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Pregnancy Bliss | Reproductive Health Hub

Possible ruptured membranes at 20 weeks

Question:  If someone is pregnant 20 weeks, and water is coming from the vagina but very little. as I can read it is PPROM. What are the available alternatives to save the baby? Can surgery help to stitch to stop the leakage? What if the pregnancy is left while leaking continued what are the effects? M. (UK)

Answer: Rupture of membranes at such an early stage of pregnancy is a very serious complication. The prospects for the baby are usually bleak but not hopeless. However, in this particular case, the immediate issue is to confirm whether this is indeed a case of ruptured membranes. There are many cases of increased watery vaginal discharge which, on first glance, can be misconstrued as ruptured membranes. Since you are saying there is “very little” water coming out, there is a real possibility that this is not a case of ruptured membranes. Concerns that arise when membranes rupture, especially at such an early stage is that contractions will ensue and at around 20 weeks, the baby will almost certainly be lost. Were this not to happen, the next concern is that of infection which, in turn, lead to loss of the baby. Any woman with confirmed preterm membrane rupture is given antibiotics to try to prevent this and to increase the chances of the pregnancy continuing to, at least, a viable stage for the baby. Another quite formidable problem associated with lack of fluid in the womb at such an early stage is that there is poor development of the fetal lungs. This can make fetal survival outside the womb difficult even if, somehow, the pregnancy was to continue to an advanced gestation. Surgery has no role to play in this pregnancy complication.

Erratic menses

Question:  Hello....i missed my periods 2 times and my pregnancy test showed negative-both blood test and urine test. I would like 2 know what’s the actual reason for this. I never missed my periods before like this and i have been treated before marriage for periods coming too earlier and 2 times a month but now i don’t have any problem and my hormonal test shows perfect and balance. S. (Bahrain)

Answer: Menstrual irregularities are actually a fairly common problem among women. It is, in most cases, a result of hormonal changes in the body. It is in fact misleading for a doctor to declare the hormone profile as ‘balanced’. There is really no such thing since the levels of the various relevant hormones fluctuate a lot through the month. It is therefore not possible to use a spot-check to declare the hormone profile ‘balanced’. Even people with conditions such as polycystic ovaries (discussed here) can be found to have hormones within the normal range even though they tend to have markedly erratic periods, sometimes going several months without seeing one.

Brownish vaginal discharge in early pregnancy

Question:  Hi, i am 8 weeks pregnant and i have just had a brown discharge with mucus. I had a miscarriage last year i was 17 weeks pregnant do you think it is happening again. Thank you. B. (UK)

Answer: I cannot of course say whether you are having another miscarriage as I do not know. However, you need to get this checked out straight away since that would be regarded as a threatened miscarriage. Your doctor should be able to arrange an emergency scan with your local hospital’s early pregnancy assessment unit and, hopefully, be able to reassure you.

Endometriotic cysts and future fertility

Question: HI! I'm 26 years old, single and lately i discovered that i also have ovarian endometriotic cysts. My question is it is possible for me to have a baby? How many percent? or if this happens (pregnant), will the cysts disappear? Thank you. K.R.

Answer: Sometimes endometriosis affects ovaries and that is how you end up with endometriotic cysts. Presence of endometriosis in the pelvis can have an effect on a woman’s ability to conceive and has even been implicated in cases of early miscarriage. This effect varies from person to person and is difficult to quantify. With severe endometriosis, fertility can be seriously affected. If you have been found to have ovarian endometriotic cysts, presumably by ultrasound scan, it may signify that you have significant endometriosis in general. It is therefore worthwhile to explore the possibility of having a keyhole procedure (laparoscopy) to confirm the diagnosis, assess severity and, if possible, use the same opportunity to surgically remove the cysts. This is the only effective way of dealing with endometriotic cysts. Let me stress that it is certainly still possible for you to get pregnant and have a baby despite the presence of endometriotic cysts. However, it may also be the case that your chances of conceiving are potentially reduced by their presence.

Gemifloxacin and breast feeding

Question:  Is it safe to take gemifloxacin tablets while breast feeding?  R (India)

Answer: Gemifloxacin belongs to a group of antibiotics known as ‘fluoroquinolones’. Like with pregnancy, the advice is to avoid using Gemifloxacin if breast feeding. There is credible scientific animal studies evidence that this antibiotic could do harm to the baby. An alternative antibiotic should therefore be sought.

Pain during sex

Question:  i was taking the pill on and off for 4 weeks; just come on and bleeding fast and i have had a bit of skin blood jelly. It looks like skin of a grape do not know what to do, i was in pain when have sex too inside of me and crying because it hurts. J.B. (UK)

Answer: Your details are not very clear so it is rather difficult to give a specific advice here. If you have suddenly started experiencing pain during sex that you never used to have in the past, it may be that you have pelvic inflammation. It is important that you get this looked at promptly because, if my guess here is right, pelvic inflammatory disease has a potential of affecting your fertility. It is therefore crucial that this is verified quickly and if necessary treatment given. Contact your GP or your local GUM clinic as a matter of priority.

Conflicting pregnancy test results

Question:  I usually have a long cycle of 34/5 days and it happened that i started bleeding as i should have at the end of the 35 days while having some signs of pregnancy. i carried out a home test with urine n tested negative while a blood test carried out the same day tested positive. am i pregnant? what do i do? E.J.

Answer: I am not sure what you mean when you say your blood pregnancy test was ‘positive’. The blood test results are not usually given in the format of ‘positive’ or ‘negative’. Instead, the levels of the pregnancy hormone (beta hCG) are quantified and it is the levels which are reported. When there is no pregnancy, the hormone is reported as ‘undetectable’. If you had this test done and it showed beta hCG in your blood, it may mean you have probably had a very early miscarriage. In any case, when the status or location of an early pregnancy is unclear, you should be offered serial tests, typically every 2 days to track the trend and confirm resolution. In a miscarriage, levels should continue to fall with each test.