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Pregnancy Bliss | Reproductive Health Hub

Fetal reduction in twin pregnancy

Question:  I have a pregnancy and currently my 14th week is goin on. Last week after consulting a doctor he said that we have twins, but in our current family scenario we want only one baby because we can’t bear financially more. so is it possible of Fetal Reduction after 14th week. What is the positive effect and negative effects? Please reply soon. J.O. (India)

Answer: It is a difficult situation you find yourself in. Fetal reduction is, of course possible, well beyond 14 weeks gestation. It can be done even if you are 20 weeks gestation. I am not sure whether the doctor explained what that is going to involve.

When required, fetal reduction involves inducing fetal demise by injecting a chemical into its heart which will make it stop. This should not normally affect the other twin. You asked what the positive effects are from this and , in your particular situation, it is what you perceive to be positive regarding your family situation. I cannot possibly have a view on that. Regarding potential negatives, there is a small risk you could lose both twins. You should also be aware that fetal reduction can have long term psychological consequences for the parents with a pervasive sense of guilt.

Please also make sure this proposed undertaking is legal where you are. I wish you well in this difficult decision you have to make.

Brown vaginal discharge in early pregnancy

Question:  Hi, I'm 7 weeks pregnant and have all the normal symptoms feeling sick a bit tired than normal but for the last two days I've had dark brown discharge like you get at the end of a period. I have a child already and did not have this in my last pregnancy. Is it normal do i need to contact my GP? Thanks for any help. F.G.(UK)                 

Answer: No, it is not normal. A brownish discharge indicates that there has been some bleeding somewhere in the genital tract or the womb. In early pregnancy, that should be treated as a threatened miscarriage until proved otherwise. You need to contact your GP and, most likely, an ultrasound scan will be organised to verify what is going on. Best wishes.

Absent fetal pole on a scan

Question:  I am positive I am  7 weeks, but an abdominal ultrasound shows 5 weeks 6 days, a sac is there without  a fetal pole and a yolk sac. T.W. (Jamaica)

Answer: I am afraid the picture you are describing is strongly suggestive of an anembryonic pregnancy. This is also called a ‘blighted ovum’. This is a type of early pregnancy failure whereby, for some obscure reasons, the fetus fails to develop. The subject is discussed here:

Drugs for epidural analgesia

Question:  Is benzodiazepine the main ingredient in an epidural? If so how long does the drug stay in your body/metabolism system? M. (USA)

Answer: Benzodiazepines are a group of drugs used mainly as sedatives and to deal with anxiety disorders. They are also used for insomnia and to control seizures (anticonvulsants). The commonest benzodiazepines are Diazepam (Valium), Chlordiazepoxide (Librium) and Temazepam. Benzodiazepines are not used to induce epidural analgesia. Normally, drugs used for inducing epidural analgesia/anaesthesia are a combination of a local anaesthetic such as Bupivacaine or Lidocaine and an opioid drug such as Fentanyl or Pethidine (Meperidine).

Vitamins during pregnancy

Question:  What vitamin is good for pregnancy when so tired? M.T. (Canada)

Answer: When you are pregnant and feeling more tired than you would expect, it is possible that you are anaemic. You therefore need to check with your doctor and a blood test to look at your blood count may be required. If anaemia is confirmed and it is seen to be due to iron deficiency, oral iron supplements will be prescribed. Less common causes of anaemia are deficiency of folic acid and or vitamin B12.

Vitamin supplements cannot be used to deal with fatigue during pregnancy. You will find more details about vitamin and nutritional supplements in pregnancy by clicking here:

Removing cervical cerclage suture

Question:  A full term breech with cerclage is planned for a C-Section. When is it appropriate to remove the cerclage; prior to or after C-Section? N. (Saudi Arabia)

Answer: Removal of cerclage depends on type of cerclage and your long term plans. If what you have is an ‘abdominal cerclage’ (suture applied to the cervix via the abdominal route); and you are planning to have more children in future, the suture should be left in place until you have completed your family. It can safely stay there for several years  and will not interfere with your ability to conceive.

If what you have is the traditional cervical cerclage (Shirodkar or MacDonald), this is typically  removed at around 37 weeks gestation. This is usually in anticipation of a vaginal delivery. If delivery is definitely to be by caesarean section as is the case with you, it can also be removed at the time of the caesarean section.

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