Pregnancy Bliss | Reproductive Health Hub
Question: I am about 6 weeks pregnant and have had a brown discharge for 4 days. I had a vaginal scan 4 days ago and the pregnancy is in womb but a heartbeat was not detected. I am having a further scan in ten days’ time. If the fetus has died how long will a pregnancy test show positive for? D.R. (UK)
Answer: The scan findings are a worrying development. This combined with the mentioned vaginal discharge means there is a significant likelihood this pregnancy is no longer viable. However, I agree with the advice you have been given to have a repeat scan in about two weeks. It can be very distressing not having clarity for so many days but the interval is vital.
A urine pregnancy test can remain positive for a few weeks after fetal demise as long as it is still in the womb. It is therefore a useless test in the circumstances.
Question: Hi, my son is to become a father soon with his new partner. He caught the herpes virus from an old girlfriend a year ago, it was treated at the GUM clinic but i do know that you carry it for life. I am very worried about the effect of it on my unborn grandchild. Could you please tell me if we have anything to worry about. Thank you. L.P. (UK)
Answer: Genital herpes is a condition which, with simple proper management, should not be a cause for concern in pregnancy. Assuming that your son has passed this viral infection to his partner (which is not inevitable), all she needs to do is observe a few general rules. The most important of those is that, if she has active lesions at Term, or more specifically, at the time of delivery, then she should have a caesarean section. The same rule applies if she had lesions within six weeks of the birth. This is because, there is a risk that she could still be shedding the virus for a few weeks after the lesions have apparently healed.
The virus can only be passed onto the baby by direct contact with active herpes lesions in the lower genital tract. In the absence of any active lesions within that six weeks window, the baby is not at any risk and a vaginal delivery is perfectly safe.
Head engagement during pregnancy
Question: why does the doctor begin to check the baby's engagement at an early stage of pregnancy? S. (Malta)
Answer: I am not sure what you mean by "early stage of pregnancy". However, in the third trimester of pregnancy, part of the abdominal examination is to identify the leading part, that is, if it is the head or otherwise. There is absolutely no value in establishing whether the head is engaged or not, remote from Term. Head engagement has no predictive value as far as timing of labour onset is concerned. If the baby is estimated to be well above average in size, engagement of the head after 37 weeks of gestation may be a useful predictor of the possible success (or not) of a vaginal delivery.
Trying to conceive with an irregular cycle
Question: My husband and I just started trying to conceive this month. I couldn't remember the exact date of my period two months ago, but my last was **/**/****. I can not really tell exactly when to expect my period since I don't know how many days are in my cycle. We used an ovulation predictor kit and it was positive on **/**/**** (10 days later), and we acted accordingly. My question is, based on the ovulation date, when should I take a pregnancy test. We are anxious to know and don't want to wait any longer than we have to. Please advise me. H.J. (USA)
Answer: Modern urine pregnancy test kits are pretty sensitive. Most will give a positive pregnancy test within 2 weeks of conception. If you want to have a result that can be really reliable, it is probably best to wait until 3 weeks have elapsed. The problem with doing the test too soon is that, if it is negative, you will be forced to repeat it a few days down the line to see if the earlier one was accurate. That can take its toll in terms of stress. However, two weeks is the magic figure.
Question: I had a very early placental abruption in my first pregnancy and this one is following suit. I am 9 weeks (last time I was 12 weeks) and there is a slight abruption now, but the blood has clotted inside my womb, and is at present twice the size of the embryo. I am in a little pain, but mostly just uncomfortable and I have a heavy feeling. I am told that this clot must not expand any further, and I must pass it. Last time I passed the clot it was 15cm long by 6cm wide at 12 weeks. I didn’t realise at the time that it was such a serious condition. I have no other symptoms other than the discomfort. I have been told that bed rest is the best thing and have been given a tablet called utrogesten to relax the womb. Is it likely that I will, again, pass this clot, and if I don't, what could the outcome be? Incidentally, I went on to have a healthy child last time, except that she was delivered at 36 weeks after she stopped moving. E.K. (Greece)
Answer: There are a few issues in your case that need to be clarified. In strict medical terms, the hematoma (blood clot) that you have or the one you had last time cannot be described to be a case of placental abruption. This is a case of threatened miscarriage. There is no such thing as a placental abruption in the first trimester. What has been found on the scan is what is termed as a subchorionic bleed. This sort of early pregnancy complication is not uncommon and in most cases is self-limiting. Of-course it is a cause for concern but the reality is that there is very little, if anything, that you or your doctors can do to influence events. Roughly 1 in 10 of such cases end in miscarriage.
Bed-rest in the face of a threatened miscarriage is still advocated by some doctors. However, there is no shred of evidence that it improves the outcome. In the absence of any such evidence, this sort of advice has been abandoned by most doctors. Instead, it is advised that you avoid stress. I know that is a vague general statement but what it emphasizes is that, if bed-rest will make you restless and therefore stressed, then, that will not be good for you or your pregnancy.
Utregesten is Progesterone. This is the hormone that is meant to support a pregnancy and is mainly produced by the placenta after the first few weeks post-implantation. It is used mainly in IVF to support the pregnancy before the placenta takes over. There is no evidence of its usefulness in threatened miscarriage. There is, however, no evidence of harm in taking it. It does not relax the uterus.
In most cases of threatened miscarriage where there is a subchorionic hematoma (like you have), the clot is actually absorbed and will have gone completely in a few weeks' time. If things resolve, and I hope so, I would expect a scan at around 20 weeks to show no evidence of a clot. You don't need to worry if you don't pass the clot. In fact the majority are NOT passed. Instead, they are just absorbed. After all, it is your own blood.