Bleeding in early pregnancy

Question: I am about 9 weeks pregnant and have been experiencing light bleeding on and off along with abdominal pain. What is the problem? G.

Answer: Those are classic symptoms of a threatened miscarriage. It is not possible for anybody to tell you why that is happening. It is important that you bring this to the the attention of your doctor promptly for an ultrasound scan to be performed to establish exactly what is happening.

Ascard (Aspirin) and recurrent miscarriage

Question: I have had 4 miscarriages and the last one i was prescribed for ascard 75mg but still i had bleeding. I have been prescribed for the same in the subsequent pregnancy. Is this safe? and if so how long can i use it? Does it prevent miscarriage? CWW (Kenya)

Answer: I am sorry to hear of your quite distressing experience with your quest for a baby. The drug you have been prescribed (Ascard) is actually Aspirin. This is, indeed, employed in a bid to minimise risk of miscarriage at that dose of 75mg daily in some cases of recurrent miscarriag Dalteparin (Fragmin) in pregnancy e. This low-dose aspirin will be expected to be beneficial in those cases caused by Thrombophilia syndrome. I take it your doctors have confirmed or are at least strongly suspecting that this is what you have. If that is the case, then the strategy is correct and you may be successful next time around. It is, however, accepted that in some cases of Thrombophilia syndrome, Aspirin on its own may be insufficient and chances of a successful pregnancy might be significantly improved by adding a low-molecular weight heparin such as Enoxaparin (Clexane) or Dalteparin (Fragmin). Administration is by injection only and these have to be given daily throughout the course of pregnancy. This can be a very expensive form of treatment so it is important to be sure it is the correct thing to do. If you are sticking with Aspirin, make sure you don’t start this too early (you have to be at least 5 weeks) and you should stop taking it at around 36 weeks. Best wishes for the future.

‘Casual’ use of heroin in pregnancy

Question: Helloo, I’m pregnant now one and half months, I m not addictive from heroine, but I use it sometimes, not regularly. How can it affect my baby? B. (UK)

Answer: I will be frank with you. You are making a big mistake. There is no such thing as a casual use of these drugs. Presumably you are injecting the heroin. I don’t need to tell you about the risks associated with this method of administration. You can dismiss this by saying you are taking all the appropriate precautions but that is a fallacy. Also, you should be aware that, by virtue of being illegal, purity cannot be guaranteed. When not pregnant, it is your life. Pregnant means you have to be responsible for another human being so my plea is that stay away from the heroin. You have said yourself that you are not addicted so you are using it as a matter of choice and not because of dependence.

Alpha thalassaemia and pregnancy

Question: Does alpha thalassaemia carrier mean the baby will be born with sickle cell disease? B. (UK)

Answer: Alpha thalassaemia is nothing to do with sickle cell disease. These are two distinct conditions with completely different issues to contend with during pregnancy, both for the mother and the baby in the womb. Since your concern is about alpha thalassaemia, I will direct you to the appropriate section with the information you need. Just click here:

Threatened miscarriage with a bicornuate uterus

Question: I am 8 weeks pregnant and bleeding heavily with clots since the past 3 days... I had a vaginal scan this morning... The doctor said that baby is fine & has a heart beat..

Also said the bleeding could be due to a heart shaped uterus that I have, since the baby is implanted on one side the other side is acting like a normal uterus & shedding its lining as in periods....

I am very worried about my situation & don’t know if this is normal during pregnancy..??? Will the bleeding continue and what are the chances that I will have a normal pregnancy? J. (UK)

Answer: This is clearly a case of threatened miscarriage. Nobody can say with any degree of certainty what will eventually happen. 1 in 10 cases of threatened miscarriage in the first trimester end with a pregnancy loss. The positive side to this statistic is that in the vast majority the problem resolves and the pregnancy continues normally. When the bleeding is ‘heavy’ as you describe yours, the prospects for the pregnancy are not so good. However, I am mindful of the fact that ‘heavy bleeding’ is a very subjective description and I cannot use this to pronounce a prognosis for your pregnancy.

I also need to correct a misconception apparently created by your doctor. The fact that you have a heart-shaped uterus does not make you prone to bleed. That description suggests that you have what is known as a bicornuate uterus. When this womb abnormality is very pronounced, the upper part of the womb cavity appears to be divided into two compartments (see picture below, left) and, in a pregnancy, one compartment will be occupied and the other will be empty in the early phase of the pregnancy. Even though this is the way it appears, the pregnancy hormones which prevent bleeding during pregnancy act equally to both sides. Bleeding will not occur from the ‘empty’ side and that will not shed its lining during pregnancy.

It is, indeed, the case that a bicornuate uterus is associated with a slightly increased risk of miscarriage but this tends to be late (in second trimester) or it could even be preterm delivery rather than a miscarriage. Bleeding during pregnancy in a case of bicornuate uterus will be for the same reasons as in any other pregnancy. Suggesting otherwise is misrepresenting basic physiology. I hope your situation resolves soon.