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Pregnancy Bliss | Reproductive Health Hub

Contact Answers In the News Hot Topics

After a stillbirth diagnosis

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 (USA)

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 high.

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:

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.

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