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Pregnancy Bliss | Reproductive Health Hub

Calculated expected date of delivery (EDD) does not match dates

Question: I recently found out i am pregnant, my EDD is the 14th March 2011. My last proper period of 5 days was the 21st May 2010 which it has been for the last several months, i had taken the morning after pill the end of May and came on my period for two days on the 3rd June 2010. My EDD is no where near two weeks to what they work it back to, will the EDD be correct? E. (UK)

Answer: The calculated EDD would put your last period at around 7th of June 2010. Working on the premise of a 28-30 day cycle, which you hinted at; it puts your conception date around 21st of June 2010, give or take a couple of days either way. Seeing as it is still relatively early in pregnancy, it is very unlikely there is a significant error in the measurements of the fetus and therefore the calculated EDD. It appears to me therefore that the period you had on the 3rd of June was in fact a ‘proper period’ and that is, in fact, your last true LMP. The morning-after pill you took end of May appears to be a red herring and has no relevance in this development. You conceived a good three weeks after.

Intact hymen

Question:  How to detect that hymen didn’t damage by physical force?? How does it look if the girl is still a virgin ??? L.

Answer: It is very difficult, if not impossible, for a non-medical individual to tell for certain that a hymen is still intact or not. The woman herself can have a pretty good idea whether her own hymen has broken if there has been penetration either with a penis or another object deliberately or accidentally inserted. Normally, if there is bleeding following the insertion, it will mean the hymen has been broken since it is the part with the least resistance at that part of the female genital tract. Visually, it is not so easy for the untrained eye to tell.

Safety of vaginal delivery after a previous caesarean section

Question:  I am about to have a baby after a 13 year break. I am quite undecided about whether I should have another caesarean section or go for a normal birth. Last time I had to have a caesarean because the baby went into distress. I want as much info as possible about the safety of vaginal delivery. Thanks. G. E. (UK)

Answer: Vaginal birth after a caesarean or VBAC as the practise is more popularly known is, overall, very safe and actively recommended wherever possible. Whenever there are no contra-indications, a woman will be advised to consider trying a vaginal birth. You should be reassured that the presence of the scar on your womb normally poses very little risk. There is also the reassurance that labour in such a case is actively managed, monitoring is continuous and when there is evidence that progress is unsatisfactory, appropriate intervention is made. There is, for one, no risk of a prolonged labour culminating in a caesarean section. The threshold for intervention is a lot lower in attempted VBAC. Successful vaginal delivery in properly managed VBAC hovers around 70%. The risk of uterine rupture is quoted at 0.05-0.07%, roughly 1 in 2000.

Oxytocin use in labour

Question: Current use of oxytocin in management of labour O.D. (Nigeria)

Answer: The role of oxytocin in labour has really not changed over time. You will be aware that the chemical oxytocin is produced naturally in the body and the uterine muscle (myometrium) contain oxytocin receptors. Once stimulated, the myometrial fibres contract. Oxytocin infusion is usually deployed in a case of dysfunctional labour. That can be diagnosed if the contractions are irregular and/or weak with consequent slow labour progress. It may mean naturally produced oxytocin is insufficient and and an external source is justified. Oxytocin may also be used after delivery to bring about sustained uterine contraction.

This is done to minimise the risk of postpartum haemorrhage (PPH). It is certainly the agent of choice for this in women with hypertension or pre-eclampsia where the use of the other agent (ergometrine) is contra-indicated.

Sickle Cell Disease and mode of delivery

Question:  I know a person with sickle cell disease and she's pregnant.Will she be able to deliver safely without any complications? Will the baby also have a fast growth rate after it comes? A.E. (Nigeria)

Answer: Of course it is not possible for me to predict whether this person will have a delivery free of complication. However, sickle cell disease on its own does not mean vaginal delivery is not possible.

It is, however, important to bear in mind that the stress of labour is a risk factor for a sickling crisis. It is therefore important for the midwives/doctors looking after  her to have the know-how of how to deal with this condition in labour. In a nutshell, it is important to ensure she remains well hydrated at all times, she gets adequate and effective pain relief (epidural is ideal) and that extreme exhaustion is not allowed to happen. This can be achieved by ensuring overly prolonged labour is avoided. As for the baby, how he/she thrives depends on  whether he/she has inherited any of this from the parents. If the father is also affected by sickle cell disease or sickle cell trait, there is a chance of the baby having sickle cell disease and that may have an impact. If the father is completely unaffected, the most the baby can have is sickle cell trait and as such should not be affected at all as far as growth is concerned.

Significance of mucous plug coming away before labour onset

Question: I am 38 weeks pregnant and the mucous plug came out two weeks ago.I have been having period like pains for the past two weeks and not progressing into labour.What is happening. L.L.

Answer: Even though in many cases the coming away of the cervical mucous plug heralds impending labour onset, this is not necessarily always the case. Seeing the mucous plug simply means cervical changes have started to happen leading to the loosening of the mucous plug and then coming away. For many women this will happen just before labour starts. In some cases, it can happen gradually over a number of weeks. This appears to be the case with you. Seeing as it happened around 36 weeks, it is not possible to accurately predict when labour proper will ensue.

It is not that easy to tell an intact hymen. It often requires a trained eye.