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Pregnancy Bliss | Reproductive Health Hub

Contact Answers In the News Hot Topics

Conception after a miscarriage

Question:  I had a miscarriage at 8 weeks. The bleeding ended after ten days. I got a very light period 16 days later that lasted 4 days. It was very light and intermittent. Could it be implantation bleeding? My periods are normally quite heavy. J. (UK)

Answer: I get the impression that your miscarriage was managed conservatively, meaning you did not need to go to theatre. That is, of-course, an option that is available when the bleeding at the time of miscarriage is not heavy. However, it also means there is a higher likelihood of rather prolonged bleeding albeit light. In your case that lasted 10 days. It also means resumption of ovulation can be delayed because of the placental tissue retained in your womb for a number of days after the actual miscarriage. Looking at the time-line you have described, I doubt very much you could have ovulated and therefore conceived. It is quite unlikely therefore that what you saw was ‘an implantation bleed’. It is indeed the case that, for some women at least, periods can take 2-3 months to settle into their original rhythm after a miscarriage.

Treating deep vein thrombosis in pregnancy

Question: I have a patient  with 16 weeks of gestation, a primigravida with left common iliac vein thrombosis. Is there a role for venacaval filter? What is the dose of Fragmin to be used for her?  K.R.B. (India)

Answer: A DVT in the iliac vessels is uncommon especially at such an early stage of pregnancy. You have not mentioned whether your patient has identifiable risk factors such as immobility, gross obesity, history of recurrent thrombosis or even confirmed thrombophilia. This may be important in the formulation of your management strategy.

Since it is that early in pregnancy, my view is that a vena caval filter will be valuable and certainly worth of urgent consideration to minimise the risk of embolism.  The recommended dose of Fragmin (Dalteparin) is based on body weight. As a guide, the recommended therapeutic dose for Fragmin is 200 iu/kg body weight per day. It is now recommended that the therapeutic dose be administered in a twice (rather than once) a day regimen. If the woman is below 50 kg in weight, the dose is a standard 5000 iu twice daily; if above 90 kg, it is 10,000 iu twice daily. For body weights in between that range, just calculate on the basis of 200 iu/kg/day and divide in two.

Is there any mileage in checking anti-Xa levels to ensure adequate dose? There is no agreement on the value of this. However, if you want to do this, then the levels should be checked 4 hours after administration of the injection and you should be aiming for anti-Xa levels of 1.0-2.0 u/ml.  Should you check platelet count regularly? Again, there is no consensus on this but since your patient will be on the treatment for several months, it may be worthwhile to keep an eye on the count.

Gastroschisis recurrence

Question: Hi there; Me and my husband have been considering having a third child. With my second pregnancy my child (now 3yrs old) developed gastroschisis and was born early by c-section. I would like to ask what are the chances if i got pregnant again of the pregnancy becoming gastroschisis related and also if i would be able to have a normal birth or have to have a c-section again . Regards. C.G. (UK)

Answer: Gastroschisis, a condition where there is an abdominal wall defect causing part of the intestines (and sometimes other organs) to develop outside the womb cavity is rare. It occurs in roughly 5 in 10,000 births. This means a standard district general hospital will see one such birth every year or so.  Why gastroschisis occurs is not fully understood. What is known is that recurrence for the same mother is quite uncommon calculated at around 3.5%. You may be aware that there are conditions that have a loose association with gastroschisis. Prominent among these is maternal age. This condition does overwhelminglyGastroschisis affect young mothers below the age of 25. It follows therefore that the older you are the less likely it is to affect you. One can only talk in terms of balance of probabilities which would suggest a recurrence being quite unlikely.

Regarding mode of delivery, if everything is normal in the pregnancy there is no reason why you shouldn’t aim for a vaginal delivery. VBAC (vaginal birth after caesarean section) is actively encouraged in such circumstances.

Pregnancy after an ectopic pregnancy

Question:  Hi; I was wondering if u can help me. I am 3 days late and have white discharge i was just wondering could i be pregnant as i have done 2 pregnancy test and they have come back negative. Back in April (3 months ago) i lost a baby and they thought it was ectopic pregnancy. Last month i seen a period and I’m a bit heavier than last time. So please could u help. Thanks. E.H. (UK)

Answer: It is difficult to say whether you could be pregnant. If your periods are normally quite regular, there is a possibility you might be. The doubt is created by the two negative pregnancy tests. With modern pregnancy test kits, that is unusual. In any case, a pregnancy after an ectopic pregnancy is always regarded as high risk. This is because of the increased risk of a repeat ectopic pregnancy. The usual plan is to ensure an ultrasound scan is done early, at about 6 weeks, to locate the pregnancy. Of-course this can only be done after a positive pregnancy test. My advise therefore is that, if your period does not arrive, you should repeat the test a week from now when it will be about 5½ weeks after your last period. If it is positive, then you need to see your GP promptly for that scan to be arranged.

The white discharge you are mentioning has no relevance as far as the potential pregnancy is concerned. Best wishes.

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