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Pregnancy Bliss | Reproductive Health Hub

Using Spasmex and Vasosuprina to prevent miscarriage

Question: Is it normal to be having as many as up to 10 contractions in an hour in pregnancy at 18 weeks? I have been taking spasmex and vasosuprina to no relief. How else can they be relieved? What are the chances of reaching team in such a case? I.S. (Italy)

Answer: Whilst the so-called practise contractions or ‘Braxton-Hicks’ contractions as the are better known can start that early in pregnancy, that is uncommon. What is true is that such contractions can occur several times during the day, even more than the mentioned 10 times. These tend not to be painful even though for some women they can be uncomfortable. You have given very brief details about your contractions. However, I am concerned that you are using Spasmex. This drug, the generic name of which is Trospium, is specific for relaxing the urinary bladder. It would not help relieve uterine contractions and its safety in pregnancy cannot be guaranteed. What is important however is the fact that it cannot be of benefit for you in what you are using it for.

Vasosuprina (Isoxsuprine), on the other hand, belongs to a group of drugs called ‘beta-adrenergic agonists’. These drugs have been employed as uterine relaxants in humans usually to prevent preterm labour. Their record in this regard is mixed at best and they would not be expected to have any clinically significant effect at such an early stage of pregnancy. In effect, what I am trying to say here is that the medicines you are using would not be expected to make any difference and, for one of them, could even be harmful. Threatened late miscarriage is managed symptomatically only, at most using pain-killers such as Paracetamol or Codeine if there is pain. You cannot influence the eventual outcome of this using drugs.

Hormone injections before conception

Question:  Are hormone injections harmful or not before conceiving a baby? P.S. (India)

Answer: You have not clarified which hormones you are referring to. If you mean the hormones that are used in assisted conception procedures such as IVF, these are perfectly safe.

Resumption of periods after a miscarriage

Question:  is it possible for one to start menstruating 3 weeks 4 days after a miscarriage? I had an evacuation on the 10th of March and presently i started menstruating yesterday the 5th of april? O. (Nigeria)

Answer: Menstruation resumption within a four weeks of miscarriage is quite possible and in fact common, especially if the miscarriage occurred in the first trimester (before 13 weeks). For many ovulation resumes within a fortnight and some women have failed to see a period after a miscarriage as they have conceived with that first ovulation.

Vaginal bleeding at 14 weeks gestation

Question:  What are the causes of vaginal bleeding at 14 weeks pregnancy with an ultra sound confirmation of normal fetal heart beat and growth? M. (UK)

Answer: When there is bleeding at such a relatively early stage of pregnancy, it is always dubbed as a ‘threatened miscarriage’. In almost all cases, it is very difficult, if not impossible, to pinpoint the cause of the bleed. The totality of what is done amounts to no more than an ultrasound scan to check on fetal well-being. Once this is confirmed, conservative management is all that can be done. The majority of such cases will resolve spontaneously and the pregnancy carries on as normal.

Antidepressants Cymbalta and Wellbutrin and breastfeeding

Question:  Is it safe to breastfeed while taking Cymbalta 60 and Wellbutrin 300? My daughter suffers from depression and has just had a baby and no-one seems to be able to advise her if its safe for the baby if she breastfeeds. S.F. (South Africa)

Answer: This, unfortunately, does not have a straight-forward answer. Cymbalta is a strong anti-depressant, the generic name of which is Duloxetine. It belongs to a class of drugs called Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). Like all SNRIs, Duloxetine or Cymbalta is excreted in breast milk so it does get to the baby in significant quantities. The effects on the infant are unknown.

Because of this, manufacturers advise that this drug should not be used when breast feeding unless it is determined that benefits definitely outweigh potential (unknown) unwanted adverse effects.

Wellbutrin is another drug used as an antidepressant, typically as a complement to an SSRI or an SNRI like Cymbalta. In fact, this drug is more famous in its other function as an aid for smoking cessation for which it is marketed under the brand name Zyban. The generic name for this drug is Bupropion. Again, this is a drug that is excreted in breast milk so it does get to the breast-fed baby. Like for Cymbalta discussed above, the effect on the baby is not known. However, there is some evidence from animal studies that it may not be entirely safe though hard evidence is lacking. The uncertainty regarding its safety for a breast-fed newborn mean advice is to exercise caution. You can interpret this to mean that doctors will be more comfortable if a mother on these drugs actually did not breast feed. It is a tough call.

Steroids and pre-term delivery

Question: My daughter was taken in hospital last week at 32 +4 days; she was contracting and given steroids and 4 capsules in an hour then for 6 hours continuously through the night. The next evening she was let home. What are the chances of her still going pre term or will she go full term ? T. (UK)

Answer: The honest answer to your question is, nobody knows. It is impossible to predict whether any pregnant woman will go into labour and deliver early. This is, regardless of whether there has been a prior scare like in this case of your daughter. What is important and what should reassure you and your daughter is the fact that as a result of that scare she has had steroids administered. This means, even if she was to go into labour and deliver early, this important measure has already been taken and the baby should do well as far as lung function is concerned.

IVF for choosing the baby’s sex

Question: Hi, my age is 36. I’m a mum for two nice girls . Can i choose sex of my third child by ivf? I (UK)

Answer: It is technically fairly straight-forward to identify the gender of the embryos created through IVF. If the prospective parents want a child of a particular gender, those will be selected for replacement into the womb. You are then in the realm of the chances of successful implantation and therefore pregnancy. It is important to be aware that age is a critical factor in the chances of IVF success. At 36, the chances of having a live birth with one IVF cycle is around 25%. Two years from now (at 38), the chances will have dropped to around 17%. Choosing the sex of the baby is not illegal in the UK but you can only get that service privately. Gender selection is discussed in more detail here: