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Pregnancy Bliss | Reproductive Health Hub

Two consecutive miscarriages

Question: I tested positive pregnancy last week, today, i have had pain on my lower stomach and bleeding with clots coming out. i think i have had a miscarriage. this was my third pregnancy, i miscarried my second one too. Can you please tell me what to do to avoid this problems? am healthy and physically fit. L.M.  (UK)

Answer: It does indeed sound as if you might have miscarried. A word of caution here: It is possible to have a substantial vaginal bleed and still have a viable pregnancy. You may therefore need to have confirmation of what may or may not have taken place. You said this is your third pregnancy. That implies you had a successful pregnancy the first time. The fact that you have had two consecutive miscarriages subsequently may be very distressing but it does not mean there is anything wrong with you. Even though sporadic one off miscarriages are more common, two consecutive miscarriages are not that uncommon. The fact that you had a problem free first pregnancy is significant as it means conditions that cause recurrent miscarriage are very unlikely. This refers to conditions such as antiphospholipid syndrome (discussed here). You have not given me other important details such as your age and weight. Older mothers (over 35) and those who are significantly overweight or obese are more prone to miscarriages, in some cases clustered. My best wishes for the future.

Cost of IVF

Question:  I would like to know the cost of IVF treatment. C.L. (UK)
Answer: I can only give you a rough guide as to the cost of IVF treatment. It varies greatly depending on individual circumstances and where the person lives and where the treatment is received. Seeing as you are in the UK, if you were ineligible for NHS IVF treatment you could pursue this privately in the country or opt to go abroad. Whilst the basic cost of treatment abroad (Spain, Italy, Cyprus etc) is generally cheaper than in the UK, overall costs may actually be significantly higher because other costs such as air tickets and accommodation come in. There is also the aspect that the course of treatment takes several days and you may need to have more than one treatment before you are successful. It is therefore ideal for most people to get the treatment where they live. Cost also varies depending on the exact type of assisted conception you require (as an individual or a couple). If, for instance, a donor egg is required, that will ramp up the cost. As I said earlier, as a rough guide, a straight forward single IVF round in the UK will cost about £4,000 to 5,000.

Coming into contact with rubella in early pregnancy

Question: I'm 5 weeks pregnant. My husband has just got rubella 3 weeks ago (confirmed by blood tests already, his IgM(+) IgG (+) ). I have been vaccinated already when I was a child and my blood test is IgM(-) IgG (+). So maybe I’m not effected by the rubella from my husband but I’m still worried that if there’s rubella virus on my husband’s sperm, and whether it effect to my baby or not. Please help me regarding this matter. Thank you so much. L.A.N. (Vietnam)

Answer: You have absolutely nothing to worry about. As you correctly pointed out, you have the evidence that

you are immune as shown by the results of your blood tests (Positive for IgG antibodies and negative for IgM). No; the rubella virus cannot be passed to your baby via your husband’s sperm and even if the baby was to be exposed to rubella (which can’t happen), the IgG antibodies protecting you are protecting your baby equally as they pass freely into the fetal circulation. There is no risk to your baby in the womb.

Mode of delivery after a caesarean section

Question: My wife is expecting her second baby at the end of June, 2011. She had caesarean at the time of first baby (First baby is now 4 years 2 months old). My wife do not have any health problems so far and i would like to know what are the possibilities to have normal delivery rather than caesarean. Most of the people to whom i contacted are saying that there are no chances to have normal delivery when the first baby was born by a caesarean. Can you please get back to me on above query. Thanks. V.R. (UK)

Answer: I’m rather surprised that you are getting that sort of opinion. If your wife is in the UK she should, in fact, have already discussed mode of delivery with her obstetrician at this stage since, from the information given, she is over 36 weeks gestation now. There is no truth whatsoever in saying a caesarean section in the first pregnancy means repeat caesarean sections in the future. Statistics in the Uk show that 40-65% of women who had caesarean sections in the past do successfully achieve a vaginal delivery subsequently. Most of these would have had a caesarean in their first pregnancy. What is important is the reason why the person had a caesarean in the first place. In many cases it would have been due to non-recurrent factors unique to that pregnancy. That could be breech presentation, an abnormal position of the baby or a low-lying placenta.

Such previous factors are unlikely to recur and do not preclude attempting a vaginal delivery subsequently. Most important however, is the expectant mother’s own preference.

Waters breaking at 24 weeks

Question: what is the prognosis if waters break at 24 weeks? N.H. (USA)

Answer: If membranes rupture at 24 weeks, the situation is challenging even if not hopeless. Most cases of membrane rupture are followed by delivery within days. Delivery at 24 weeks means there is a huge battle with breathing problems for the baby. Even though modern advances in looking after these babies have meant higher rates of survival, many of these extremely premature babies end up with significant handicap.

In some cases, against the odds, the pregnancy manages to continue for several more weeks after membrane rupture. Apart from administering steroids to enhance lung function, the woman will be put on antibiotics, typically Erythromycin to minimise risk of infection which can be lethal. Progesterone which is known to help prolong pregnancy in cases of threatened premature labour does not appear to confer the same benefit in cases of pre-term membrane rupture like this and is therefore not recommended.