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Pregnancy Bliss | Reproductive Health Hub

Low platelet count and epidural in labour

Question:   Hello! I am now 35 weeks in my second pregnancy and today I saw my OB who said I could not have an epidural block in labor because I have a low platelet count. Is this right? I had an epidural last time and my platelet count was also low. What has changed? K.H. (Canada)

Answer: I will have to guess here since I do not have all the details. I think your platelet count is most probably even lower than it was during your last pregnancy. There is a cut-off point below which most anaesthetists agree that administering an epidural might pose a significant risk of bleeding. That, if it were to happen, can be a very serious complication with a risk of spinal cord compression which can quite easily lead to paralysis of lower limbs.

If your platelet count has dropped below 80, that will almost certainly lead to the advice you have been given wherever you might be in the world. Remember, the normal platelet count range is 150 - 400 during pregnancy. If your count was below 150 in the last pregnancy but well above 80, you would technically be having a low platelet count but not to an extent precluding the use of epidural analgesia.

Anti-Kell antibodies and pregnancy

Question:  Can you have a baby with anti kell? J.W. (USA)

Answer: Your question is so brief that I am not sure I understand what you want to know. If the question is whether a mother with anti-Kell antibodies can carry a pregnancy successfully, the answer is a definite yes. The risk of the baby being affected is much lower compared to mothers with Rhesus anti-D antibodies. This is because the proportion of people with the antigen that can provoke a reaction is relatively small. The standard management of a pregnancy affected by this condition is discussed here:

Significance of prenatal checks

Question:  I would like to ask what if i never have a prenatal check up its possible to have a healthy baby? W.L.

Answer: The whole point of having regular prenatal reviews is to be able to detect any unforeseen pregnancy complications. It is true that the majority of mothers are never found to have any problem or complication through the entire course of a pregnancy. In hindsight therefore, the prenatal reviews would not have not made any difference to the outcome of their pregnancies. However, deciding deliberately not to have any prenatal reviews has a degree of lottery in it. It could turn out that a serious problem for mother or baby (or both) develops undetected where a simple 10 minutes routine review could have discovered it. It is a strategy that is hard to recommend.

Heavy vaginal bleeding mid-cycle

Question:  I have been bleeding for 4 days now. I’m not due to come on. I’m 10 days early so this is unusual for me. It varies between light/heavy flow, its brown in colour, sometimes red, not like a normal period, its not as heavy as a normal period but I’ve noticed more blood clots than blood flow.  I’ve had this dull ache in my stomach and lower back since Friday (three days ago).  My period usually lasts 2/3 days so i know this can’t be an early period.  I’m worried it could be an early miscarriage, could you advise, please? C. (UK)

Answer: Looking through your dates, it is difficult to see how this could be a miscarriage. You say the bleeding has started 10 days before your period was due. That implies that your period was about 2½ weeks ago. If that was a ‘true’ period, mid-cycle when you would have been expected to be fertile and therefore conceive would be barely 4 days ago. It makes it virtually impossible that you could have conceived in this cycle and now are having a miscarriage. However; and this is a possibility, if the last period was not actually a period but an implantation bleed following a conception in the preceding cycle, then this could very well be a miscarriage. Your symptoms are certainly suggestive of a possible miscarriage but the dates, as clarified above, makes this an unlikely scenario. It may take a pregnancy test for you to get clarity of what is happening. Remember, even after a miscarriage, it takes a few days for the test to revert to negative. If the symptoms are persistent, you may wish to consider doing this. Alternatively, see your doctor who may examine you and even arrange an ultrasound scan to see what is going on.

Missed period after unsuccessful IVF

Question:  I had ivf in July/August which was unsuccessful.  Since then I have had a normal period and am now waiting for my next period so I can begin the next cycle of ivf.  I am now about 11 days late for my period and am experiencing backache, cramps and light headedness - but have done 2 pregnancy tests at 7 days late and 8 days late which both showed negative.  Is there any chance I could still be pregnant?  Could this be the ivf drugs still in my system and messing around with my cycle?  Any ideas around what could be going on welcome! Thanks. S. (UK)

Answer: It is difficult to say. The most likely explanation is that your ‘normal’ cycles have not quite resumed. This can happen after you have had drugs to stimulate ovulation. The possibility of an ongoing pregnancy is very remote with the tests being repeatedly negative. I am not sure whether the symptoms you described i.e. the backache and cramps are related to the absent periods but my guess is they aren’t. If you were planning to make another IVF attempt soon, it may be worthwhile to see your doctor for a blood beta-hCG hormone test and if this conclusively rules out pregnancy, you can then be given progestogen tablets to provoke a withdrawal bleed. That will allow you to resume in vitro fertilisation.

Passing Fragile X to the unborn baby

Question:  My husband’s family has fragile x syndrome. He himself has never been tested. Now the scan says our baby’s a boy and the doctor says he can never get the fragile x. How can they be so sure? I’m sorry but I’m very anxious about this. Can you help make things clear for me please. Thanks. Z. (USA)

Answer: It is actually very simple and I wish your doctor had taken time to explain the reasons behind his/her verdict. It is true that a father with fragile X can never pass this to his sons. It is also the case that all his daughters will carry the defective chromosome. This is simply because the father passes only the Y chromosome to his sons (that’s how they end up as boys). Since a man has one Y chromosome and one X chromosome, he can pass sperm with one or the other. In fragile X, it is the X chromosome that is defective, as the name suggests. Gametes (sperm) carrying the defective X chromosome will result in a girl  so boys can never inherit this from their father. Any male child found to have Fragile X will have inherited this from his mother.