Methadone dose and degree of withdrawal symptoms for the baby
Question/ Comment: I do not believe current literature says that the higher methadone
doses lead to more severe withdrawal in baby. J.D. (USA)
Answer: Thank you for your comment.
It is certainly the case (and that's not new) that the degree of withdrawal in the
newborn does not always correlate to the dose of methadone the mother has been maintained
on. However, that's the common tendency. All methadone programs in pregnancy endeavour
to maintain the woman at the lowest effective dose for that primary reason. This
is actually not controversial. Opiate dependence neuro-physiology is well understood
and it is clearly dose dependent. The situation in the infant's brain is no different.
Views in a very early pregnancy scan
Question: I had a scan due to previous blighted ovum and abdo pain. They think I’m
5 weeks, can see gestation sac and yolk sac. Is this normal at this stage? A.P. (UK)
Answer: 5 weeks is certainly very early for an ultrasound. The most you are likely
to see at this stage is a gestation sac and a yolk sac therein. Of-course a vaginal
scan can just about detect the fetal heart pulsation but this is best detected a
week further on. The gestational sac itself is tiny at 5 weeks, measuring around
6 mm diameter.
If the actual fetal pole is seen and it measures 4 mm or more, a size reached at
around 6 weeks, a fetal heart pulsation should be seen. Absence of this is a cause
Toothache pain relief in early pregnancy
Question: My daughter has bad toothache, what would be the best painkiller for her
to use, she is 10/11 weeks pregnant. Paracetamol has not helped she (and we) are
suffering. Thank you. P.M. (UK)
Answer:Apart from Paracetamol (Acetaminophen in North America), other pain-killers
that are safe to use in pregnancy are Codeine and Dihydrocodeine. This means she
can use any of the preparations which combine Paracetamol with either of these two.
Such medicines include Co-codamol, Co-dydramol, Kapake etc. Just bring this problem
to the attention of her GP who, I am sure, will be happy to help with the correct
prescription. I am assuming your daughter has already seen the dentist to find out
whether they can get to the root of the problem (pun unintended). Therein lies the
most reliable solution.
Possible missed miscarriage
Question: I am pregnant with confirmation from urine test at about a week after i
missed my period. I have been bleeding from spotting to some light bleeding without
pain. I went for an emergency scan it shows that there is no heart beat and it is
the size of six weeks pregnancy while i believe I am eight weeks. I am worried may
be the heart beat can still be found although, the light bleeding still continues
without pain. Another scan has been booked for another week. I am still having all
the symptoms of pregnancy. Please advice me i am worried. J.O. (UK)
Answer:The picture you are describing is rather worrying. I have to confess the
features are strongly suggestive of a failed or failing pregnancy. The vaginal bleeding,
the smaller than expected size of the fetal pole and crucially, the absent fetal
heart pulsation are all bad signs.
It is very tough on any mother in your situation but it is perfectly correct for
your doctors to suggest a repeat scan after an interval of a week or two. That should
clarify the picture and also allow you to be sure that the diagnosis reached is correct.
I do not want to create unrealistic expectations on this but it is worthwhile for
you to wait and see what that shows.
Chicken-pox exposure in pregnancy
Question: When I was 8 weeks pregnant with my son, my 13 month-old daughter contracted
Chicken Pox. I had a blood test which showed I had never had chicken pox myself.
I had the vaccine but the question I would like to ask is, am I now immune to chicken
pox and also my son who I was carrying at the time when I had the injection? If
yes, how long for? V.P. (UK)
Answer: The short answer is No. Neither your son nor yourself have immunity against
chicken-pox. What you were given during your pregnancy is an immunoglobulin; a specific
protein which is aimed at neutralising a nascent chicken-pox infection following
exposure. It is not a vaccine. A chicken-pox vaccine cannot be administered in pregnancy.
The benefit of this passive immunity jab lasts for several days before you revert
back to your old non-immune status. Both of you are still susceptible to the infection.
Your daughter, on the other hand, is now immune for life following that infection.
Question: What’s the definition of prolonged labour? As in; after how many hours
can we term it as prolonged labour? S (Uganda)
Answer: There is no set length of time beyond which labour will be termed prolonged.
The conventional definition for many years was a first and second stage of labour
lasting more than 18 hours. However, there is consensus among experts that such a
general standardisation is probably wrong and potentially dangerous. Take an example
of a woman who goes through the first stage of labour fairly smoothly and is fully
dilated after 4 hours. You would surely not leave her for another 14 hours pushing
simply because technically her labour is still not prolonged.
For a labour ward practitioner (midwife or doctor), one will be aware of a labour
progress chart called a partograph. This will have an alert line and an action line.
The two lines are usually 4 hours apart. It is a very effective and easy to use tool
which is meant to prevent prolonged labour. Once the action line has been crossed,
delivery has to take place, if necessary by caesarean section. Assessing whether
labour is prolonged has got to be individualised for every woman.