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Pregnancy Bliss | Reproductive Health Hub

Conservative management of ectopic pregnancy

Question: I have just done an ultrasound and transvaginal test and was told that i have an ectopic pregnancy. I have been bleeding for a week now, but not heavy with pains in my leg. Doctor said i will be monitored for 3 weeks until my hcg drops as it’s dropping gradually. My question is, will all the clot come out on its own as i am bringing out some clots. Was told that if my hcg rises, then i have to get treatment. Have u come across any situation like mine, as in the miscarriage going through by itself without needing to go through any treatment? And how long will the bleeding continue and get back to normal. G. (UK)

Answer: What you are describing is what is known as conservative  (or expectant) management of an ectopic pregnancy. It is certainly a correct form of management in selected cases of ectopic pregnancy. When there is evidence that the ectopic pregnancy is no longer viable, reinforced by absence of symptoms (abdominal pain) and falling blood levels of beta-hCG (the pregnancy hormone), a decision can be made to offer the patient this option of management. This helps avoid unnecessary surgery but inevitably entails a fairly prolonged follow-up lasting at least 2 weeks and serial blood tests to determine levels of beta-hCG. If the assumption that the ectopic pregnancy is no longer viable is correct, the vaginal bleeding should last around a week, give or take a few days. It should get lighter with each passing day. A non-viable ectopic pregnancy in the tube can still rupture making surgery inevitable but chances of this happening are small.

Darkening genital area skin during pregnancy

Question:   The skin around my armpits and vagina are a lot darker than before I was pregnant.Also my body hair seems to be thicker and my nipples are darker. Is this normal and will it go back to normal after I deliver?? C.L.

Darkening areola in pregnancy

Answer: Darkening of those areas of the body is very common during pregnancy but the degree varies from person to person. It is a hormonal effect. Those changes will gradually disappear after delivery but this process also takes months.

Gestational diabetes

Question:  I had gestational diabetes in my last pregnancy and i got to have a GTT to make sure i haven't still got it and i am worried that i may still have diabetes, any ideas? G.S. (UK)

Answer: True gestational diabetes always ends with the end of pregnancy. In some cases, the person may have latent diabetes which only gets unmasked during pregnancy and could be wrongly labelled as gestational diabetes. In such a case, the diabetes will not go away with the end of pregnancy even though the symptoms may not be apparent. If the woman is in her 30s or beyond and has risk factors such as being overweight and/or a family history of adult onset diabetes, it is worthwhile doing the glucose tolerance test (GTT) a few weeks or months after delivery to rule out this type of diabetes.

Low-lying placenta at 16 weeks

Question: I had vaginal bleeding at 16 weeks of pregnancy but ultrasound confirm that the placental is lying low. What effect can this one have on my pregnancy or can the placenta still come back to normal position? B. (Nigeria)

Answer: The vast majority of those pregnancies identified to have a low lying placenta at this early stage of pregnancy, the placenta will be in a normal location by the time they are in the final 8-10 weeks of pregnancy.

This finding is therefore of no significance for most women. For a small proportion of such women, the placenta will persist in a low position well into the third trimester. That will be known as placenta praevia a condition we have discussed in detail here:

HIV infection and episiotomy

Question: Is it true that episiotomy is not recomended due HIV\AIDS ? And also supporting of the perineum? E.A. (Italy)

Answer: Apart from the normal considerations, the essence of managing labour and delivery for a woman carrying the HIV infection is to minimise the potential risk of vertical transmission i.e. passing the infection from mother to baby. One of the measures that are taken is to avoid unnecessary exposure of maternal blood to the baby. If an episiotomy can be avoided, then that will be the strategy.

However, if necessary, the episiotomy will still be done because trying to avoid it at ‘any cost’ could lead to a perineal tear which will defeat the purpose and may, in fact, be worse for both  the mother and her baby.

I am not sure I understand what you mean by  ‘supporting the perineum’.

Fetal position and preterm labour

Question: I m in the 8th month of pregnancy and my baby is still not in the right position. Is that a risk for preterm labour? L. (Albania)

Answer: Not at all. Position of the baby in the womb at any stage of pregnancy has no bearing whatsoever on the timing or onset of labour.

Suboxone in pregnancy

Question: Can pregnant woman take suboxin?  J (USA)Suboxone in pregnancy

Answer: I think you mean Suboxone, a known heroin substitute. Well, there is no clear-cut answer to this question. This is because concrete and sufficient information on its safety for the baby is simply not available. Suboxone also known as Subutex has in fact been used as a heroin substitute for some women in various countries during pregnancy. However, methadone is still the preferred agent for this because there is a more solid body of information about its safety. Anybody considering this should get an individualised advice from her specialist. The generic name for Suboxone is Buprenorphine.

Area around the nipple, known as the areola, goes darker during pregnancy. The extent of this varies from person to person