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Pregnancy Bliss | Reproductive Health Hub

Cervical incompetence support groups

Comment:  My boyfriend's brother and sister-in-law lost their baby at 4 months due to complications due to an incompetent cervix. She speaks French and Spanish only. Do you know of any support groups she could contact in French or Spanish? Many thanks. A.J. (UK)

Answer: I’m afraid we are not able to help in this regard. Your relative’s best option would be to contact any of the numerous medical establishments in either Spain or France and, I have no doubt, they will be able to point her in the right direction. Sorry that we couldn’t be of more assistance.

Vitamin B12 deficiency and trying to conceive

Question:  I was diagnosed with vitamin b12 deficiency in September I am just about finished my monthly injections and then start my 3 monthly ones for life. Me and my husband want to try for another baby. Should I wait a while or is there any other things I require to take apart from the norm i.e. folic acid? Thanks. J. (UK)

Answer: Since the B12 deficiency appears to have been corrected and the maintenance regime is already in place to ensure levels remain normal, there is no reason why you cannot go ahead with your quest for a baby. My best wishes.

Issues with labour and delivery

Question:  Hi, You have recently answered my question regards fetal weight at late pregnancy scans errors. Thank you very much for that. I do have some more questions please.
Question No1. In your previous answer to my question, you said that it's very surprising that due to baby being small (which was wrong information) I've been advised against normal delivery and been forced to have a C-section. 2 of the consultants I saw told me that because the baby shows to be small on the scans there for it could not survive the labour and apparently scanning equipment showed that the oxygen levels via placenta are low. To me this information did not sound correct as I gained the same amount of weight as with the first child and every midwife told me that my belly is all baby as I didn't have any fat on my stomach. Were those 2 incorrect equipment readings enough for the doctors to tell me that if I don't do C-section, my baby will be born brain damaged? Over all, what could cause for the baby to be born brain damaged in normal delivery (VBAC, when there are no signs of scar rapture)?

Question No2. Membrane sweep. I though I had 2 of them done, but as I find out later, first one was not performed and I wasn't even told about. The reason midwife didn't do it as I find out later is because baby's head was 1/5 in the pelvis at 40+3 week and apparently it's dangerous. Why it's dangerous and what it makes not dangerous when the head is further down? And the head position is felt during the internal examination or when feeling the belly? As if the head can be predicted feeling the belly, means that the internal examination was not needed at all.

Question No 3. pool birth. I did go into labour my self and I had to try pool birth for 10-15 min. However I felt that the water was way too hot, it felt much higher than 36 degrees. And as soon as I got in the pool my baby started to show some signs of distress (heart rate dropped once from 150-60 and came back in seconds during contraction to 120-130 and then to 150 within 5 min and I was told to get out the pool). Could the water temperature cause the distress and why midwife told me that if she would tell me to get out of pool, I would need to do that immediately?

Reserve test. What damage could it have do to the baby? My girls heart rate have dropped again twice during the test to 60 and came back within seconds to 120 and again to 150 within 5 min. I could not bare this torture test as I nearly passed out from pain and the doctor could not finish it, however my little girl has a scar on her head now. Could the test make the baby distressed 2 more times? And finally taking in the consideration that doctors had wrong scanning information of the weight (it was showing about 2 kg and the baby was born 3.2 kg) and that the heart rate dropped 3 times all together within an hour,was that enough reasons for the doctor to tell me that if I don't do the C-section, my baby will be born brain damaged? which this wording obviously made me say "yes" to the worst nightmare of my life - C-section. Thank you very much in advance for your answers. Kind regards. G.T. (UK)

Answer: This is a long question or, rather; set of questions. Having gone through the details, I’m going to try to keep my answers short. This is deliberate because I firmly believe I’m not the right person to give satisfactory answers. The details in your question show the level of unease that you still feel at the standard of care you received. This may or may not be justified but, to be able to get satisfactory answers and therefore move forward, you clearly need to have a proper debrief of the whole process. The only people who can do that are the ones who provided your care. Your GP should be able to arrange that for you or you can contact your consultant’s secretary directly. It is your right and therefore you do not need to feel any reticence about that process. Now that we have addressed that, let me briefly and in general (rather than specific terms) address the three issues you have highlighted.  

A pregnant woman’s weight gain is a very poor and unreliable reflection of the baby’s growth. In fact checking weight is no longer routinely done in antenatal care. Measurement of the abdomen are a much more reliable clinical tool. It appears there were concerns and that is why a growth scan was requested. This, as it turned out, was inaccurate. However, your doctors would have had genuine concerns about your baby’s wellbeing hence their low threshold for intervention, especially with your additional history of previous caesarean section.

A membrane sweep ( as an attempt to get a woman into labour) is usually done once. If a midwife or doctor, on examining you finds that the baby’s head is still very high and unengaged, may make a judgement that an attempted sweep may carry the risk of accidental membrane rupture with possible umbilical cord prolapse and therefore decide not to make the attempt. If the head was 1/5th in the pelvis (i.e. 4/5th in the abdomen), it was quite high and unengaged. With such a ‘high head’, it may not even be feasible to do the sweep. That should of course have been explained to you at the time.

I’m rather surprised that you were allowed to labour in the pool despite your history of previous c-section and a suspected growth restricted baby. Such a situation calls for continuous electronic fetal monitoring, something incompatible with labouring in water. In any case, the water temperature could not have been the cause of the baby’s heartbeat pattern. Asking you to come out so as to monitor the baby properly (and perform the necessary tests) was, in my view, the right thing to do.  With regard to what you term the ‘reserve test’ which I take to mean fetal blood sampling (FBS); that would have been done to verify whether, indeed, the baby was getting distressed and to what degree. If a doctor suspects that the baby is getting distressed during labour and attempts to perform this test (FBS), he/she is going to be guided by the results. An FBS does not cause the baby distress. If the doctor is unable to get the sample, it is common sense that they should err on the side of caution and deliver the baby. It appears this is what was done. With the information I have, I can only say their practise was largely spot-on and , by and large, clearly well-meaning. However, I would strongly encourage you to arrange that formal debrief with your consultant.

Vaginal spotting in early pregnancy and bed rest

Question:  I am in the 7th week of my second pregnancy. The first was 8 yrs ago. I started spotting since 5 weeks. My doctor advised me complete bed rest for 10 days and gave me some hormonal support. I have been feeling better since then. My question is that will this spotting return once I get back on my feet or has the difficult phase passed? S.P. (India)

Answer: Let  me state absolutely categorically that the bed rest prescribed by your doctor has no benefit whatsoever in a case like yours which is, in effect, a threatened miscarriage. That is old medical practise that has been discredited for many years now. If the vaginal spotting has stopped, it has nothing to do with that enforced bed rest. Whether the “difficult phase” has passed is really difficult to say because it is all dependent on what caused the spotting in the first place. You may be encouraged by the statistics which show that around 90% of threatened miscarriages in the first trimester resolve spontaneously and the pregnancy continues as normal.

Non-viable pregnancy?

Question:  My early pregnancy scan details are as the following on 28.12.11. My LMP was 31.10.11. "Slightly irregular gestational sac seen; gestational sac MSD 19.6 mm corresponding to 6w3d. Good trophoblastic reaction noted. yolk sac measured 2.6 mm. Double bleb sign seen. Tiny fetal pole seen. Cardiac activity not seen. CRL 2.1 mm corresponding to 5w5d."
My doctor says it is highly unlikely to be a viable pregnancy and to repeat the scan after a week. Would like to know the chances of this pregnancy being a viable one. S. (India)

Answer: I’m afraid I agree with your doctor here. The chances of this pregnancy being viable are really not very good at all. Every finding on this scan is out of kilter especially when referenced against your dates. I also agree with the advised measure of having a repeat scan in a week’s time. There is a possibility that events may overtake that plan.

Post-coital bleeding

Question: I have been married since 5 months, it's my sixth month. My age is 32 years, this time my periods were 3 days late and when they finish and I intercourse with my husband and I got blood again. Yesterday after 1 week I intercourse with my husband again and in morning when go to washroom have some light color blood again, is it dangerous? A. (Pakistan)

Answer: It is most likely nothing to be worried about. Since your period is late, it is possible that you have conceived and it may be worthwhile to do a pregnancy test to check whether that is the case. However, much more significant is the described pattern of post-coital bleeding. If this persists, let’s say, in the next 4 weeks or so, I would advise that you see a doctor to be examined. Most cases of post-costal bleeding are due to benign conditions of the cervix such as inflammation, ectropion or polyps. None of these are a cause for concern but it is important to rule out other more serious problems.