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Pregnancy Bliss | Reproductive Health Hub

Urgency of early pregnancy bleeding

Question:  how long after i have started bleeding during my early stages of pregnancy do i have to see a doctor? S. (UK)

 

Answer: Bleeding in early pregnancy is regarded as an emergency because, at the very least, it should be regarded as a threatened miscarriage until proved otherwise. It means, therefore, you need to contact your doctor as soon as you develop this symptom. Of-course following that initial review the doctor may judge that it is reasonable to wait and see. More often than not a hospital review is arranged where an ultrasound scan to get clarity of what is going on will be arranged. Again this is prioritised.

It is certainly true that, in case of a threatened miscarriage nothing other than to ‘wait and see’ will be done. However, it is also true that a light vaginal bleed in early pregnancy could be the first warning that the pregnancy is not viable such as in a case of anembryonic pregnancy and even an ectopic pregnancy.



Metformin and polycystic ovaries

Question:  I’ve got polycystic ovaries and I’m trying to conceive. The doctor has given me metformin. Will this help? S.D. (Pakistan)


Answer: Metformin is sometimes used for women with polycystic ovaries especially if the woman is overweight or obese (which is common). The theoretical basis for its application is that, since many of these women tend to have insulin resistance, Metformin, a drug used in Type II diabetes, will improve carbohydrate metabolism, thereby facilitating the person’s efforts to lose weight and, through that, improve her ovulation pattern and ability t conceive naturally. Various studies have failed to show that Metformin has the expected positive impact on these aspects. It should therefore be given with an explicit understanding that it is not a weight loss medication. Moreover, it should be made clear that there is no evidence that it can improve a woman’s chances of conception. Metformin will still have a role to play among women with polycystic ovaries where proper biochemical tests have confirmed that they indeed have insulin resistance.



Safety of swine flu vaccine in pregnancy

Question:  Is the vaccine for swine flu safe in pregnancy? S.A. (Ireland)


Answer: With this vaccine being completely new, it will be less than honest to declare with absolute confidence that it is definitely safe. However, the track record of safety of seasonal flu vaccines (which are similar) is quite good and reassuring. There are concerns that safety checks in clinical trials of the vaccine have been rushed. However, this was a fine balancing act as winter bears down upon us, when a surge of cases of swine flu is virtually inevitable. As I said before, there is a track record of these types of vaccines to give additional reassurance. The injection is made of inactivated virus.



Recurrent early trimester miscarriage

Question:  I have been having miscarriages in first three months and recent was found with diabetes. I really want a baby, what do i do? It has been five months am not conceiving. N.S.N (Zambia)


Answer: I am sorry to hear this. Recurrent miscarriages are a cause for a lot of distress and anguish. You have not said how many miscarriages there have been or whether you have had a successful full-term pregnancy in the past. Your recent diagnosis of diabetes is significant but probably unlikely to be the cause of your recurrent pregnancy loss. It may be worthwhile for you to be investigated for possible antiphospholipid syndrome (discussed here) or Thrombophilia syndrome. These are the commonest known causes of early trimester recurrent miscarriages. If facilities where you are do not allow you to have the appropriate tests, there are measures you can take to maximise your chances of a successful outcome of your next pregnancy. First you need to ensure the diabetes is well controlled. Whether you are using medication such as Metformin or using insulin injections, make sure the blood sugar is kept within the normal range as much as possible. Follow the dietary advice that you would have been given.


The second measure you can and I think you should take is to have low dose aspirin tablets daily. This is the 75 mg tablet rather than the standard 300 mg one. You should only take this after your pregnancy has been confirmed and not before. Start about a week after you have missed a period (when a pregnancy is about 5 weeks). Do not take the aspirin before conception because that will reduce your chances of a successful conception. You will need to continue with the aspirin until four weeks before your due day (at around 36 weeks gestation. Wishing you the best in your quest.




Sterilisation after a vaginal delivery

Question:  Can I have a sterilisation just after a vaginal delivery? S.A. (UK)


Answer: Yes you can but this is not advised. Two main reasons for this: the failure rate of a sterilisation immediately after delivery is higher (at least double) compared to when you have it done later. An interval of three months is generally accepted as ideal as everything has gone back to normal anatomically by then. The increase in the risk of failure is because of increased possibility of re-canalisation of the fallopian tube after delivery. The second reason why sterilisation in the early puerperium is not considered a good idea is because of the heightened risk of thrombosis at this time.

You may be aware that immediately after delivery is the riskiest time for this complication. Adding pelvic surgery, albeit minor as sterilisation is, may not be a clever move even if it appears convenient for the woman concerned.



Prolapsed intervertebral disc and pregnancy

Question:  what is the effect of a prolapsed intervertebral disc (slipped disc) on pregnancy? Is it safe to go for a caesarean? A. (USA)


Answer: A pre-existing prolapsed intervertebral disc in the spine will not have any effect on a pregnancy. However, the pregnancy may have an aggravating effect on the symptoms caused by the slipped disc (pain, ‘pins-and needles’ etc.) especially if the slipped disc is in the lower part (lumbar) of the spine. Whilst vaginal delivery is not absolutely contra-indicated, many obstetricians will advise against this because the exertion involved in the second stage of labour might aggravate the problem farther still. A caesarean section is therefore the preferred mode of delivery. Location of the slipped disc will also have an influence on the type of anaesthesia .


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