 1996).

The effects of ectopic pregnancy can be quite serious. Because the Fallopian tubes, cervix, and abdomen are not designed to support a growing fetus, when a growing fetus implants in one of these places, it can cause a rupture, causing internal hemorrhaging and possibly death. Symptoms of ectopic pregnancy include abdominal pain (usually on the side of the body that has the tubal pregnancy), cramping, pelvic pain, vaginal bleed­ing, nausea, dizziness, and fainting (Tay et al., 2000). Future reproductive potential is also affected by ectopic pregnancy. A woman who has experienced an ectopic pregnancy is at higher risk for developing another ectopic in future pregnancies (Sepilian & Wood,

2004) . Today physicians can monitor pregnancies through ultrasound and HCG levels, and many ectopic pregnancies can be treated without surgery (Wiseman, 2003).