Brown vaginal discharge at 19 weeks gestation

Question: Why do i have dark brown blood discharge doing 19 weeks of pregnancy? I.O. (UK)

Answer: I cannot answer the question ‘why’ but what I can tell you is that any bleed, (and a brownish vaginal discharge is a bleed), is regarded as a threatened miscarriage until proved otherwise. I would urge you to bring this to the attention of your GP promptly. Alternatively, if facilities where you are allow, contact the hospital for an ultrasound scan to be arranged at your local hospital’s Early Pregnancy Assessment Unit.

Miscarriage: Singleton or twins?

Question: I miscarried at just under 8 or 9 wks pregnant which was 3 weeks ago i was still clotting 2 days after so i had an ultra sound but they scanned me really low to check for tissue which had not passed out which was what they found and im just wondering if they could of missed a second baby as twins run on my dads side and my mums side of the family. I had a scan at 5/6 wks but the scan picture looks like it has a little bit of another sac showing at the top right hand side from behind the first sac and i still have the symptoms. So, could they have missed the second baby because of all the tissues as they did not do a d/c on me? I feel crazy for asking because i think i just want it to be the case but hopefully you can put my head straight. R. (UK)

Answer: Whilst I understand how devastating any pregnancy loss can be, it will be dishonest of me to tell you that I can give you a definitive answer to your question. All I can say, however, is that it is very unlikely that a twin would have been missed Diamniotic twins at 6 weeks on the scan you had earlier at 6 weeks. The gestational sacs at this stage are quite distinct. I am wondering whether what you refer to as ‘a little bit of another sac’ was actually the yolk sac. On balance, I think the pregnancy you have lost is unlikely to have been twins. Check this image below to see how a twin pregnancy at 6 weeks appears on a scan.

Absent fetal heartbeat at 8 weeks

Question: What are the reasons for absence of heart beat in 8th week of the embryo? M.E. (India)

Answer: You should never attempt to listen for a fetal heartbeat at such an early stage because it is too early and you won’t be able to hear anything. I take it therefore that you mean no heartbeat is seen on an ultrasound scan. If that is the case, the diagnosis is that of a missed miscarriage. It means the fetus has died in the womb at a very early stage of the pregnancy. Why missed miscarriage occurs remains a mystery in the majority of cases. It is believed, fetal demise in many cases could be due to there being something seriously wrong with the fetus that may be incompatible with life. In other cases, there may be an underlying condition such as anti-phospholipid syndrome which leads to fetal loss, usually early in the pregnancy. Women with antiphospholipid syndrome (discussed here) will tend to have recurrent miscarriage.

Treating swine flu in pregnancy

Question: How do we treat pregnant ladies with confirmed H1N1 infection? A.M.

Answer: There is no significant difference between the treatment of pregnant women and other people affected by swine flu (H1N1 infection). Of most importance is the supportive therapy for those seriously ill. Anti-viral medication, in practise, has a peripheral role, aimed at possibly moderating the intensity and duration of disease. There is a lively debate among experts whether the available anti-virals make that much of a difference. The debate is tilting towards the view that the effect of anti-virals is at best, modest and probably insignificant. In countries such as the UK, the antiviral recommended for pregnant women is Relenza (Zanamivir) mainly because it is inhalational. This means, very little can get to the fetus. This is purely precautionary since the effects of all these antivirals to the unborn baby are unknown. The subject of Swine flu in pregnancy is discussed in more detail here:

Head engagement and timing of labour onset

Question: My baby's head is fully engaged and I’m 36 weeks. Does this mean i can go into labour at any stage? I am also getting tightenings and ripping feelings in the vaginal area and am having some sort of contractions. A. (Australia)

Answer: Head engagement is not a predictor of imminent labour. The head can stay engaged for four , five or more weeks before labour starts. On the other hand, labour can start before the head is engaged. There is, therefore, no direct relationship between head engagement and timing of labour onset. The tightenings you are describing may be more significant. These may be a feature of impending labour, though, even these are not a sure-fire sign.

Previous missed miscarriage

Question: Hello, I had a missed miscarriage back in march but have just found out i am pregnant again. i am very happy to be pregnant again but am also worried that i might miscarry again. i cant wait the 12 weeks wondering if this has happened. If i took a weekly pregnancy test and i had miscarried would it show up on the pregnancy test results? Also, i have a constant dull period like pain, is this normal? ( i am only just pregnant - 4 weeks from my last period). Thank you. C. (UK)

Answer: I understand your anxiety which comes through quite clearly in your question. Pregnancy loss is devastating and leaves a mark. Doing a regular pregnancy test will NOT assure you that the pregnancy is viable. Because in missed miscarriage the still attached placental tissue continues to produce a certain amount of the pregnancy hormone beta-hCG, a urine pregnancy test can continue to be positive for weeks after fetal demise. I do not think the ‘dull period pain’ you describe is significant because at 4 weeks it is far too early for the pregnancy to cause any perceptible symptoms, whatever might be going on. I am sure your doctor will treat your request for an early scan with sympathy and understanding in view of your history. I think that is what you should do when you are around six weeks or so. My best wishes.

Twins in separate sacs at 6 weeks gestation. The little ring seen inside each sac is the yolk sac. This will have disappeared by 12 weeks.