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Pregnancy Bliss | Reproductive Health Hub

No obvious fetal pole on ultrasound

Question: Today, I am 6w 0 d after LMP, and 4w 0 d after ovulation date (measured by LH test). A pregnancy test done 2 days ago showed immediately that HCG was present. A trans-vaginal US scan today showed sac but no clear fetal pole, just a possible haze. The doctor could not confirm a viable pregnancy but did not rule it out either. We took blood to measure HCG and progesterone levels and will repeat the scan in a week. What are my chances that this pregnancy will develop normally? L. (Germany)

Answer: A difficult question to answer but I have to confess I am a touch concerned. At 6 weeks (and your dates appear to be spot on), I would really expect to see a clear fetal pole and even a clear fetal heart pulsation. This is especially with the use of a transvaginal probe, which is what you had. Unless there is some error in the dates, the inability to see these is a legitimate cause for concern and raise a real possibility of an anembryonic pregnancy. This is, however, far from conclusive and I fully concur with the suggested plan of having a repeat scan in a week. If you feel this may be too long to stay in limbo and that will be understandable, a repeat blood test for hCG measurements in a couple of days may shed more light on the viability of this pregnancy. The trend of change of the levels can be very illuminating if not conclusive. My best wishes.

Blood in the urine

Question: Why is there blood in my urine? Where could it have come from? And why hasn't three different antibiotics cleared it up? Over a month ago I’ve had this problem. I had vaginal swabs done which came back all clear. I done a urine sample which came back moderate mixed growth and blood in my urine, I'm really worried about this as I’ve been on 3 different antibiotics and they haven’t done much at all. Iv been on cefelaxin, an antibacterial and ciproflaxacin. Please help. J. (UK)

Answer: Urinary tract infection rarely cause presence of blood in the urine. It is therefore not surprising that antibiotics have not made any difference. Urine test results showing ‘mixed growth’ indicate sample contamination and almost always mean there is no infection. A couple of things remain unclear to me: Do you have any other symptoms apart from presence of blood in the urine and, another thing: Is the blood visible to the naked eye and can you see it yourself or is it only detectable under a microscope? These are important details to get a clear impression of what might be the cause. Because I don’t have those details I have to make a few guesses. If you are having discomfort on passing urine but blood is not visible, that could be due to ‘interstitial cystitis’, an inflammatory condition of the urinary bladder. If you get pain and there is visible blood especially at the end of the stream, it could be due to presence of tiny stones in the urinary tract (kidneys and bladder). It is difficult to be certain with so little details. If the symptoms are persisting, you may wish to see your GP and broach the subject of being referred for investigations for those conditions I have mentioned. Taking antibiotics in this case is most probably a waste of time.

Prolonged pregnancy

Question: what are the risk factors to prolong pregnancy? J.A. (Ghana)

Answer: We have a whole chapter dedicated to the subject of prolonged pregnancy. You can reach the answers to this and other questions about prolonged pregnancy by clicking here.

Could I be pregnant?

Question: Hey, i miscarried about a year ago and me and my fiance have been trying ever since, my period isn't late but i have been feeling faint, sick and dizzy my last period started on the 17th of april. Could i possibly be pregnant? S. (Australia)

Answer: The dates you are giving show that your period was less than 3 weeks ago. If you have conceived that would have taken place around mid-cycle which was less than a week ago. That’s far too early to start getting pregnancy symptoms. For the same reasons, I cannot say whether you might be pregnant or not. What I can say for certain is that the symptoms that you have described which you have been experiencing are not due to pregnancy.

Conceiving while taking Lamotrigine

Question: My husband and i want to start trying for a child this year and I'm on 200 mg lamortragine only daily. Looking at the website it says that there is no increase in risk to the baby with this medication. Is this true? and should i start taking folic acid supplements now? Many thanks. N.K. (UK)

Answer: There is no anti-epileptic medication that is completely safe in pregnancy and that includes Lamotrigine. However, Lamotrigine is recognised as one of the safest to take during pregnancy. In other words, even though it may cause fetal anomalies, in comparison to other medications used in epilepsy, the risk of malformations is relatively low.

The most notable anomaly associated with Lamotrigine use in pregnancy is cleft lip and palate. There is also a risk of neural tube defects such as spina bifida so, yes; you should definitely start taking Folic acid supplements at 5mg daily from the mLomatrigine in pregnancyoment you start trying and continue throughout.

Compared to other drugs used in epilepsy, Lamotrigine is considered relatively safe but  is by no means free of risk.