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Pregnancy Bliss | Reproductive Health Hub

Conception after removing Implanon

Question:  I had my implant taken out on 11th June 2010 after having it in for 9 months. In these 9 months i only had 3 periods , but they were just very light spotting. I had unprotected sex on 8th, 9th 10th of june. On 15th i had spottin for a few hours just when i wiped. On 18th i had it for a couple hours for 2 days. I have headaches, feeling sick, also being sick and a difference in my breasts . I think the line going down from my b.button is getting dark, i get heartburn occasionally i use the bathroom more than usual and tonight i have a cramping feel. Could i be pregnant? K. (UK)

Answer: You do give many non-specific symptoms that can be associated with early pregnancy. However, the timeline of events you are giving makes me doubt whether those symptoms could be due to pregnancy. You said you had unprotected sex between the 8th and 10th of June. That is about five weeks ago. Crucially those days were before you had the contraceptive implant removed (you said it was removed on the 11th of June). That will, in fact, mean you still had effective contraception in place when you had sex and therefore it cannot be legitimately described as ‘unprotected’. If the quoted dates are correct, it is exceedingly unlikely that you could have conceived as a result of sex on those dates. Implanon is an extremely effective form of contraception and it takes a few weeks for ovulation to resume after you have it removed. The changes to your breasts could be due to normal ovulatory cycles resuming now. The darkening of the line below the belly button that some women see during pregnancy is always a relatively late feature and is not seen in early pregnancy. If you are convinced that you might be pregnant despite evidence to the contrary, the only way you are going to remove that doubt is to perform a pregnancy test. However, on balance of evidence supplied, I doubt you are.

Sex and bleeding in pregnancy

Question:   Is sex allowed after pregnancy bleeding stops? E.P  (Zambia)

Answer: Conventional sex needs to be approached with caution if there has been bleeding during pregnancy. If antepartum haemorrhage happens where an ultrasound scan has shown that the placenta (afterbirth) is low-lying, penetrative sexual intercourse should be avoided altogether. If the cause of bleeding is not obvious (as is often the case) and there is no concern about the baby’s well-being in the womb, normal sex can resume if and when several days have elapsed after the bleeding episode.

Discomfort following membrane sweep

Question:  I am 40 weeks and 5 days pregnant, and I’m overdue by a week. i had a membrane sweep yesterday but I’ve still not gone in2 labour. I am going in to be induced tomorrow the procedures is called i.o.l.  Is this going to bring on labour?  If yes how soon after?  I’m very uncomfortable, and in pain in my uterus and back. Thank you. K. (UK)

Answer: Unfortunately a membrane sweep does not work for everybody. It is estimated that only about 25% of women who undergo the procedure at term will go into labour within the following 24-48 hours. It might still happen for you. I am encouraged to hear there is a back-up plan in the form of a definitive induction of labour. The initials you quoted (i.o.l) actually stand for ‘induction of labour’. As for how long it is going to take for you to get into labour, that varies and depends on a number of factors. If your cervix is found to be favourable (soft and stretchy), your induction of labour may involve simply breaking your waters and starting an infusion of oxytocin which will stimulate the womb to contract. Labour should then establish within a couple of hours of starting the process. If, on the other hand, on examination your cervix is found to be unfavourable, it will need to be primed first before you can go into labour. This involves insertion of a gel or pessaries in the vagina. That process can last from a few hours to up to 24 hours. My best wishes.

Hirschsprung’s disease genetic association and recurrence

Question: My son was born with severe long segment Hirshsprungs disease which has resulted in him also having Short Bowel Syndrome. I am now 9 weeks pregnant and I need to know if there is a genetic association and if this baby could be affected? S.B. (UK)

Answer: The underlying problem in Hirschsprung’s disease is absence of nerve supply to a section of the large bowel. As a result this lacks ability to contract and distends continually as it fills up. The absence of the nerve supply to the bowel section is a result of specific genetic mutation. In the vast majority of individuals with this condition, this genetic mutation is sporadic and apparently spontaneous during the embryonic stage.

This is why recurrence affecting other siblings is rare. However, there are exceptional cases where  Hirschsprung’s disease has been seen to run in families. Why such families are predisposed to this particular mutation is not known. In strict terms, however, Hirschsprung’s disease is not an inherited condition and is not passed from parent to child.

Bleeding whilst on Clexane in pregnancy

Question:    Hi, I am 24 years of age and I am 7 weeks and 2 days pregnant. I have been put on clexane 40mg once daily cause in my last pregnancy i had a dvt. I have been bleeding for the last 18 days straight and i have had 4 ultrasounds and the baby is fine but they don’t know why or where the bleeding is coming from. I also have a rare heart condition and also have anti-E antibodies in my blood. Would the clexane injections be the reason for my bleeding? What do i do about it? R. (Australia)

Answer: It is, understandably, a very anxious time for you. However, Clexane is almost certainly not to blame for the bleeding. You are on a standard prophylactic dose (40mg) which never causes spontaneous bleeding. If you had confirmed DVT in your last pregnancy, it is crucial that you are maintained on Clexane or a similar preparation as your risk of recurrence of this potentially serious complication is high. Presence of anti-E antibodies is also not a factor in this and it is not related. Like your doctors, I cannot answer your question as to where the bleeding is coming from and why. This is almost always the case in cases of threatened miscarriage (which is what you have). There is a genuine silver lining in all this: You might remain in the dark as to why this is happening but you should also know that you have a 90% chance that this will spontaneously and fully resolve and the pregnancy carry on as normal.

Recurrent early miscarriage

Question:   i just had a 3rd miscarriage. Had the first miscarriage before the birth of my baby girl. After then I’ve suffered 2 more. The miscarriage occurred at 8 weeks,7 weeks and 7 weeks respectively. What do you think is the cause of these miscarriages and what tests do you advice i undergo? Your quick response will be very appreciated. Thank you so much. O. (Nigeria)

Answer: Pregnancy loss is always heart-breaking. Recurrent loss even more so. Your history is not a classic recurrent miscarriage one as you appear to have had a full term pregnancy and delivery among the episodes. However, I would be tempted to regard this as a possible case of thrombophilia or even anti-phospholipid syndrome. We have discussed these conditions and their association with recurrent miscarriage in detail here: Even if you do not have access to specific tests for these conditions, it is quite reasonable and justified to put you on low dose (75mg daily) Aspirin as well as an injection of low-molecular weight heparin such as Enoxaparin (Clexane) or Dalteparin (Fragmin). These treatments need to be started after a confirmed pregnancy at about 5 or 6 weeks gestation. Starting Aspirin before conception actually reduces your chances of a successful conception. The treatment is typically continued until late in the third trimester or throughout the pregnancy.