Pregnancy Complications

Sadly some women experience complications during pregnancy and these can often occur in the first trimester. It is vital to keep an eye on your body throughout your pregnancy and if you notice any of the warning signs seek medical help quickly:

Key warning ‘red flag’ symptoms include:

• Vaginal bleeding
• Abdominal pain
• Excessive nausea and vomiting
• Dizziness and shoulder tip pain

If you think you are suffering with miscarriage or ectopic pregnancy please contact us on [telnumlink]0207 10 11 700[/telnumlink].

 

Miscarriage

How common are miscarriages?

Early pregnancy miscarriages are common and 1 in 5 early pregnancies end in a miscarriage. This may present with pain and or bleeding or may be identified only at the time of the first scan.

How is a miscarriage diagnosed?

A miscarriage is diagnosed by an ultrasound scan and can be a missed miscarriage, an anembryonic pregnancy or blighted ovum and a repeat scan is commonly needed to confirm.

How are miscarriages managed?

• Expectant management: A miscarriage can be managed expectantly, ie expecting the pregnancy tissue to come away spontaneously. This is usually associated with pain and or bleeding.  A follow-up appointment is arranged in 7-10 days and in some cases a surgical procedure is needed to remove all pregnancy tissue.
• Medical management: This is done in 2 stages with oral tablets on day 1 followed by a vaginal tablet after 24-48hrs. In a small proportion of cases this may not work and a surgical procedure is needed to remove all pregnancy tissue.
• Surgical management: This is a surgical evacuation of the retained pregnancy tissue under a short general anaesthetic.

Will I be able to find the cause of my miscarriage?

Following a miscarriage any acquired pregnancy tissue is sent for histological examination. In cases of two or more miscarriages, certain tests can be carried out on the pregnancy tissue and blood tests in the mother to determine if there is a preventable cause of miscarriages, however despite these investigations many miscarriages remain unexplained but approximately 75% of women go on to have future successful pregnancies.  This statistic worsens as maternal age and number of miscarriages increase.

Can I help prevent future miscarriages?

RCOG guidelines for recurrent pregnancy loss state “the value of psychological support in improving pregnancy outcome has not been tested in the form of a randomised controlled trail.  However data from several non-randomised studies have suggested that attendance at a dedicated early pregnancy clinic has a beneficial effect, although the mechanism is unclear.”

Ectopic Pregnancy

If you think you may have an ectopic pregnancy, please either call us on 020 7101 1700 any time of the day and it may be possible to be put through to Mr or Mrs Pisal or go to your nearest Accident and Emergency department.

What is an ectopic pregnancy?

99% of conceptions are normally situated inside the uterine cavity. However, in a small percentage of cases, the pregnancy may be outside the uterine cavity and is known as ‘ectopic pregnancy’.

Fallopian tube is the commonest site of an ectopic pregnancy. Very rarely, it can also be situated within the abdominal cavity, ovary, cervix or caesarean section scar.

An ectopic tubal pregnancy can grow and rupture. This can lead to bleeding inside the abdomen which can sometimes be serious and life-threatening.

Symptoms associated with an ectopic pregnancy

Most ectopic pregnancies are now diagnosed at an early stage because of advances in pregnancy tests and ultrasound scans. A positive pregnancy test with an empty uterus on ultrasound scan could be a very early pregnancy, but could also be an extra-uterine pregnancy and should be followed up. A combination of a missed period, pelvic pain and/or erratic or minimal vaginal bleeding is the commonest presentation. Shoulder-tip pain, dizziness or fainting may also be present.

Sometimes, ectopic pregnancy can cause serious bleeding in the abdomen causing severe pain, abdominal distention and shock due to excessive internal blood loss. Fortunately, this presentation is now becoming rare due to early diagnosis.

How is an ectopic pregnancy diagnosed?

B-HCG (pregnancy hormone) level over 1000 U/L and transvaginal scan showing an empty uterus is the commonest way of diagnosing an ectopic pregnancy. A tubal pregnancy may sometimes be visualised on the scan along with free fluid in the abdomen. On examination, there may be tenderness on palpation of abdomen and sometimes rebound tenderness (it hurts on pressing, but hurts more when the pressure is taken off) which can indicate internal bleeding. On vaginal examination, there may be cervical excitation and tenderness in the adnexal region.

Risk of ectopic pregnancy is increased by:

• Previous history of ectopic pregnancy
• History of endometriosis, pelvic infection or previous pelvic or tubal surgery
• IVF pregnancy
• Pregnancy conceived while using minipill (progesterone only pill) or intrauterine device (IUD, coil)

How is an ectopic pregnancy treated?

There are three main ways of treating an ectopic pregnancy:

1. Surgical (laparoscopy): This involves introducing a camera (endoscopic) into the abdomen to visualize and confirm the ectopic pregnancy. Pregnancy can sometimes be removed and the tube saved (salpingostomy). However, usually, removal of the involved tube (salpingectomy) is necessary.
2. Medical treatment: In selected cases, medical management of an ectopic pregnancy using an injection of methotrexate may be considered. This option is not available privately.
3. Expectant management: This is an option where natural resolution of an ectopic pregnancy is allowed with very careful monitoring of blood HCG levels.

What precautions should be taken in future pregnancies?

There is an increased risk of a further ectopic gestation in subsequent pregnancies. This is estimated at 10%, or higher if the other tube looks abnormal or unhealthy, so there is still a good chance the pregnancy will be in the right place (intrauterine). A scan is recommended between 6 and 7 weeks of gestation to confirm that the pregnancy is normally situated.