Risk of fetal anomaly recurrence

Question: My sister is 36 years old . She has 3 sons and they are well good . But in her 4th pregnancy she got a baby with cleft palate with small head and died and finally in her last pregnancy she got a fetus with anencephaly and aborted in 4th month . Do you advise her for pregnancy in the future? H. (Egypt)

Answer: This is a tragic story. With a history like that, I have to say, the probability of having another child with a serious congenital anomaly is rather high. If there has been no change in partner, the consecutive nature of two pregnancies so affected could either be pure chance or there is an unidentified predisposing factor. Since it appears she had these two pregnancies in her early to mid-30s, age is unlikely to be a factor. It is neither possible nor right for me to tell your sister whether she should try for another baby or not. However, she should be aware that there is a real possibility the outcome will not be good.

‘PID’ in pregnancy?

Question: I am a carrier of sickle cell and I am 4 months pregnant. I have been diagnosed with PID. I have been on several antibiotics but it can’t go away. Pls help. S.M. (Zambia)

Answer: PID (pelvic inflammatory disease) in pregnancy is an extremely rare occurrence that it can almost certainly be discounted as a cause of the symptoms that you have. You have not said what those symptoms are that led your doctor to ‘diagnose’ PID. In theory, it is possible to conceive with pre-existing pelvic infection but in most cases this situation will lead to early miscarriage. Pelvic inflammatory disease (PID) developing during pregnancy cannot occur. If that is what is being suggested, I’m afraid your doctor is wrong. If the problem is pelvic pain, then a cause other than PID needs to be found. If the problem is a vaginal discharge then you may simply have vaginal thrush or bacterial vaginosis. Neither of these is PID. With bacterial vaginosis there is a small risk of preterm labour. A vaginal swab should be able to establish whether you have bacterial vaginosis and treatment with Clindamycin vaginal cream is both safe and effective. Best wishes.

4/5th head engagement

Question: What does 4/5 engagement mean? What is cephalic? What is posterior high? B. (UK)

Answer: it is clear you have been looking at your (or somebody’s) pregnancy notes and scan reports. Well, let me clarify these:

Pregnancy with fibroids

Question: I am 43 yrs and just found out i am 7 weeks pregnant, I also have fibroids; 5 to be exact. What kind of complication could I face if I go through with the pregnancy? M. (UK)

Answer: Congratulations! You have not said whether this is your first and what size these fibroids are. In fact fibroids, on the whole, don’t tend to be a significant problem in pregnancy. The number is also unlikely to be significant. Potential problems can arise as a result of size and location of the fibroids. Very large fibroids can undergo what is known as ‘red degeneration’ during pregnancy whereby the core of the fibroid virtually liquefies. This can cause severe ongoing pain. It is uncommon. Large fibroids which have a thin stalk and located outside the uterine cavity can undergo torsion which will cause acute severe pain usually requiring emergency surgery. This type of fibroid is uncommon. Fibroids located inside the uterine cavity (submucosal) can distort the cavity making it difficult or impossible for the baby to lie in a normal head-first position. That situation will mean vaginal delivery is not possible. Having said all that, the majority of women with fibroids, even big ones and yes; even those with multiple fibroids, tend to have uneventful pregnancies.

Breast milk has dried up

Question: I have been breastfeeding my baby for the past 16 wks and all of a sudden tonight my milk stopped, i even expressed today. I am on my 6th course of antibiotics (Moxiclav Duo 200/125)would that have anything to do with it? I'm also on Pariet EC

I'm really worried i don't want to stop breastfeeding. I fed my first baby for ten and a half months and could’ve fed for longer still. I normally have no shortage of milk, at one stage i was changing my breast pads 2 times a day. What's going on. Please help. B.L. (Australia)