Question: How can you define prolonged labour? Can you please group the causes? How can you manage a woman presenting with fibroid complications at 28weeks gestation? P.O. (Kenya)
Answer: As you might have seen in the text on the site, prolonged pregnancy is any gestation that goes beyond 42 completed weeks. You will be aware that this is counted from the date of the first day of the last menstrual period. In an ideal world this will, strictly speaking, apply to those women whose menstrual cycles are 28 days. For practical purposes, it is applied to everybody.
I am not entirely sure what you meant by ‘fibroid complications’. If the woman in question presents with pain identified to be due to possible fibroid degeneration, the management is conservative, with pain-control in a bid to buy time for fetal maturity. Steroids will also be administered to help fetal lung maturity in case intervention becomes inevitable. If the woman has a pedunculated sub-serosal fibroid, and if this undergoes torsion, there is no option but to operate and remove the fibroid to alleviate the symptoms. All efforts should be made to avoid surgical intervention if at all possible to try to avoid premature delivery.
Question: What does a thick sticky vaginal discharge at 39 weeks of pregnancy mean? M (Sri Lanka)
Answer: If this is a mucous-like discharge, clear or blood-stained, it is likely to be what is called a ‘show’. Basically it means there is silent gradual dilatation of the cervix and the mucous plug has been released. It is usually a pre-cursor to labour onset which can be expected within hours or, at the latest, a couple of days. If the discharge you are describing is different from this, it is best to get this checked out by a midwife or doctor.
Question: I have about a week before my period is due.My breasts are incredibly sensitive and I am very tired.My concern is I have a brown discharge when I go to the toilet it is not in my underwear and I have had it for about a week. Please can you help me) C.N (UK)
Answer: Your symptoms sounded to me like an impending period more than anything else. This can happen especially if you have just come off the pill. It could also simply mean you have a cervical polyp causing the discharge. Another less common cause is what is called a cervical ectropion (also called an erosion). This is completely benign. Are you up to date with your smears? The sensitive breasts are clearly a progesterone hormonal effect as you get near your period.
Question: My son was born at 22 weeks with anencephaly. As it is more common in girls, does this mean as I had a son there will be a higher risk of it happening again? S (UK)
Answer: It is important to bear in mind that recurrence is uncommon anyway. The gender of the affected baby does not affect rate of recurrence. The only significant factor in this is if there is an associated genetic or chromosomal defect. In such a case, the rate of recurrence is high, in the region of up to 25%, irrespective of what the gender of the baby was.
Question: If a woman with a gestational period of 15 weeks is suffering from chickenpox,should she be advised termination of pregnancy? S.S (India)
Answer: There is very little, if any, justification in advising a pregnant woman to consider a termination simply because she has acquired chicken-pox. Remember, at that gestation, the baby has more than a 90% chance of being completely unaffected. What’s important is to ensure the prospective parents are properly counselled as to the small but significant risk of the baby being affected and what the problems could be. For quick reference, those are listed
Question: How early are symptoms of pregnancy visible? K (India)
Answer: I will start by correcting a slight misconception in the question. ‘Symptoms’ are what the pregnant woman feels and not what is visible to other people. What others see would be described as ‘signs’. Now that we have cleared that, let’s go back to your question:
To the woman herself, the symptoms of pregnancy such as breast engorgement and tenderness, nausea etc are felt fairly early, sometimes as early as within a week of missing her period. This, however, varies widely and some women can go for two or three months without being aware they are pregnant. To the outside world, outwardly signs of a woman’s pregnancy are normally not apparent until after 12 weeks of gestation when the bump may start to appear. Visible signs tend to appear earlier in a case of multiple pregnancy such as twins etc.