Question: What happens after you find out your child is stillborn, what procedures
are followed or do you deliver normally? What kind of hospital stay to expect? S
Answer: The handling of stillbirth varies somewhat from country to country. (I note
that you are in the US). In general, once fetal demise is confirmed, measures will
be put in motion within 24 hours to bring about delivery. This is unless the mother
has any objections to this. When there is no concern about maternal well-being the
induction of labour can be delayed even for a few days, if she so wishes. However,
if there are issues concerning maternal health, delivery will need to be expedited
to prevent serious complications (for the mother). An example of such a situation
is where the membranes (waters) have broken whereby the risk of infection is rather
If there are no complications, hospital stay following delivery of a stillborn baby
does not need to be more than 12-24 hours.
Heavy bleeding at 6 weeks gestation
Question: I am 6 weeks pregnant now bleeding seriously; why? Have I had a miscarriage?
My doctor says the baby is still there but am seeing thick blocks of blood. Please
tell me what is wrong. Thanks D (Cote D'Ivoire)
Answer: Heavy vaginal bleeding at such an early stage of pregnancy is a legitimate
cause for concern. In most cases it is a sign that you are in the process of miscarrying.
This is particularly the case if the bleeding is accompanied by lower abdominal cramps
or pain. It is very important that you arrange to have an examination and, facilities
allowing, get an urgent ultrasound scan which will give you clarity. Best wishes.
Urinary catheter with spinal anaesthesia
Question: Do you still need a catheter with a spinal anaesthetic as opposed to epidural?
Spoken to anaesthetist who told me you recover more quickly from spinal compared
with epidural. C.W (UK)
Answer: You do indeed need a urinary catheter with a spinal anaesthetic. The usual
sensation of a full bladder is blocked with a spinal. Your bladder will therefore
fill up and you will remain oblivious to that. You therefore run the risk of over-distension
of the bladder, something that is undesirable and can cause functional damage. Since
the effect of the spinal normally lasts several hours (at least), having continuous
drainage of the bladder using an indwelling catheter is the right thing to do.
Persistently positive pregnancy test after a miscarriage
Question: How long after a suspected early miscarriage will a pregnancy test still
remain positive? - I had heavy bleeding for 7 days starting on day 28 of my cycle
but had a confirmed pregnancy the week before. The bleeding stopped completely 3
days ago and yet I still have a positive pregnancy test now. Many thanks A.A (UK)
Answer: After a miscarriage, if all the placental tissue has been expelled from the
womb, the pregnancy test reverts to negative within a few days; in most cases, in
less than a week. You may be aware that the test detects the hormone called beta-hCG.
This is produced by the placenta and membranes. When everything has been expelled,
the source of the hormone is no longer there and whatever was there is quickly cleared
from your system.
There are four possible explanations for a pregnancy test that continues to be positive
after an apparent miscarriage:
You are, in fact, still pregnant. An ultrasound scan should soon clear this up.
You still have retained products of conception in your womb. In this situation, the
bleeding tends to persist, even if somewhat lighter.
The test is false positive and the miscarriage is indeed complete.
If the tests persists in being positive, let’s say for another week or so; you will
need to consult your doctor.
Standard antenatal care
Question: I am 14 weeks pregnant with my second child but have not been seen or contacted
by anyone since I visited my GP at around 5 - 6 weeks. Is this normal? Do I wait
for 20 weeks scan or should I visit a midwife? Thank you. L (UK)
Answer: There is clearly a problem here. In the UK where you are,you should have
had your maiden (booking) visit by now. It is always aimed to see every pregnant
woman for booking by the time they are 12 weeks. This allows for a thorough review
by the midwife to identify any issues that may require special attention during pregnancy.
It is at that visit that all the booking blood tests are taken. You are also offered
the Down’s syndrome screening test and if you want that, it is arranged to be done
at around 15 -16 weeks. In fact, for those who may need (or want) to go straight
to a diagnostic test, this may need to be done as early as 12 weeks (CVS) or around
15-16 weeks for an amniocentesis. The point here is that you should have been seen
already. Get in touch with your GP or midwife promptly to find out where the problem
is and kick the antenatal care process into gear, albeit rather belatedly.
Miscarriage at 4 weeks gestation
Question: How is it possible to know if you have had a miscarriage at 4 weeks? Can
the doctor know there has been a miscarriage at that stage? How? Thank you. S (USA)
Answer: So that I know we are talking about the same thing, the four weeks of pregnancy
refers to the duration since the first day of the last period, right? This means
the miscarriage has occurred at almost the same time when the period was due. Because
of this, it is almost impossible for the woman herself to know that she was indeed
pregnant and that the bleed she is experiencing is in actual fact an early miscarriage.
The bleed may be a little heavier than normal but because of its timing, it will
almost always be dismissed as a ‘heavy period’.
A doctor can only tell that this is a miscarriage if a pregnancy test is done and
it is positive. To be certain, a blood assay to quantify the levels of the pregnancy
hormone beta-hCG will need to be done to exclude the possibility of a false-positive
urine pregnancy test. Raised levels of beta-hCG are confirmatory. Ultrasound scan
has no role to play in this scenario.