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Pregnancy Bliss | Reproductive Health Hub

Contact Answers In the News Hot Topics

Dealing with fetal death at 23 weeks gestation

Question: I am 19 years old and have just found out my baby has died. I am 23 weeks and have been told i will have to deliver my dead baby. I am not good at showing my emotion and like to bottle things up, i know it sounds heartless but i don’t want to have to bury the baby or have it cremated. I don’t think i even want to see it, do i have to bury my baby or can the hospital do this for me? I know i sound heartless but i don’t think i can cope with any more pain. S.G. (UK)

Answer: Yours is a tragic story. Please do not torture yourself thinking that anybody is going to be judging you. That is absolutely never the case. You will be aware that at 23 weeks this is classified as a late missed miscarriage. If you want the hospital to handle the disposal of your baby’s remains, you need to discuss this with your midwife. There are established arrangements in place in every maternity unit in the UK for the option of the hospital taking full responsibility both in arrangements and costs if the grieving parents so wish.

First pregnancy ultrasound scan

Question:  When should I get my first ultrasound?  A.R. (Australia)

Answer: I am making an assumption here that you are pregnant. If so, congratulations. As a rule of thumb, it is advised that the ‘booking scan’ is done well before the end of the first trimester, preferably around the 7-10 weeks mark. This is useful in confirming pregnancy, viability, location of the pregnancy (in case of an ectopic), number of fetuses and, quite crucially, accurately establishing the gestation. You may be aware that the more advanced the pregnancy, the less accurate the scan is in determining the gestation. Best wishes.

Clexane and breastfeeding

Question:  I have been using Clexane during pregnancy because of history of dvt and factor v leiden. I have been told that I will need to continue for six weeks after the birth but I plan to breastfeed and it says clexane should not be used if breastfeeding. N.N. (UK)

Answer: Your anxiety is understandable but be reassured that, done correctly, Clexane (Enoxaparin) is perfectly safe with breast-feeding. Clexane is available in two different types of packaging. There are the pre-filled syringes which come with an exact dose required and then there are the so-called multi-dose vials. With the latter, a preservative called benzyl alcohol is used. This preparation is not and should not be used if breast-feeding.

Most mothers using Clexane to prevent thrombosis will be using the pre-filled syringe preparation which does not contain benzyl alcohol. This is safe to use when breast-feeding. As long as you are using these you can rest easy. Please make sure you continue with the injections as advised. The postnatal period is actually the most risky when it comes to thrombosis.

Hepatitis C in pregnancy

Question:  The mother has Hep-C before she is pregnant. Can this effect the baby? Does the baby get the antibodies that’s what my friend has? A.M. (Australia)

Answer: A woman with hepatitis C and who is HCV RNA positive has a 4-6% chance of passing the infection onto her baby. This is equivalent to a 1 in 16 to a 1 in 25 chance of the baby getting the infection. This is what is known as vertical transmission.  The baby will need to be tested for HCV RNA at around 2 months of age and the test repeated 4 months later. Even if these tests are negative, there is still a bit of time to wait before the child can be given the all clear. A test for antibodies will need to be made at about 18 months of age and if this too is negative then parents can be sure that the child is not infected. Important to remember that, even at worst, the baby has an almost 95% chance of not being affected.

Fetal heart rate and gender prediction

Question:  does a heartbeat count  help to guess a baby gender after 18 weeks of pregnancy? M. (Pakistan)

Answer: No, it does not. There is absolutely no difference between the fetal heart rate or pattern of a male and that of a female fetus. Any suggestion to the contrary is based on old wives’ tales!

Vaginal spotting in very early pregnancy

Question:  I am pregnant 5 weeks, having slight bleeding in brown colour. Doctor said that the sac is inside the uterus. What is my position now? M. (United Arab Emirates)

Answer: Any such bleed at such an early stage of pregnancy is regarded as a threatened miscarriage. There is nothing you or your doctor can or should do. Of course the vast majority of threatened miscarriages resolve on their own and pregnancy continues successfully to term. It is not possible to accurately predict which of these will fail. Five weeks is really early and the best you can do is try your best to avoid stress and have the repeat scan in a week or two to see what is happening with the pregnancy. I would want to think this has been arranged. Best wishes.

More questions and answers on the next page

Pre-filled Clexane injections do not contain benzyl alcohol and are safe to use if breast feeding