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Pregnancy Bliss | Reproductive Health Hub

Estimating extent of risk pre-conception

Question:  Comments/Question: Could you give me an indication of how high risk another pregnancy would be for me please? I’m 35, borderline high blood pressure, weigh 15 stone, had six previous pregnancies which ended in:

1-miscarriage of twins at 8 wks
2-miscarriage at 10 wks
3-healthy son no problems in pregnancy or birth
4-Miscarriage at 6 wks
5-Neonatal Death of 2nd son at 5hrs old 39wks gestation through congenital condition but did have pre-eclampsia from 32wks
6-Healthy son born at 37wks - However had gestational diabetes (diagnosed at 28 wks), pre-eclampsia from 24 wks, (remember BP being 160/118 even though on methyldopa which is meant to lower it) and had partial placental abruption when was 2cms dilated and baby's heart rate was 190 until they broke my waters and luckily it settled.

Would love another child but equally couldn't bear it if anything else went wrong. I know it's a bit like asking how long is a piece of string and I know I'm high risk but I'd like to know how high that risk would be. Also maybe I should mention that when Baby no3 was born he was 9lbs11oz but over the 48hrs we were in hospital he seemed to shrink before my very eyes and so got him weighed on day 4 and he was 6lb 6oz! - it was found that my milk was very poor quality and quantity possibly through the insulin and bp tabs so put him on the bottle and was fine - I just wondered if he could have had sugar withdrawal from the insulin - his arms used to fly up to his head and he would jerk every few mins - also he would wet a nappy through each half hour and sweat loads - I mentioned it to staff but they said it's normal! But surely not to lose over 3lbs in less than 96 hrs!. Be grateful for your comments. Thanks a lot - loving this website it's jampacked with info - so glad I stumbled across it! Thanks. M.W. (UK)

Answer: Thank you for your kind compliments. OK, let’s look at the detailed picture and the specific risk factors.

As you have clearly acknowledged in your details, pregnancy is bound to be correctly classified as high risk. With your age, weight, medical and obstetric history, you are virtually guaranteed to suffer from gestational diabetes and pre-eclampsia and the latter might be quite severe. There is also the concern about your history of placental abruption which puts you at higher than average risk of this complication again. There is also the matter of the age-related increased risk of chromosomal abnormalities. Were you to have the baby in the next year (at age 36), the risk for Down’s syndrome is roughly 1 in 300 which is three times higher than for a woman at 30. Now, whether you regard that to be an unacceptably high risk or not is an individual thing. You are the judge. In the end, you are not going to be advised on the level of risk in concrete numbers simply because that is not feasible. It is a multi-faceted picture and the hard task to judge whether the risk, clearly high, is worth taking, is ultimately yours. I hope you make the right call. My best wishes.

Found to have an omphalocele

Question:  The doctor at the hospital tells me that they have found an OMPHALOCELE. They want me to have an amniocentesis. I am scared of losing the baby... A-M.C (UK)

Answer:  An omphalocele is a malformation of the abdominal wall whereby some of the abdominal contents, mainly intestines, are found in a thin-walled pouch outside the abdomen. In a minority of these babies, the omphalocele is associated with a chromosomal disorder. This is particularly the case if other organ defects (such as that of the heart) are found on the scan. I think this is the reason why you have been advised to consider an amniocentesis. This is meant to give you a definitive diagnosis as to whether your baby is affected or not. You can get more information on this here:

Possible Thrombophilia and miscarriage

Question:  Hi, last year i suffered from a miscarriage in my 3rd month of gynae did several tests and found out that my miss was due to blood clotting and that the condition was thrombosis. i would like to know how soon do i have to start the injections when im pregnant?and is there no other way for me to treat this condition?this was my first pregnancy,and im really concerned about falling pregnant often do i have to do the injections and how often do i need to see my gynae coz i live in a small town in Botswana and there is no gynae. The gynae i see is 500km away. Are there any foods that can help my blood thinning instead of clotting? Are the injections safe during pregnancy? A.A. (Botswana)

Answer:  The details you have supplied suggests that your doctor thinks you have thrombophilia syndrome. This is a condition whereby you are prone to form clots especially within the very small blood vessels. This can be lethal for the fetus particularly in the early stages of pregnancy leading to a tendency to suffer from recurrent early miscarriage. I am really not sure how definite the diagnosis was in your case or whether this was merely an assumption on the part of your doctor. Were I to assume that the diagnosis of thrombophilia syndrome has been confirmed, you will definitely need to be at least on low dose Aspirin at 75mg taken daily from the moment you confirm your pregnancy. That will be around 5-6 weeks. This will need to be taken until very late in pregnancy, usually stopped at around 36 weeks gestation. Better still you should be on what are known as low-molecular weight heparin injections. There are a number of brands of these and all are equally effective. These include Fragmin (Dalteparin), Clexane (Enoxaparin), Innohep (Tinzaparin) etc. These are administered once a day from when pregnancy is confirmed and ideally, like Aspirin,  used until late in pregnancy. The first trimester (up to 14 weeks) is the most critical. These injections are fairly expensive and, unless the State provides or you have health insurance, the cost can be prohibitive. As I said earlier, it is important that the diagnosis is definite otherwise I would not advise using these. For Aspirin, the advice is much more relaxed and you can and maybe should use this in your next pregnancy regardless. Remember, Aspirin should not be used before you conceive; only after you confirm pregnancy. Also, don’t use the standard dose (300mg) tablets. Make sure you are using the low dose (75mg) preparation.  I’m afraid there is no known dietary preparation that is known to help in this condition as a substitute for the medication. My best wishes.