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Pregnancy Bliss | Reproductive Health Hub

Pregnancy, malignancy and thrombosis

Question:  A young lady with 20wk of gestation was expired in sudden.In post-mortem findings, pulmonary embolism was found to be the cause of death. Also, tumor growth was seen in her descending colon. Association between pregnancy, pulmonary embolism and malignancy. J. (Myanmar)

Answer: This is a very tragic case but the train of events and postmortem examination findings do make sense. Bowel cancer is uncommon in the younger age groups but it has been known to occur, sometimes as a secondary from other organs such as ovaries. What is clear is that this young woman had two simultaneous conditions which are significantly thrombogenic. Most forms of malignancy, including bowel cancer are associated with increased platelet counts as well as levels of clotting factors making these conditions thrombosis risks. Pregnancy is of-course associated with increased risk of deep vein thrombosis (DVT). The risk from both would add up. Tragically, this lady’s malignancy was not known before her fatal collapse with pulmonary embolism (PE). Looking back with what is now known, it is clear she was at very high risk of DVT and consequent PE which is what  killed her.

Anti-malarials in pregnancy

Question: I will like to know the different antimalarials used in different trimesters of pregnancy and the combination therapies. B. (Nigeria)

Answer: We have addressed this question in the section on ‘Medicines Use in Pregnancy’ and the specific area of drugs used for prevention and treatment of malaria is covered here:

Late period; negative pregnancy test

Question:  Hi, my period is now 2 weeks late, i am 34 yrs old and have never before missed a period except on the 2 occasions i was pregnant with my 2 sons. I only had sex with my husband once approximately 2/3 days before my period was due so its unlikely i would have got pregnant that late in my cycle and i have also took 2 home pregnancy tests which were negative, 1 of these was and first response early test. For the last week I have been having period type cramps but still no period and now my breasts are sore. What else could cause my period to be so late?  Do I go to my GP or wait a few weeks more to see if my periods return? I have an under-active thyroid but apart from that I’m healthy. Thanks. E. (UK)

Answer: I think it is safe to assume that you are not pregnant. You have quite logically argued against this possibility in your question details and I agree with every point there. As to why your period is uncharacteristically late, there are a number of possible explanations. You mention that you have an underactive thyroid. Presumably you are on thyroxine replacement and you are having regular checks to ensure the dose is adequate. A poorly managed hypothyroid state is a relatively common cause of erratic or even complete absence of periods. In that situation you will normally have other symptoms such as weight gain, lethargy etc. Another explanation could be a change in your ovulation pattern. It is common for women once they get past their mid-30s, but sometimes before, for ovulation to become less and less regular. With this, the pattern of periods also changes with the clockwork regularity disappearing to be replaced by unpredictable and usually heavier periods. I would not bother the GP at this stage unless there are other symptoms as suggested above. Also, if the next period does not arrive (due in about 2 weeks?), then you should definitely seek medical advise.

Symptoms of an early miscarriage

Question:  What are the symptoms of a miscarriage when you are only 3 weeks into your pregnancy, and what should be done in case it happens? D. (Italy)

Answer: An early miscarriage behaves almost like a period, albeit heavier than normal. There may be pronounced abdominal cramps as well. The duration of bleeding does not tend to differ much from the woman’s norm and the heavy phase lasts no more than a day or two. If this is the pattern, the miscarriage will usually be complete at the end of the bleeding phase and nothing more needs to be done. A woman having abnormally heavy bleeding and/or severe abdominal pain may wish to seek medical help for assessment to see if there are retained products of conception requiring surgical evacuation. However, modern management of early miscarriage tend to lean heavily towards conservative or the expectant (hands off) strategy. The woman should expect to have her periods resuming within 4 to 6 weeks.

Withdrawal method and risk of pregnancy

Question:  I am 17 and I have sex every weekend. We use the pull out method but while I give him oral sex it taste like ***. Which I would think is pre ***. I'm not sure of when I would have conceived. But my symptoms are: I have been bloated everyday! Usually around night or when I eat. I feel sick when I stretch and i have an almost constant dull pain on my left lower side. I took two pregnancy test but they were negative. My period was two days late (is that bad?) And then I had a brown discharged mixed into it. I bled for around 3 days.(a light period but dark blood (only enough to fill one tampon per day.) Then It just stopped. No discharge or bleeding for a whole day.

Then the next day I had light to dark brown discharge for 3 or 4 days. Then a clear watery discharge. Then  a chunk white discharge. Now its a constant watery discharge., not very thick white. And I have at least one head ache a day. Is it possible that I'm getting false negatives? And I’m constantly dizzy. S.

Answer: Let me address the first issue first: The withdrawal method (or pull out as you call it) is a very poor contraceptive method. You do sound well informed so you would know that even before actual ejaculation, live spermatozoa are passed and find their way into the vagina, sometimes in their millions. You therefore don’t need an actual ejaculation into the vagina to conceive. You may not be pregnant now but you efforts to keep things this way do not amount to much.

On the specific issue of concern for you, that of whether you might have conceived, I think it is unlikely. Your period was “late”, that is by 2 days (which is not really late) but the main thing is that it did arrive. OK, it was apparently lighter than your norm but periods can be variable. What’s more, you have had two negative pregnancy tests. All this amounts to pretty solid evidence against the possibility of pregnancy. The discharge is most likely unrelated to the preceding events and if you are concerned about it, get your GP to examine you and take a swab. Other symptoms (headache, dizziness etc) are also most likely unrelated and probably enhanced by your obvious anxiety about the situation. I still think you are not pregnant but there may be other issues, probably minor, going on. If you are very concerned, I would advise that you contact your GP.