A miscarriage or not a miscarriage

Question: I have been having early pregnancy symptoms (cramping, headaches, lightheadedness, etc) for the last 2 weeks--as I did with my 2 previous pregnancies. I took a home pregnancy test the day my period was suppose to start and it was negative. However, the cramping continued and so did the symptoms--about 4 days after my expected period was to start, I have started to bleed (bright red) which my periods are not. I am still having cramping with the bleeding. Could I still possibly be pregnant or is this a miscarriage or something else? C.L (USA)

Answer: The first question I am called upon to answer is, were you indeed pregnant? The honest answer to this is ‘I don’t know’. With a vaginal bleed appearing four days later than expected, it is entirely possible that what you are witnessing is simply a delayed period. A delayed period normally occurs if you have not ovulated in the preceding cycle. With this, the character of the bleed can differ significantly from your norm. This is because, without ovulation, the build-up of the lining of the womb continues unchecked. The subsequent bleed can be heavier than usual.

It is of-course still possible that you were pregnant and the pregnancy test was false-negative. In that case, what you have witnessed over the last few days is an evolving early miscarriage. Sometimes it can be difficult to know for sure what has taken place. All in all, with the limited information I have, I think it is safe to say there is very unlikely to be an ongoing pregnancy. If you continue to have significant symptoms over the next couple of days or so, contact your new GP to see whether a hospital blood test to quantify the pregnancy hormone beta-hCG can be arranged. I think it is unlikely you will need this.

Am I pregnant?

Question: I had a miscarriage on 4 months ago and started having unprotected sex about a fortnight after that fairly frequently. Just before my last period on **/**/**** (12 days ago) that lasted 3-4 days(normal) I've experienced bloatedness & a little nipple tenderness. Still having unprotected sex before & once during my last period.

It's almost 2 weeks since my last period & I'm experiencing all of the above, i.e. dehydration (drinking a lot more) exhaustion (needing a lot more sleep than usual), going to the toilet more frequent than normal & nipples feeling more sensitive & I've taken a Pregnancy test today which states I'm negative?!?... Could it be I could still be pregnant but the results will show up on my next period? K (UK)

Answer: I am not at all surprised that the pregnancy test is negative. You say your last period was 12 days ago and that it was normal. I am guessing that your cycle is the usual 28 days or there about. You are now approaching mid-cycle. The possibility of pregnancy is remote to non-existent.

I agree the symptoms you are describing are similar to early pregnancy symptoms but you will agree with me also that such non-specific symptoms cannot be used to conclude one is pregnant. You get these with many other conditions. Yo are probably keen to conceive again hence your heightened sense of anticipation. That’s completely understandable. I hope it happens for you soon but this clearly is not it.

Size of the gestation sac or fetal pole?

Question: Hi, If pregnancy size defined as +0.66cm-*1.00cm how many weeks already been? A (Singapore)

Answer: I am afraid it is not possible for me to answer your question specifically. Is the size you are referring to (presumably from an ultrasound scan) that of the gestation sac or the baby? If it is the baby, is this what is termed CRL (crown-rump length) or ‘fetal pole’ where the length from the top of the head (crown) to the bottom or breech (rump) is measured in early pregnancy? It is important to know exactly what you mean otherwise my answer could be misleading. Just as a guide, a CRL measurement of 66mm (0.66cm) will be seen in a fetus of about 12 -13 weeks gestation. A gestational sac is not usually measured after 6 weeks and instead fetal measurements are used.

Alcohol after a miscarriage

Question: Is it OK to consume alcohol after a miscarriage? L (Australia)

Answer: The usual considerations apply when it comes to alcohol intake after a miscarriage. Pregnancy is no longer in the equation so plays no role. You do as you would in a non-pregnant state.

Absent sensation after forceps delivery

Question: My daughter has just had her first baby with forceps used she said she hasn’t had any pain what so ever during and after labour and now she has no feeling at all. She doesn’t know when she needs to go the toilet the baby weight was 6lb 9oz and she is only 4 ft 11 inches. I would be grateful for any information you may have. M.M (UK)

Answer: The absence of sensation bothers me. I am assuming your daughter had an epidural for pain relief during labour. That would explain her being pain-free both during and after. An epidural would of-course abolish the sensation which gives a person the urge to pass water. That is why there is always a urinary catheter inserted in such circumstances. Once delivery is completed, the effect of the epidural wears off gradually and in a few hours, the person is supposed to have the sensations back. When you say she has no feeling I take it to mean that she is numb.

With the limited information I have, I would guess that she is experiencing prolonged effect of a very dense epidural. However, even the effects of such an epidural should wear off and be completely gone twelve hours after. If the duration since the epidural was finished is more than that, this needs to be looked at as a matter of urgency. If she did not have an epidural (or spinal), the advice is the same.

Slow fetal heart rate in early pregnancy

Question: I am currently in my eighth week and my vaginal scan indicates that the foetus' heart rate is too slow (70 bpm). What is the likelihood of this being a viable pregnancy? Other than rest, is there anything I can do? L.U (Hong Kong)

Answer: Such a slow fetal heart rate is a legitimate cause for concern. Studies show that when this feature is found, approximately 60% of these babies are lost within the first trimester. It is important therefore to ensure that a close eye is kept on the baby by performing regular scans, at the very least, once a week. A substantial proportion of these babies are found to have a normal heart rate on a subsequent scan. However, even for those, miscarriage in the later phase of the first trimester and early second trimester is still well above average.

There isn’t much that you can do to influence this. Even rest that you appear to want to do is not known to have any effect on eventual outcome. In some cases, it might be counter-productive as it can be associated with a state of perpetual anxiety. I hope it all works out well for you.