We conducted the Ask-A-Doctor at Raffles Medical. We got a huge response and here’s part 1 of the questions.
Thank you for participation. We’ve sorted them into the major categories for your convenience.
You can view part 1 here
General Obstetrics and Gynaecology Question
Response by Dr Koh Gim Hwee, Specialist in Obstetrics and Gynaecology and Consultant, Raffles Women’s Centre
1. How many weeks of pregnancy we have to consult with gynae? Does thigh pain link to miscarriage?
In my opinion, most pregnancy complications occur in the first 9 weeks of gestation. While some women are at higher risk of such complications, there is little we can do in prevention other than advise on adequate rest and giving progesterone hormone medications to supplement the pregnancy hormones. Hence if there is no bleeding problem, the first consultation with an obstetrician can be at 9 weeks of pregnancy. However, if there has been occurrence of bleeding during pregnancy, she should see an obstetrician as soon as possible.
Pregnancy can be detected by a urine pregnancy test as early as 4 weeks plus 2 days. As the urine test may sometime be wrong, a repeat test can be done two days later. I do not think it is necessary to repeat the urine test on the same day. As the pregnancy hormone (HCG hormone) rises rapidly (almost double the level every two days), a repeat test two days after the first will show a much stronger positive result. If the second result is weakly positive or becomes negative, there is a need to see a doctor early for blood test to check the HCG level.
Pelvic ultrasound scans are done to confirm the proper location of the pregnancy in the uterus (womb) and establish that the pregnancy is good. In addition the measurements of the foetus at around 8 to 9 weeks will help us establish the correct gestation of the pregnancy. This is because women have different menstrual cycle lengths. One who has a short cycle of 24 days will have earlier due date than another who has a long cycle of 35 days. The calculation of the due date is based on a 28 day cycle. That means one who has a LMP (last menstrual period) of 1.1.2012 will have a due date of 8.10.2012. This is a total of 40 weeks with the conception occurring on week 2 or Day 14 of the cycle that conception took place. Other women who do not have a 28 day cycle will have the due date adjusted to coincide with the measurements from ultrasound scans. The most accurate ultrasound measurements are at 8 to 9 weeks. The measurements become less accurate the later the pregnancy.
While there can be no symptoms of bleeding or pain in a miscarriage, the occurrence and the amount of bleeding increases the risk of miscarriage. However if there is pain but no bleeding, the risk of miscarriage is not increased. Hence a thigh pain alone does not indicate a miscarriage. An ultrasound scan for pregnancy can be done any time after 5 weeks. The pregnancy sac is too small to be detected before 5 weeks. As for viability, we cannot tell whether the pregnancy is good until after 9 weeks. Pregnancy that occurs in the fallopian tube (ectopic pregnancy) is potentially dangerous as it can cause life threatening severe internal bleeding. Ectopic pregnancy should be diagnosed early by 6 to 7 weeks before irreversible damage is done to the affected fallopian tube.
Once we confirmed the viability of pregnancy after 9 weeks, we will advise a screening test to assess the risk of having a Down syndrome baby. This screening test is also called the OSCAR test (One Stop Clinic for Assessment of Risk) is done at about 12 weeks of pregnancy. The next assessment is done at 20 weeks to check for developmental abnormalities of the foetus. The minimum visits to an obstetrician for a healthy pregnant woman without bleeding are at 12 weeks, 20 weeks and 32 weeks. The third trimester scan at 32 weeks is for growth assessment. She can see her primary health care doctors at other times for monitoring of pregnancy.
2. Is pre-natal massage safe? How soon can a pregnant lady go for one?
Prenatal massage is not required, but some women may find it helpful to relieve aches and cramps. It is safe as long as no massage is done on or around the uterus (womb) and no massage on the breasts. Massage is best avoided when there is bleeding or contractions of the uterus. Breast massage has been known to cause potentially dangerous intense contractions of uterus before delivery.
3. How do you prevent jaundice in a newborn? Are there any foods that we should avoid during pregnancy to prevent it?
Jaundice in baby after delivery occur because the baby is not able to remove the bile quickly from the body. This is due to inadequate enzymes from immature liver or too much bile due to too much breakdown of red blood cells. There is nothing much pregnant women can do in prevention during her antenatal period. Food consumption during pregnancy does not affect baby’s jaundice level. Breast feeding has been known to increase the jaundice level of the baby. This may be due to certain hormones in the breast feeding mother. The usual advice to breast feeding mother is to avoid Chinese herbs like “Dang Gui” and “Danshen” and avoid adding alcohol in her diet. She should also increase her fluid intake to ensure good flow of milk.
4. When can hormones tests be done accurately?
Hormone test are not necessary as long as ultrasound scans are able to monitor the growth of the pregnancy. If any hormone test like the HCG is necessary, it is only useful before 6 weeks of pregnancy. Progesterone level is almost never done in pregnancy as the level does not add value in the assessment of the pregnancy.
5. How do we know we are pregnant if still breastfeeding when there is no menses?
When a woman is breast feeding, she may not have menses for many months. It will be difficult for her to know whether she is pregnant. Bearing in mind that a urine pregnancy test is only able to detect pregnancy at least 17 days after conception, it is better to wait for at least 17 days after sex before she checks for pregnancy. Take note of her body symptoms. There may be sensitive nipples, nausea and giddiness when there is pregnancy.
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