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Pregnancy Bliss | Reproductive Health Hub

Recurrent miscarriage

Question: Hello, i had 3 missed abortions due to absence of cardiac activity. There was no cardiac activity at 1st and 2nd pregnancy,but at third pregnancy there was cardiac activity till 8th week but at 9th week it was not due to which i had to go for D&c. i had undergone with various tests but every test was normal except Montex test and now i’m under medications. My 2nd missed abortion report shows the opinion that PRODUCTS OF CONCEPTION CONSISTING OF TROPHOBLASTIC AND DECIDUAL TISSUE. MILD DEGENERATIVE CHANGES PRESENT.Can u explain to me what that means? M. (India)

Answer: You have suffered three consecutive pregnancy losses, all in the form of missed miscarriage. This, as you will know, means the fetus dies in the womb, usually in the early trimester and a scan will show absence of fetal heart pulsations. Three consecutive missed miscarriages do very strongly suggest the possibility of the condition known as anti-phospholipid syndrome (APS) which is discussed here. Another possible cause is Thrombophilia syndrome (discussed here). I’m not sure as to which tests you have had to try to establish the cause of your recurrent miscarriages. However, it is almost certainly going to be useful for you to at least start taking low dose aspirin (75mg daily) as soon as you conceive next time. You should not start taking this before conception.

As for the ‘Montex test’ that you mentioned, this is not a test I’m familiar with. Is it possible that you mean the ‘Mantoux test’? This is a screening test for TB and, whatever the results of that, they are unlikely to be of any relevance as far as your pregnancy losses are concerned.

The histology report that you mentioned showing “products of conception consisting of trophoblastic and decidual tissue” is nothing to worry about. It simply means that when the tissue submitted to the lab was analysed it showed trophoblastic tissue which is placental tissue and decidual tissue which is tissue from the lining of the womb. Degenerative changes which were reported are normal after a miscarriage. Best wishes for the future.

Do a pregnancy test

Question:  Last month i experienced some spotting about a week or two before my period. that month i noticed my period felt a lot lighter and only lasted 3 days. i have been feeling quite sick, my partner and i have noticed my breasts seem much larger and they feel very heavy also very sore. could this be a sign i’m pregnant or am  just paranoid? S. (UK)

Answer: You know, it is not always possible to remotely assess whether the signs and symptoms described by a person are definitely pointing towards a pregnancy. As you can see, most of the sPregnancy testigns and symptoms you have described can point towards a pregnancy but are not specific to the condition. They can be experienced in other situations too. This may not be immediately helpful to you but if you are still experiencing those symptoms, the most reliable way of removing doubt, one way or the other, is to perform a urine pregnancy test. Modern tests are very sensitive and if the test turns out negative, you can be virtually certain that you are not pregnant.

Preventing Sickle Cell Trait

Question:  i am sickle cell trait and am pregnant. Is their anything i will do to prevent my baby from having it or is there any medication i should be taking. Thank u very much. R.F.

Answer: Sickle Cell is a genetic condition. Your status as sickle cell trait is determined by your genetic make-up and you cannot change that. The baby in your womb will have inherited either the defective gene or the normal gene. That is not something you can change by taking medication or any other action. Please read again the section on sickle cell disease and trait (here:) to familiarise yourself on the various permutations and prospects for the baby.

Recurrent bleeding in early pregnancy

Question:  I am 14 weeks pregnant. I am bleeding off and on from 11th week. I’m on strict bed rest. I had my last ultrasound yesterday, baby is absolutely fine. But i’m having severe lower back pain as well. Kindly let me know what are the reasons of bleeding  n backache. S. (Pakistan)

Answer: You are describing features consistent with a diagnosis of threatened miscarriage. In the majority of such cases, the underlying cause cannot be identified. It is also the case that the majority of these resolve spontaneously after a period of days, but sometimes the symptoms can persist for a few weeks.

Sadly, in up to 10% of cases of threatened miscarriage, the pregnancy is lost. I also need to add that there is no intervention, personal or medical that can influence the course of events. That includes the outdated advice of bed-rest that you appear to have been given. My best wishes.

Forceps or ventouse delivery for HIV positive mother

Question:  For pregnant woman who is hiv+, which instrumental delivery better, vacuum or forceps? W.B. (Ethiopia).

Answer: There is now a consensus that the best mode of delivery for a woman who is HIV positive is an elective caesarean section. This is the method that is associated with the least risk of vertical transmission of the infection (to the baby). That should ideally be combined with prophylactic antiviral medication taken during pregnancy and at the time of delivery. If, for whatever reason, that was not possible then the aim should be a vaginal delivery where trauma to the mother and baby is avoided as much as possible. It is believed that trauma to the mother’s birth canal is one of the leading factors in transmission of the infection to the baby as maternal blood carrying the virus will inevitably gain access to the baby’s mucous membranes (nose, eyes etc.). There is no scientific data comparing the risk of transmission associated with the use of forceps and ventouse (vacuum). However, in theory, the vacuum may be safer because an episiotomy is not necessary with the use of this instrument whilst with forceps the application of an episiotomy is inevitable. I have to reiterate, however, that every HIV positive mother ought to be offered a caesarean section as the best mode of delivery for her baby.