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Pregnancy Bliss | Reproductive Health Hub

Contact Answers In the News Hot Topics

Vaginal birth after caesarean section (VBAC)

Question:  I had my first baby 5 weeks early by c-section,an now I’m pregnant with my second child and I’m scared about giving birth normally,I’m only slim and about 5 foot 3. What can i do to stop been scared? R.P. (UK)

Answer: I don’t think you need to be scared at all. You will have seen from this site and other sources that trying for a vaginal birth after a caesarean section is encouraged whenever possible. I’m sure your midwife and doctors would have advised you the same. You did not say why you had to have a caesarean section and at a pre-term stage last time. However, as a general rule, the advice is that, if your caesarean section was for a non-persisting reason and everything is normal in the current pregnancy, there is a very good chance that a vaginal birth will be successful. You need to remember that you will be carefully assessed towards the end of your pregnancy to make sure it is safe to go for labour. If there are concerns that labour is unlikely to be successful, you will be advised accordingly. Nobody can guarantee a successful vaginal delivery to any woman walking through the labour ward doors. However, if conditions are ideal, it will be a shame to pass up the chance. Your size and height are of little if any significance. Good luck.

Attending antenatal clinic

Question:  After conception how long should I take to start attending clinics? E.K. (Kenya)

Answer: Pregnancy care and antenatal services in general vary enormously from country to country. However, it is universally accepted that a pregnant woman should do her antenatal booking; that is the first visit, within the first trimester, preferably before 12 completed weeks. That is, 12 weeks from her last period rather than the ‘date of conception’. Remember, most women will not know the exact date when they conceived so it is unrealistic to try to use that as a guide. Frequency of visits to the antenatal clinic will then depend on individual needs. In most countries, after the half-way mark (20 weeks), a woman will be seen every four weeks until the third trimester when the frequency may be increased to every two weeks. This is for low-risk women. Where there is a known risk factor such as pre-eclampsia, gestational diabetes, sub-optimal fetal growth etc., visits will be much more frequent.

Multiple sex partners during pregnancy

Question:  Hi, i just wanted to know whether during pregnancy having intercourse with other man can lead to miscarriage. One of my near one had miscarriage 4 times and she has affair with other guy. Is this the reason of miscarriage? She was taking some injection during pregnancy then only she delivered her first child. R. (India)

Answer: The simple answer is No. Having sex with a man who is not the father of the child or even having multiple sex partners during pregnancy does NOT cause miscarriage. That person you referred to would have had a condition that made her prone to get recurrent miscarriages. Presumably the ‘injections’ she had in her successful pregnancy were meant to deal with that condition. Sex with another man was not the cause of the miscarriages.

Bleeding after embryo transfer

Question:  I had IVF egg replacement on ** June 2009, took a pregnancy test on ** July 2009 (18 days later) which the hospital told me to do. This showed that I am pregnant 1-2 weeks. Later on the same day of doing my pregnancy test I started to bleed rather heavily like a normal period. I have had to have a blood test at the hospital yesterday and have to return tomorrow for another blood test to see if I am pregnant or not. BUT, could I still be pregnant ?  I am very worried and anxious. S.F. (UK)

Answer: This is clearly a worrying development and your anxiety is understandable. Bleeding just over two weeks after embryo transfer into the womb should be regarded as a threatened miscarriage until proved otherwise. I have an impression from your question that you had only one embryo transferred back into the womb. The blood test that your hospital has done is to estimate the blood level of the pregnancy hormone beta-hCG. If the pregnancy is still intact and viable, the level of this hormone will double (or more) after 48 hours, hence the repeat test that is planned. That should give you clarity of what is going on.  Difficult as it may be, and I appreciate this may sound futile, you should try as much as you can not to worry. It doesn’t do the pregnancy any good. I do sincerely hope it works out alright for you.

Ovulation in the absence of periods

Question:  Is it possible for someone to ovulate in the absence of menstrual flow? M.M. (UK)

Answer: It is indeed possible for this to happen but it is uncommon. The classic example of ovulation occurring where erratic periods are the norm is in cases of polycystic ovarian syndrome (PCOS). A person with polycystic ovaries can go for months without a period and then spontaneously ovulate. The implication of this is that, if unprotected sexual intercourse coincides with the ovulation, conception could result and the pregnancy merges seamlessly with the preceding absence of periods. Polycystic ovaries as a condition is discussed in detail here:

Immunotherapy for recurrent miscarriage

Question:  I am 42 and 4 1/2 weeks pregnant. I have had 3 miscarriages, the latest one in December. I have had lots of investigations which have revealed I am sub-fertile, have polyps and in March I was told by a specialist at the Portland that anti paternal cytotoxic antibody test results indicated my husband and I were incompatible and would benefit from immunisation therapy (LIT). This consultant is the only 1 who provides this treatment in the UK and when we looked the subject up on the Internet it seemed to be unproven so I never had the required injection. I could have 1 before I'm 6 weeks but that means taking the risk of an allergic reaction which hasn't been tested. I just remain dubious about the benefits of the treatment - do you have any details or advice on LIT?

Also, I am due to fly next week to Barcelona. My GP said it would be ok but given my history do you think it wise? K.B. (UK)

Answer: Recurrent miscarriage is extremely distressing and you will know this more than most. This leaves you under pressure to accept any remedy that appears to offer promise of eventually getting a baby. The issue of immunotherapy for recurrent miscarriage is not new and the hypothesis of possible incompatibility between the couple is probably half a century old. There has been many high quality studies on this but, as you pointed out, no good quality study has shown the benefit of this in improving live birth rates. The use of paternal leukocyte immunization therapy and even intravenous immunoglobulin therapy has been exhaustively scrutinised. Any objective commentator will tell you that it has not shown itself to be any better than placebo. This is from hundreds of studies all over the world. Your situation is not easy. Academic discussions are not what you want and you find yourself in a situation where you are under pressure to decide. You do not want to reach a decision which might put you in a situation where you will look back and say ‘what if...’  All one can do is present the facts and leave you to make the decision. Having said all that; I do hope you are, at least, on low dose aspirin and a low molecular weight heparin (LMWH). The value of this is proven even in the absence of identified antiphospholipid syndrome. Antiphospholipid syndrome is a different condition to the suspected but yet to be proven ‘paternal incompatibility’.

Regarding that trip to Barcelona, I would hesitate making that unless it was absolutely necessary. The flying will not be a risk, but with your history, you may be well-served by eliminating any possible source of stress to your system. That is, at least until you have cleared the crucial first trimester. My best wishes.

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