Bacterial vaginosis and miscarriage

Question: Hi, I had swabs taken by doctors because of a watery discharge and this showed bacterial vaginosis. The doctors want to treat this. Is that necessary as I did not want to use any drugs during pregnancy. I’m 17 weeks. K.P. (UK)

Answer: Bacterial vaginosis has been linked to cases of late miscarriage and occasionally preterm labour. The evidence is not strong but it is there. Antibiotics used to treat this are certainly safe to use in pregnancy and, on balance, I would urge you to go ahead and get it treated. Were you to lose this pregnancy after declining treatment, even if unrelated, you may find it difficult to forgive yourself. We have discussed this condition (bacterial vaginosis) here:

Augmentin use in pregnancy

Question: Do you think is ok to take augmentin at 11 weeks of pregnancy? R. (Nigeria)

Answer: Augmentin is a combination of a relatively common antibiotic Amoxicillin and Clavulanic acid. Its generic name is Co-amoxiclav. It is a broad spectrum antibiotic that is regarded to be safe. Latest advice is that you should exercise caution if using this in the third trimester. There are certainly no known concerns about its use at 11 weeks (first trimester) provided the user is not allergic to penicillin.

Contraceptive patch (Evra®) and smoking

Question: I have been told that I cannot continue using the pill as I am now 36 and I smoke about 10-12 a day. I have been offered the coil but I’m not keen on this. Can I use the patch? N. (UK)

Answer: The patch that is available in the UK comes under the brand name Evra®. This is based on the same estrogen hormone as the standard combined pill. It is a very effective and reliable contraceptive with a patch applied once a week. When you smoke, especially when in the age group above 35 years, the main concern with using the pill is the increased risk of blood clots (venous thrombosis). As a matter of fact, because of efficient absorption from the skin directly into the blood stream, with the Evra patch, the body is exposed to more estrogen than if you were on a standard combined pill such as Microgynon, Cilest etc. Your risk of thrombosis is therefore higher. If you have been advised against using the combined pill, you should stay away from the patch too. You can check our section on long acting reversible contraceptives (LARCS) to see what your options are.

Selective termination in twin pregnancy

Question: Can I choose to terminate one baby if I find I am carrying twins and I just want one baby? A. (UK)

Answer: Seeing as you are in the UK, you may find that it will be quite difficult, if not impossible, to persuade your doctors to perform a termination on the basis of the fact that you only want one child. This is even before considering practical barriers that might be in your way. There are issues like the type of twins i.e. are they sharing a placenta or not, are they sharing the amniotic sac; what gestation they are; are you going to wait and see if both are healthy or not (which means a scan at 18-20 weeks and a late decision). This is a complex question that only a proper sit-down and detailed discussion with your doctor will allow you to make a considered decision.

Braxton Hicks or early labour?

Question: I am 35 weeks pregnant and for the past 2-3 days i have been having mild, irregular 'tightenings' in my stomach which have been uncomfortable and slightly painful that are lasting around 30 seconds and happen 2-3 times an hour.

I also have an inkling my waters may have broken when my partner and I were having sex the day before my ‘contractions' started. And I have been drinking raspberry leaf tea.

How do i know if this is the latent phase of labour or if it is just braxton hicks contractions? As i do not want to turn up at the hospital if it is for nothing. J. (UK)

Answer: The latent phase of labour rarely, if ever, last that long. In any case, if there were contractions suggesting possible labour at 35 weeks gestation, that should be regarded as threatened preterm labour rather than routine impending labour. That always needs to be verified by doctors and my firm view is that it is better to turn up at the hospital with a false scare than hold back because you are not sure. This is particularly important if you are still preterm. All in all, I think the contractions you have been experienced are more likely to be Braxton-Hicks than the start of labour. I might be wrong of-course and if you feel there is more to this, get yourself to the local maternity unit for an assessment. As for waters breaking, I would tend to think that is unlikely. When waters break at such a late stage of pregnancy, the gush tends to be rather dramatic leaving the mother in little doubt as to what has happened. There will also be continuing trickling after the initial gush.

Bleeding in pregnancy, no baby seen on scan

Question: My wife has been bleeding and when she visited the hospital they could not see the baby via scan. However, the doctors went ahead to do an insertion thru her vagina which was painful for her cos her vagina is still tight. The hospital advised that that was the only way. Please, can’t there be an alternative of seeing the baby inside her? Please advise. E. (Nigeria)

Answer: I must admit to be rather concerned about what is going on with your wife. However, a crucial piece of information is missing. You didn’t say how far your wife is into this pregnancy. If she is in very early pregnancy, less than 7 weeks; this may be a miscarriage but there may even be a possibility of an ectopic pregnancy. I am assuming the instrument inserted in the vagina was a speculum. This may have been an attempt to see if there are signs of miscarriage such as an open cervix. The fact that the baby could not be seen on ultrasound scan is a real cause for concern but without that crucial piece of information (the gestation), I cannot give more specific advice.

If you are smoker, especially if above 35 years old and/or overweight, the Evra patch (below, right)would not suit you.