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.
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.
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)
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)
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)