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Pregnancy Bliss | Reproductive Health Hub

Recurrent early miscarriages and significance of viral test results

Question: My wife recently had a 3rd failed pregnancy (miscarriage) in the first trimester (1st: miscarriage; 2nd: IUGR case). Doc this time had put her on Aspirin as part of the antenatal care meds. Scan stated cause of incomplete abortion to be “blighted ovum”. The specimen from the Uterus during D&C was sent to the lab, the report of which read: “Histology shows inflamed necrotic decidua” .
In an effort to determine the cause the Doc ordered blood test on 30/08/10 for viral infection. The lab report of 30/8/10 read:-
(Results supplied)
Doc has prescribed meds for Herpes (Herperax) to be taken by both of us for 3 Months and to be protective for 3 months. Now an infectious disease specialist says that these tests indicate there is presence of the Herpes and CMV virus and according to his interpretation of these results, my wife did not catch the viral infection during pregnancy which might have caused the miscarriage; the virus may have been picked up long before she even first conceived – perhaps in childhood. He further said that these results only tell us of the existence of the virus in the body and there is no way the virus can be eliminated from the system. The virus can become active and there are symptoms like rashes (as in shingles), soreness in lips, blisters in genital area, etc. According to this Infectious Disease Doc, the treatment that the Obs/Gyn has prescribed is of no use and it is only useful in the treatment of the symptoms of the infection – if the virus became active he would prescribe the medicine and that for about 5 days. This medicine will therefore not eliminate the virus, and even after 3 months of taking the medicines the lab result will still be similar. So, as far as the viral infections go we should not be taking the meds. The Obs/Gyn has asked us to visit him after 3 months when he will repeat the Herpes tests and then consider other tests like genetic testing. I would like to know 1) whether to follow the Obs/Gyn or the Infectious Disease specialist and 2) whether these tests are conclusive as to the cause of these failed pregnancies based. Many Thanks

Answer: I am afraid your  wife’s Obstetrician has misled you. From the results you have given here, the infectious diseases specialist is spot on with everything he/she has said. The results show that  your wife has come in contact with the herpes and CMV viruses at some point in the past and certainly not recently. These old infections cannot  possibly be the cause of the latest miscarriage. Recent viral infection is indicated by rising levels of the IgM antibodies. These were negative in your wife’s case. Another thing: These infections do not cause recurrent miscarriage.  I am puzzled as to why your doctor even considered giving you those anti-viral medications. They will serve no useful purpose. It is indeed the case that if she was to have a flare up of herpes lesions, medication can be prescribed to moderate the symptoms and try to shorten the episode. The medication is taken for a week or less but it is not necessary. The important point to take from here is that these are almost certainly not the cause of the pregnancy losses your wife has suffered and the medication prescribed will serve no useful purpose. Your choice of doctor is of course your prerogative.  Best wishes for the future.

Early pregnancy; concerned about previous heroin use

Question:  I just find out i am pregnant, maybe of couple of weeks. I have used heroin twice, i am really worried i may have harmed the fetus. Is there any risk? Please help. Many thanks. M.

Answer: Congratulations on your good news. If the issue is previous heroin use, you can relax. As long as you do not succumb to the temptation to use it again during the pregnancy, your baby should be fine. Specific concerns about maternal heroin use are related to fetal exposure to the drug, especially if repeatedly so. As long as you stay away from it as you seem determined to, your baby should suffer no ill-effect from your previous dalliance with the substance. Best wishes.

Establishing paternity

Question:  I had my first scan done on the **/**/2010 and my EDD is calculated to be the 14/03/2011. This date is not from the first day of my last period as my last period was the 03/06/2010. When would my likely conception date be? I had sex with man A on the 23rd June 2010 early hours of the morning and then took the morning after pill on the 24th but also had sex with my boyfriend, Man B on the 24th June also. What is my likely conception date? I did have a dark discharge the following month on the 7th July which lasted for 3days. Help me please???  E. (UK)

Answer: The simple answer is that, it will be impossible to establish when exactly you conceive until the baby is born. You had sex with two different men within a period of less than 48 hours. It is simply not possible to determine precisely the timing of conception within such a narrow window. The slight discrepancy between dates calculated from your last period (it makes your EDD 10/03/2011) and the scan is irrelevant as it falls comfortably within the margin of error and may in fact be misleading. Here is why:

Seeing as you had sex on the 21st and 22nd day of your cycle, the fact that you successfully conceived suggests that you do not have a 28 day cycle and I would hazard a guess that yours is more of a 35 days or so cycle. That makes the traditional way of calculating Expected Date of Delivery (EDD) misleading as that formula assumes a 28 day cycle with conception expected around Day 14.

The  emergency contraception (‘morning after pill’) clearly failed. Had it been effective, it would have prevented implantation regardless of whichever of the two encounters resulted in conception.

The bottom line is that there is absolutely no way you are going to establish the exact conception date and therefore paternity before this child is born. Unless he/she is a spitting image of his/her father, that means a DNA test.

Fibroids and pregnancy

Question:  Does fibroid close to the cavity affect the shape of the baby in the womb? E. (Nigeria)

Answer: If a fibroid is mainly within the cavity of the uterus it will distort the shape of the cavity. The degree of distortion depends on the size of the fibroid. The baby is not normally affected but the position towards term can be greatly influenced by the fibroid. Presence of a fibroid within the uterine cavity does therefore increase the possibility of an abnormal lie and consequently increasing possibility of a caesarean delivery.

Sickle Cell trait inheritance

Question:  Hi, I would like to know if  I have the trait for sickle cell and if my husband is Chinese. If we were to have a baby would the baby get sickle cell trait from me or him?  Thank you. L. (USA)

Answer: First of all I hope you know that your having sickle cell trait does not make it inevitable that a child you have will inherit the condition. Let me explain: Your status (sickle cell trait) means you carry one defective gene for manufacturing the pigment haemoglobin. If both were defective, you would have had the full condition sickle cell disease. Your partner, regardless of his ancestry, may not have the relevant gene abnormality. His being chinese is irrelevant. If he does not carry that gene defect, a child you have together will have only a 25% chance of inheriting the defective gene (from you). The child cannot inherit that from the father if he doesn’t have it. On the other hand, if he happens to carry a similar defective gene like you, that dramatically alters the possibilities for your child. It then means, there is a 25% chance the child will have normal hemoglobin, a 25% chance he/she will have full blown sickle cell disease and a 50% chance of sickle cell trait. I hope that is not too confusing. More details can be found here: