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Pregnancy Bliss | Reproductive Health Hub

Contact Answers In the News Hot Topics

Early miscarriage or endometrial cast?

Question: I was a few days late, the days leading up to my late period, I had almost like stretching pains.  My breasts are usually tender and painful before my period, but they were more full this time.  I finally did get my period, but I had cramps from the morning, felt like someone had cut me just below my navel, Towards the evening I started to spot, wasn’t sure if it was my period so I wore a pad. Later, did have quite heavy bleeding with clots.  Yesterday being the fourth day, did bleed moderately, however when I did go to the ladies, I found a single piece of tissue on my pad, it was surrounded by a dark clot, the tissue itself was a orangey colour and in the middle was another long piece of tissue, a creamish colour. Looked more like a vein or something.  Could this have been an early pregnancy and a miscarriage?  If not what is the cause of the late period and the clotting?  What can I do? Z.S. (South Africa)

Answer: What you have described could be one of two events: An early miscarriage or a passage of what is known as an endometrial cast. The behaviour of the two is quite similar and fit the picture you are painting here. You will, of course, know what an early miscarriage is. An endometrial cast describes the piece or pieces of tissue of varying sizes passed after a woman has had a longer than usual cycle. Such a cycle is usually caused by having not ovulated in that month. This sometimes created a situation where the lining of the womb gets built up to an abnormal thickness. That is brought about by the estrogen stimulation which is unopposed. Eventually the lining becomes so thick that the blood supply is no longer sufficient. The culmination is the breakdown of the lining with it being passed as a large piece of tissue or tissue pieces.

Because the bleeding tends to be abnormally heavy and occurs days after when it was expected, it is easy to see why this is sometimes confused for an early miscarriage, unless the woman had not been sexually active prior. It will be difficult in your case to know whether it was one or the other. In any case management in both situations is expectant. In other words, you do not need to do anything as, whether it was one or the other, it should resolve spontaneously in the next couple of days or so.

ECV for a breech baby in a previous caesarean section

Question:  I’ve been told my baby is breech. The doctor told me that she could try to turn him but Im not so sure. Is this safe? This is my second baby and my first was a caesarean 4 yrs ago. Im a little scared. Pls help! P. (UK)

Answer: Trying to turn a breech presenting baby is meant to give you a chance for a vaginal delivery. In the UK and most other countries, singleton Term babies leading with a breech are not delivered vaginally any more. That means, if your baby remains breech, you will have to have another caesarean section. Although this is not universally accepted by all obstetricians, there is growing consensus that, barring any other risk factors, a woman with only one previous caesarean section can and should be offered an ECV. ECV or External Cephalic Version is the name used to describe the manoeuvre employed to turn the baby from breech to head first. There is no evidence that doing this in a woman with a uterine caesarean scar is any riskier than doing it on one with no previous history of uterine surgery. It is therefore a reasonable and useful option to consider. If you have had more than one caesarean section, ECV would not be offered for the simple reason that a vaginal delivery is not offered anyway so there would be no benefit in doing that. I hope you will give it serious thought.

Dermoid cyst in pregnancy

Question: I had a scan the other day and doctor said I’ve got a dermoid cyst. Will this harm the pregnancy. I am just over 4 months now? What’s a dermoid cyst? K.O. (St. Kitts & Nevis)

Answer: Please do not worry. A dermoid is a completely benign cyst arising from the ovary. It may cause alarm when you hear that it tends to contain various types of tissue which may include hair, skin, thyroid, teeth etc.) Dermoid cysts are not uncommon. It should have no effect whatsoever on your pregnancy. You may be offered surgery, either open or by keyhole (laparoscopic) after you have had the baby. Alternatively, were you to have a caesarean section for whatever reason, the opportunity could be taken to remove the cyst at the same time. Enjoy your pregnancy.

Anti-D after an early miscarriage

Question:  I recently had a miscarriage at 5 weeks. I did not get an anti-D. A midwife I know has told me that I should have been given one and that it is now too late. Now I’m worried!! Z.A. (UK)

Answer: The midwife is misleading you here. If the miscarriage was indeed that early, anti-D is not  required and is not usually given. The management offered was correct. It is true that some women with early miscarriage are given the anti-D injection but this is usually precautionary if they don’t seem to be certain of the gestation. Another situation where anti-D is administered following an early miscarriage is where surgical evacuation of the uterus (D&C) has been required.

Wearing a seatbelt during pregnancy

Question: What is the correct type of seatbelt to wear when pregnant? I am just worried that the belt is going across my bump and could harm the baby if there is a sudden stop. A.F. (Canada)

Answer: You definitely need to use a seatbelt even if pregnant: Safe mum, safe baby. As for the type of seatbelt, avoid the two-point strap found in the middle back-seat of someseatbelt in pregnancy (usually older) cars. You should use the three-point seat-belt with a lower strap and shoulder strap. Now, make sure the lower strap is below the bump and across the hips. The shoulder strap should fall between your breasts and on to the side of the bump (never across). That keeps you safe and your baby is consequently safe.

More questions and answers on the next page

Three point restraint belt, in between the breasts , to the side of the  belly and across the hips. You  and your baby are safe.