All about pregnancy, childbirth and reproductive health in general
Pregnancy Bliss
Possible endometrial cast
Question: I have just lost a strange big-ish (felt like skin) blood clot how do i know if this was/is a miscarriage ? G.(UK)
Answer: From the very brief details that you have provided I can only assume this was probably what is known as an ‘endometrial cast’. An endometrial cast is when a very thickening lining of the womb (endometrium) is shed in one piece rather than breaking down as in a typical menstruation. This tends to occur in a cycle where ovulation had not taken place and consequently the lining is thicker than normal and the cycle longer.
Rubella vaccination during pregnancy
Question: What happen with mother if she already has rubella vaccination on her pregnant (4 weeks)? N. (Singapore)
Answer: If a mother is inadvertently vaccinated against Rubella during pregnancy, she should not worry too much about it. It is true that this vaccine utilises live weakened virus and is therefore advised not to be used in pregnancy, However, of the thousands of documented cases where the vaccine has been administered inadvertently during early pregnancy, no cases of birth defects have been found. So, whilst the vaccine would not be administered knowingly to a pregnant woman, where this occurs accidentally, it is correct to reassure her.
Using Clexane (Enoxaparin) in early pregnancy
Question: I’m 22 and I’m pregnant with my 3rd child, during my last pregnancy, which was just over 5 months ago, i developed pre-eclampsia and after delivery i had a DVT. For the past 5 months I’ve been on Warfarin, and now since i discovered i was pregnant I’ve been having Clexane injections, I’m only 5 and a half weeks and this morning i had some mild bleeding which was a brown like colour. Should the fact I’m on Clexane mean i should be seeing a midwife or a consultant? And could the Clexane have caused the bleeding I’ve had or could it be something else?. And how will my pregnancy be affected by the Clexane?. Your thankfully . C. (UK)
Answer: Switching you from Warfarin to Clexane was the correct thing to do. Yo
u are
likely to be advised to stay on this throughout your pregnancy and for at least six
weeks after delivery. Clexane would not and cannot be the cause of your vaginal bleeding.
At normal prophylaxis doses, there is no such risk. There is absolutely no risk to
your baby from Clexane since it does not cross the placenta. Clexane, the generic
name of which is Enoxaparin, like all low-molecular weight heparins, carries a slight
risk (to you) of reducing your bone density. The risk is small and clearly outweighed
by the proven benefit in a case like yours.
Using steroids during pregnancy
Question: I have a BMI of 40 after taking steroids for an immune condition for 4 years, which I am still on. I am 7 weeks pregnant and the doctors have been very vague in informing me of the risks associated with steroids, I am very concerned. L.H. (UK)
Answer: Unfortunately you have not stated the type of steroids you use. However, as a general statement, the commonly used long-term steroids such as Prednisolone, hydrocortisone, Beclometasone etc are regarded to be safe to use in pregnancy. Where they are required mainly due to pre-existing conditions, women are actively encouraged to take them. Of-course, like with all drugs, it is advised that you use the lowest effective dose.
It is true that a few studies over the years have shown possible increase in the risk of such birth defects as cleft lip and cleft palate where oral steroids have been used in the first trimester. The increased risk was reported to be modest. Studies have consistently shown no increase in the risk of stillbirth, cardiac, neural tube or limb defects.
Insulin and pregnancy test results
Question: Can insulin affect the results of a home pregnancy test? D. (USA)
Answer: Insulin has no known effect on a standard pregnancy test. In other words, it cannot make it falsely negative or vice versa.
Inheriting the sickle cell gene
Question: What are the consequences of a child if the father has sickle cell disease and the mother has the sickle cell trait? J.S. (USA)
Answer: Where one parent has sickle cell disease (SCD) and the other has the trait, there are two possible outcomes:
The child will either have sickle cell disease (SCD) or be a carrier (sickle cell trait). The chances of ending up with either outcome are 50:50. That is, the chances are exactly equal. Since one parent has both defective genes and the other one has one defective gene, there is no possibility of the child being completely free of this defective gene.
Using Aspirin in pregnancy
Comment: Aspirin during pregnancy, especially during later stages of pregnancy is contraindicated due to its effect on the baby's circulatory system (pre-mature closure of the ductus arteriosus). Therefore, I suggest that Aspirin not be taken by a pregnant woman. I do agree that Aspirin use to prevent deep venous thrombosis (clots in legs) has never been proven to be of any help. F.S. (USA)
Answer: You are quite right in your observation that NSAIDs including Aspirin should not be used in pregnancy, not only because of their potential effect on the ductus arteriosus (in late pregnancy) but also the proven adverse effect of increased risk of miscarriage in early pregnancy. However, there has been no negative effect recorded with low-dose (75- 100 mg daily) Aspirin despite extensive use. The issue of premature DA closure is still a cause for some concern even at this very low dose hence the advice by many obstetricians that it should not be taken beyond 36 weeks.
