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Pregnancy Bliss | Reproductive Health Hub

Diagnosing cervical incompetence

Question:  what are the classical clinical features of cervical incompetence that i as a medical student must ask or elicit during taking history and physical examination for me to make diagnosis of cervical incompetence? S.U.Y. (Nigeria)

Answer: I am sure you will be aware that in practically all cases of cervical incompetence or cervical weakness the diagnosis is made after at least one pregnancy loss, usually more. There is therefore bound to be at least that history.

Now; once you have that information, you need to get more details on the timing and presentation of the actual miscarriage(s). Where cervical weakness is the underlying cause, miscarriages are usually late, typically mid-trimester. Not every such miscarriage will present with the text-book scenario of a sudden gush of water followed by the miscarriage but such a history is strongly suggestive. Once you have this history, you need to dig even further back. Is there a history of surgical pregnancy termination where the damage to the integrity of the cervix might have occurred? Is there a history of surgery to the cervix such as loop excision or cone biopsy which might have left the cervix deficient?

Cervical incompetence or weakness does not lend itself to strong physical signs so examination might be unproductive. However, if there is history of previous cervical surgery such as cone biopsy, a speculum examination might show a markedly deficient cervix, in some cases flush with the vagina. That will complement the information garnered during history taking allowing you to reach a reasonable clinical impression of cervical weakness.

Conceiving  while on the pill

Question:  I’m 17 years old and I have been on the pill for about two years. I have not had a period for three months now and was wondering whether I could be pregnant. If I’m pregnant, will the pill have harmed the baby? I’ve not missed taking the pill. I take cilest. Thanks. B.G. (UK)

Answer: It is not possible for obvious reasons for me to say with certainty whether you are pregnant or not. Even though it is very unlikely to get pregnant whilst on the combined pill such as Cilest (when taken correctly), it certainly isn’t impossible. Some people fail to get a withdrawal bleed (period) when on the pill. That is certainly a possibility. However, the only way you are going to remove the uncertainty is to do a pregnancy test. If this is negative, you may need to arrange an appointment with your GP for a couple of blood tests to rule out other causes of missed periods. In the unlikely event that the pregnancy test is positive, no; the pill would not have harmed your baby.

Erratic periods; negative pregnancy test

Question:  I’m 41 years old, I have regular periods, last period was late for 50 days, I had negative pregnancy test. After that,two days later I had my period on 11th Oct. I was expecting my period on 11th of Nov. I got negative pregnancy test today (12 days later). Please advise. my heart beats fast some times a day, I have lower back pain, headaches some times a day and at nights. Thank you so much. Z. (Sudan)

Answer:  There is a possibility that, at 41, you might, just might, be going through very early menopause. If you have always had regular periods as you say, and suddenly they start becoming this erratic, you may need to do a blood test to see if this is what is happening. The useful blood tests are the ones that check the levels of the hormones called FSH and LH. These are collectively known as gonadotrophins. Checking levels of estrogen may not be very useful because this tends to fluctuate wildly.  Of-course another possible explanation is that your ovulation pattern has changed hence the irregular periods. If facilities allow, I would advise that you get that blood test done.

Regaining flat stomach after childbirth

Question:  I delivered my second baby 4 month ago. I’m not breast feeding and im 53kg now, height 158cm. I have a problem with my belly, its not stretched that much and its clear to anyone seeing it. i tread mill 3 times a week 40 min. so what can i do to get back my tummy???? Plz help!!! S. (Lebanon)

Answer:  Congratulations on your new baby. I take it you mean your abdomen is still prominent and has not gone back to being flat, presumably as it was before your pregnancy.

With a Body Mass Index (BMI) of 21, you are clearly somebody with a slight figure and will be acutely conscious of something like an apparently prominent abdomen. Exercising is far and out the best thing to do to tighten abdominal muscles which may have stretched during pregnancy and are not getting back to their original tone. However, if the main exercise you are doing is using the treadmill, that will not address the problem of poor tone of abdominal muscles. For this you need to do specific exercises which might include press-ups, push-ups, bicycle crunch exercises and many more. If you search online, you will get a lot of free tips on exercising to regain abdominal muscle tone. Best wishes.

PCOS, missed miscarriage and measures to prevent its recurrence

Question:  Presently, after a missed miscarriage, my scan report shows "No CYST/MASS. Uterus is ANTEVERTED-GRAVID, WELL EXTENDED". My Doctor also examined me and observed that I do not have polycystic ovaries anymore and uterus is normal, but my ovaries are "BULKY" and has asked me to cut down on stomach fat. She has prescribed Folinol and Flucos 150. Will absence of CYST and these folic acid supplements increase my chances of conception and in having a healthy baby soon? Also she suggested that she would put me on HCG injections and hormonal supplements for 12 weeks post my next pregnancy. Will that help? I did not take these for my first pregnancy that ended up in miscarriage. In general, are there any ways of preventing chromosomal abnormalities? Does Chromosomal abnormality have a link with poor quality egg? In my case, if there is no cyst, the egg quality would be better to rule out missed miscarriage. Is that correct? Also what other tests can I take to ensure I do not have a (missed) miscarriage in future. Thanks again for your valuable time and effort. Thanks to the team. D.B. (USA)

Answer: I am afraid there appears to be a number of misconceptions in your understanding of polycystic ovaries (PCOS) as a condition. I would strongly advise that you take the time to read our coverage of this condition found here for your proper understanding of this. This is important because it will shed much more light on what you have gone through. I am just concerned that you are either being misled or you misunderstand what your specialist is telling you.

To begin with, you cannot examine somebody and tell them that that they no longer have polycystic ovaries. You either have polycystic ovaries or you don’t. It is not a condition that comes and goes. Using folic acid supplement pre-conception is a good idea but it will not improve ‘quality’ of eggs. People who have PCOS do not have ‘poor quality eggs’. They simply don’t release the eggs as efficiently as everybody else.

You can certainly have hCG injections as advocated by some doctors. These won’t do any harm.  However, there is no scientific evidence that these help to prevent miscarriage in a naturally conceived pregnancy.

You ask whether chromosomal abnormality has any link to  poor quality eggs. This is clearly the case but it is a back-to-front question. Where there is chromosomal abnormality, the egg is, by implication, poor quality. If you do one thing as a result of this correspondence, please read that article on PCOS. I am sure it will give you a much better understanding of the condition and what it implies.