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Pregnancy Bliss | Reproductive Health Hub

Anti-K antibodies and timing of delivery

Question: i am currently 31 weeks pregnant and have anti k antibodies in my blood, titres have remained stable at 1:32. I am having 2 weekly scans on the middle cerebral artery which have been fine. My consultant wants to induce me at 38 weeks, and i am keen to avoid this as had a bad experience with 1st baby (ventouse, pph, transfusion). Do you think it would be strictly necessary to induce if baby is healthy? thanks for your attention. E.R. (UK)


Answer: It is very important that you discuss the suggested plan of management fully with your obstetrician. This should include the reasons behind each suggested management option. Also, it is important to be aware that, when it comes to anti-K (anti-Kell) antibodies, the titre levels of the antibodies correlate poorly with effect on the baby and general outcome. It is wrong therefore to be reassured by stable titres. Middle cerebral artery (MCA) scans are, in fact, more important because they give an objective analysis of what is happening to the baby’s blood. If there is any breakdown of the baby’s red blood cells and consequent anaemia, the severity of this will be directly reflected in the MCA blood flow pattern. As I said before, your obstetrician has a duty to tell you the reasons behind any suggested management. In all this, I am making an assumption that the baby’s father has had the blood test to establish whether he does carry the Kell antigen. This is arguably the most important test since the majority of people (over 90%) will be negative for this. That finding will mean there is no risk to the baby and there is therefore no need for any of the monitoring. Best wishes.


Unexplained shadow on a pelvic ultrasound scan

Question: I am 24 and the last 2 months i have had an irregular period (i was 3 weeks late one month then got my period the following month and then a week after it ended i got my period again). Before that it my period was always normal. I assumed it became abnormal due to stress since I just bought a house, got married, and started a new job!! Now i had a friend practice a pelvic ultrasound on me for work and she found a small darker circle with a bright border and edge shadowing below it in my uterus. I took a pregnancy test and it came back negative, what could this be? Could I be pregnant? H. (USA)
 

Answer: I think it is extremely unlikely that you are pregnant. You have had an irregular pattern to your periods but in the last phase you have not actually missed a period. If I understand you correctly, you have had two periods since that phase when your period was late. On top of that you have had a negative pregnancy test. The scan has shown unexplained findings but it is most unlikely these have anything to do with pregnancy. I am a little bit uneasy with your informal arrangement where you have had a scan by somebody who is unable to interpret the findings. I couldn’t possibly pretend to know what this is and a temptation to speculate has to be resisted because all it will do is add to your confusion. The only logical advice I can proffer is that you arrange to see a doctor to have the whole situation demystified.



Deficiency of B12 and folic acid; planning a pregnancy

Question: Hi;  I have recently been diagnosed with b12 anemia and folic acid deficiency i was just wondering if this will have any effect on the feotus if i was to conceive? thank you . L.S. (UK)


Answer: The first thing you need to be aware is that uncorrected Vitamin B12 deficiency reduces your chances of a successful conception. It means therefore adequate correction of the deficiency should be your main priority. If the deficiency is dietary  (as occurs sometimes with strict vegans), you need to make the appropriate dietary adjustments. If there is an underlying absorption problem as seen in the condition ‘Pernicious anaemia’, you will need to have B12 injections on a regular basis. Your  having Folic acid deficiency at the same time as B12 is a bit of a surprise as this is an unusual combination. It is really seen only in cases of chronic malnutrition, very rarely seen in the UK. In any case, this too will need to be corrected. If you conceive with folic acid deficiency, there is a dramatically increased risk of the baby having a nuural tube defect such as spina bifida. Vitamin B12 deficiency has also been associated with spina bifida but to a much lower extent. You may also be interested in the answer given to an earlier similar question which you can find here:


Bleeding in early pregnancy

Question: Hi. I did several pregnancy tests last week and they all came back positive. i began bleeding on friday (a bright red blood) and had stomach cramps, when can i next do a pregnancy test to find out if im still pregnant or if i miscarried? many thanks. H.P. (UK)

Answer: Even though the vaginal bleeding and abdominal cramps would seem to suggest a possible miscarriage, a repeat pregnancy test is unlikely to give you clarity on the situation for several days yet. That is, even if you have indeed had a miscarriage. There are several possible scenarios. You may have miscarried in which case bleeding should subside and stop in around 3-5 days. You may have had a twin pregnancy and just miscarried one of them. You may have had a ‘threatened miscarriage’ which resolved and the pregnancy continued normally. What’s more; even in the case of a miscarriage, the pregnancy hormone may persist in your system for several days after thereby giving you a persistently positive pregnancy test.

You can certainly repeat the test in the next couple of days. If it is negative you will have your answer. If positive, you will still be in the dark, in which case, only an ultrasound scan will give you clarity. Best wishes.




Bradycardia on a CTG

Question:  how can you tell by looking at a ctg that a fetus is having a bradycardia? N.F. (UK)


Answer: Bradycardia means a ‘slow heart rate’. In this case, it is that of the fetus, the normal rate of which should be between 110-150. If the baby’s heart rate as shown on the CTG trace is persistently below 110 beats per minute, that will be bradycardia as seen onBradycardia on a CTG the example below.