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Pregnancy Bliss | Reproductive Health Hub

Abdominal cramps and brownish discharge

Question:  My last period was 21st Feb. As at 26th March, my period had not come. A pregnancy test kit result showed POSITIVE. From the 26 March to date, i have had severe abdominal cramps with dark brown discharge. The doctor did a scan an said the womb is empty but i will be doing another scan it two weeks’ time. He has prescribed Primolut depot and recommends bed rest. This morning, there was a heavy dark brown mucus discharge when i passed urine. What can be happening to me? M.P. (Ghana)

Answer:  Difficult to say what is going on. By the 26th of March, you were less than 5 weeks and therefore, even with a normal pregnancy, you would not expect a scan to show anything. The abdominal cramps and the brownish vaginal discharge are a legitimate cause for concern. It could be a sign of a non-viable pregnancy and an evolving miscarriage.There is also an outside chance this could be an ectopic pregnancy. However, that’s far from clear and everything may turn out OK. If facilities allow, the best thing at this stage would be to perform a blood test to check for levels of the pregnancy hormone (beta-hCG) and get that repeated 48 hours later. In a viable normal pregnancy, you would expect those levels to double. If facilities for such a test aren’t available, your doctor’s plan to repeat the scan in 2 weeks time is the next best option. That’s, as long as things remain quiet and stable. If this is an evolving miscarriage, events will move forward well before then. Can I also add that, whilst Primolut depot (a progesterone hormone) will do no harm, it is certainly of no benefit whatsoever in a naturally conceived pregnancy with threatened miscarriage. That used to be common practise in the past but is no longer done because there is no basis for it. So is the advice to have bed rest. It is important that your doctor practises evidence-based medicine. There is more information here: I hope it all works out well for you.

Weight gain in pregnancy

Question:  I am 30 weeks Pregnant, I was 50kg till 4th am in 8th month now my weight is 63kg. Why such rapid increase in weight? During 6th month in scanning baby was normal and the weight of the baby was 650g. My bp level is 100/60 and my blood sugar level is 54 before taking food and 105 after eating but i have some traces of sugar in urine. Some say that increase in weight shows the sign of girl baby.Is it true? How can i control my weight. Should i follow any diet? S. (India)

Answer: You have raised a number of issues here. A weight gain of 13kg in 4 months is certainly excessive. The most likely explanations is that your diet has been quite high in calories and therefore your intake is much more than what you are expending. There is sometimes a mistaken belief during pregnancy that a pregnant woman should ‘eat for two’. As a result, the person is encouraged to eat bigger quantities than normal and the food may be rich in fat. That is a mistake and can lead to excessive weight gain. There is no specific diet to recommend other than to ensure a healthy and balanced diet.  

Your blood pressure is normal and your post-prandial (after food) blood sugar is comfortably within the normal range. Blood sugar level should stay below 7.8mmol/litre (140mg/dl) after food. Yours, at 105mg/dl, is well within normal range and therefore there is no suspicion of gestational diabetes at all. As such, presence of traces of sugar in urine are not a cause for concern as this is not uncommon in pregnancy.  

You have also asked whether the weight gain could be a sign that you are carrying a girl. There is absolutely no connection between weight changes in pregnancy and the sex of the baby. Of course you still have a 50% chance of having a baby girl. Best wishes.

Post-caesarean complications

Question: My daughter had a postpartum abscess 24hrs after an emergency section. Her waters broke 4 days earlier but was leaking rather than a full break so was booked in for delivery on the fourth day but was delayed as delivery suite was busy and was sent to the delivery suite the following day. Things went wrong and a section was done. Everything seemed fine but about 48 hrs later was given a blood transfusion, This did not help and her health deteriorated suddenly and was sent for an urgent scan which showed a huge mass in the womb/pelvic area. She underwent an emergency operation and they found a huge abscess, the size of a melon. She lost her womb and cervix, but barely survived. She later had two other abscesses in her back. we need some feedback as to what was the possible causes, that is all as we are not getting any answers from the hospital. She is still suffering abdominal aches. She was in hospital for 5 weeks and her baby is now 12 weeks. I want to know if I'm worrying too much. Her baby needs her as does her partner. L.C. (UK)

Answer: This was, undoubtedly, a major complication following the caesarean section. From the details given here, it appears to me that there was concealed bleeding following the caesarean section. This would have led to the discovered anaemia, probably with falling blood pressure, leading to all those tests. The scan would have shown the accumulated blood in the pelvic cavity that prompted the emergency surgery. This is where it is rather difficult for me to know what transpired during the operation to lead to a decision to perform an emergency hysterectomy. It is possible they found that the haematoma (the accumulated blood) was massive with evidence of infection already. That may be the reason why this was described as ‘an abscess’. That being the case, they may have found that the uterus too was involved in the infection and it was deemed unrealistic or even risky to try to conserve the uterus.

Alternatively, they may have evacuated the infected haematoma and discovered that there was ongoing bleeding from the uterus which they could not control effectively, a situation which can ultimately be solved by actually removing the uterus because, at that stage, it is immediately life-threatening. I’m sorry if this appears non-specific but, in the circumstances, I have had to make a few assumptions as I do not have the fine details of what transpired. As for the future, bearing in mind that your daughter had just undergone two emergency major operations and survived a massive infection, it should not come as a surprise that, 3 months on, she is not back up to her old self. This is, in addition to the fact that she has an infant to look after. After 12 weeks she is almost certainly on her way to full recovery. One thing I would advise is that she should arrange to have a bllod test to ensure normal ovarian function. Following a hysterectomy and especially an emergency one, there is a small risk of getting premature ovarian failure within a few months of the procedure. It is therefore prudent to get that checked a few months down the line. It is a simple hormone profile blood test and her GP should be able to do that. My best wishes.