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Pregnancy Bliss | Reproductive Health Hub

Contact Answers In the News Hot Topics

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 for concern.

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.

Prolonged labour

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.

More questions and answers on the next page

Yolk sac

The distinct ring-like structure is the yolk sac. It appears very early before the fetus is apparent and disappears well before the end of the first trimester

Yolk sac