Question: What about heparin injections in pregnancy? R (UAE)
Answer: I gather, from your question, that you want to know if heparin is safe in
pregnancy. If that is the question, then the answer is yes. Heparin does not cross
the placenta and therefore does not reach the baby. However, there is a caveat here:
For the mother, prolonged use of heparin does lead to the thinning of bones and therefore
a risk of fractures. There is also an increased risk of bleeding and reduced platelet
count (thrombocytopenia). It is important that all these are taken into account.
When there has been a thrombosis or thrombo-embolism in pregnancy or, where there
is an identifiable risk factor for this; the risk from that is far greater than the
potential risks of heparin complications mentioned above. Heparin should therefore
be used when required. Traditional heparin use in pregnancy has now been largely
replaced by what are known as ‘low molecular weight heparins’ (LMWH). These are available
in a variety of brand names including Clexane®, Fragmin®, Clivarin®, Innohep®, Fraxiparin®
and several others. The administration and monitoring of these is easier, they have
a lower potential maternal complications profile and they are just as effective.
Contraception after caesarean section
Question: Which methods of contraception are more suitable after caesarean section?
Answer: Choice of contraception method largely depends on whether the mother is going
to breast-feed or not. The method of delivery is largely irrelevant. The intra-uterine
contraceptive device (IUCD) popularly known as the ‘coil’ cannot be fitted before
at least six weeks have elapsed since the delivery. However this applies for both
caesarean and vaginal delivery. The old advice that this should not be used in cases
of previous caesarean section no longer holds true.
Early pregnancy bleeding
Question: What are the causes of early pregnancy bleeding? I (Kenya)
Answer: Vaginal bleeding in early pregnancy is always regarded as threatened miscarriage
until another explanation is confirmed. The potential causes of this problem and
management options are all discussed in greater detail on the aptly-named ‘Bleeding
in early Pregnancy’ section of the site. Please click on that link to go there.
Post-coital bleeding in pregnancy
Question: I’m nine weeks pregnant and bleeding lightly after intercourse. Am I having
a miscarriage? M.M (UK)
Answer: While it is not possible for me to state categorically that you are not
having a miscarriage, the picture you paint here suggest that it is probably unlikely.
If the vaginal bleeding is only occurring post-coital and not at other times, it
suggests a local cervical problem, usually minor. This is called ‘contact bleeding’.
Contact bleeding from the neck of the womb (cervix) is relatively common when there
is a condition called cervical ectropion (‘erosion’) or even a polyp. Both these
are benign conditions.
In any case, any bleeding in pregnancy, early or late, needs to be verified by the
doctor. You need to arrange to see your doctor promptly who may need to examine you
and possibly arrange an ultrasound scan to confirm fetal viability.
Orgasm during pregnancy
Question: Hello, I was just wondering is it safe to have orgasms in first trimester
and so on? As I have been told it isn't and can cause damage to the fetus and even
a miscarriage, so now I am worried. I am 5 weeks pregnant! J.K (UK)
Answer: To all ‘old wives’; an apology in advance: This is a classic old-wives tale.
I can tell you categorically that all this about orgasm causing damage to the baby
or provoking a miscarriage is nonsense. An orgasm is a normal physiological phenomenon.
It does not have any negative impact on the pregnancy whatsoever. You can enjoy your
normal sex life with peace of mind. It is perfectly safe.
Menstrual irregularities after a blighted ovum
Question: I had a blighted ovum three months ago and was admitted to hospital where
they evacuated my womb. Since having this my periods are every 16 - 18 days where
as before my pregnancy they were 21 - 24 days. Is this normal? N.H. (Ireland)
Answer: it is not unusual to have some degree of menstrual irregularities following
a miscarriage. This is regardless of whether this was a blighted ovum or any other
type of miscarriage. In fact, it is not the miscarriage per se that brings this about.
It is more the psychological impact of the pregnancy loss that can influence this.
With only three months since your pregnancy loss, the pattern you are describing
is not at all surprising. The old pattern should come back within the next 2 -3 months.
If this does not happen, a review by your doctor is advised. Trying not to worry
will certainly help.
Feeling fetal movements at 20 weeks
Question: Having not long ago had a miscarriage, I am 41 yrs old and I am 20 wks
pregnant. I was told by the mid wife the reason I’m not feeling the baby movements
strong is because my placenta is at the front of the baby. Can you explain more and
that I have not felt the baby move? F (UK)
Answer: It is actually not unusual not to start feeling the baby’s movement until
after 20 weeks of gestation. Most mothers perceive the true fetal movements from
around this stage of the pregnancy. It is also believed that an anterior placenta
(placenta located to the front of the womb) can blunt perception of the movements
and therefore cause a delay in feeling them.
Having had a miscarriage, your anxiety about this is completely understandable. However,
your experience is certainly not unusual. Your midwife should be able to get you
to listen to the baby’s heartbeat using the portable electronic device (fetal döppler).
That should reassure you. In any case, you should expect to start feeling the movements