Doctor in Dr. Priyanka's Online consultation clinic
Submit a review for Dr. Priyanka's Online consultation clinicYour feedback matters!
Patient Review Highlights
I found the answers provided by the Dr. Priyanka Singh to be very helpful, professional, sensible and knowledgeable. Yes I found it useful,
Dr. Priyanka Singh provides answers that are knowledgeable. Thank you so much for the suggestion doctor.
I found the answers provided by the Dr. Priyanka Singh to be very helpful. Excellent. Very nice doctor.
Dr. Priyanka Singh provides answers that are very helpful. Thank you for clearing my doubt.
I found the answers provided by the Dr. Priyanka Singh to be very helpful. Thanks doctor
I found the answers provided by the Dr. Priyanka Singh to be very helpful. Thanks
Dr. Priyanka Singh provides answers that are very helpful. Thank you so much mam
Labour is painful - ask your doctor to explain what's available so you can decide what's best for you. Remember that you need to keep an open mind. You may find you want more pain relief than you'd planned, or your doctor or midwife may suggest more effective pain relief to help the delivery.
Self-help in labour
You're likely to feel more relaxed in labour and better placed to cope with the pain if you:
learn about labour – this can make you feel more in control and less frightened about what's going to happen; talk to your doctor, ask them questions, and go to antenatal classes
learn how to relax, stay calm, and breathe deeply
keep moving – your position can make a difference, so try kneeling, walking around, or rocking backwards and forwards
have a bath in early labour
Gas and air (Entonox) for labour
This is a mixture of oxygen and nitrous oxide gas. Gas and air won't remove all the pain, but it can help reduce it and make it more bearable. Many women like it because it's easy to use and they control it themselves.
You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.
there are no harmful side effects for you or the baby
it can make you feel light-headed
some women find that it makes them feel sick, sleepy or unable to concentrate – if this happens, you can stop using it
If gas and air doesn't give you enough pain relief, you can ask for a painkilling injection as well.
Pethidine injections in labour
This is an injection of the drug pethidine into your thigh or buttock to relieve pain. It can also help you to relax. It takes about 20 minutes to work after the injection. The effects last between two and four hours, so wouldn't be recommended if you're getting close to the pushing (second) stage of labour.
There are some side effects to be aware of:
it can make some women feel nauseous, sick and forgetful
if pethidine is given too close to the time of delivery, they may affect the baby's breathing – if this happens, another drug to reverse the effect will be given
the drugs can interfere with the baby's first feed
An epidural is a special type of anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. It shouldn't make you sick or drowsy.
For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour.
An anaesthetist is the only person who can give an epidural. If you think you might want one, check whether anaesthetists are always available at your hospital. How much you can move your legs after an epidural depends on the local anaesthetic used. However, this also requires the baby's heart rate to be monitored.
An epidural can provide very good pain relief, but it's not always 100% effective in labour. One in eight women who have an epidural during labour need to use other methods of pain relief.
How does an epidural work?
To have an epidural:
A drip will run fluid through a needle into a vein in your arm.
While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic, and then introduce a needle into your back.
A very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It doesn't always work perfectly at first and may need adjusting.
The epidural can be topped up through a machine.
Your contractions and the baby's heart rate will need to be continuously monitored. This means having a belt around your abdomen.
Side-effects of epidurals in labour
There are some side effects to be aware of:
An epidural may make your legs feel heavy, depending on the local anaesthetic used.
Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure.
Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby's head (instrumental delivery). When you have an epidural, your midwife or doctor will wait longer for the baby's head to come down (before you start pushing), as long as the baby is showing no signs of distress. This reduces the chance you'll need an instrumental delivery. Sometimes less anaesthetic is given towards the end, so the effect wears off and you can feel to push the baby out naturally.
You may find it difficult to pass urine as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.
About 1 in 100 women gets a headache after an epidural. If this happens, it can be treated.
Your back might be a bit sore for a day or two, but epidurals don't cause long-term backache.
About 1 in 2,000 women feels tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural. You'll be advised by the doctor or midwife when you can get out of bed.
I am 21 years old and from a week I was suffering with malaria. Actually my period should come on 25th August but not yet come till date what can be the reason?
A hysterectomy is an operation to remove the uterus and, usually, the cervix. The ovaries and tubes may or may not be removed during this procedure, depending on the reasons for the surgery being performed. If the ovaries are removed, you will commence menopause. A hysterectomy is a major surgical procedure with physical and psychological consequences.
Why is a hysterectomy performed?
How is this done?
The procedure is normally performed under a general anesthetic and takes approximately one hour. To commence your anesthetic a drip is inserted into your arm. Once you are asleep, you will have a urinary catheter inserted. The importance of the catheter is to reduce the size of your bladder, keeping it away from the operation site and reducing the risk of complications.
There are three ways to remove the uterus:
- Vaginal hysterectomy - The removal of the uterus and the closing of the wound is performed through the vagina. There is no cut in the abdomen.
- Laparoscopic hysterectomy - About four small keyhole cuts are made in the abdomen to divide the attachments of uterus, ovaries, and tubes in the pelvis. The uterus is usually then removed through the vagina.
- Abdominal hysterectomy - The uterus is removed through a cut in the lower abdomen. The cut is about 15–20 cm in length and runs across your abdomen, usually below the bikini line. Less commonly, it may be necessary to have a cut that runs from the belly button down to the pubic area.
What are the risks of undergoing this procedure?
- Although the risks associated with hysterectomy are low, you should be aware that every surgical procedure has some risk. This may also depend upon the type of surgery you have.
- Severe bleeding from large blood vessels around the uterus or top of the vagina. This is not common. A blood transfusion may be required to replace blood loss. A vaginal pack may also be used to control the bleeding.
- Infection in the operation site, pelvis or urinary tract.
- Nearby organs such as the ureter (tube leading from kidney to bladder), bladder or bowel may be injured—expected to happen to approximately one in every 140 women. Further surgery will be needed to repair the injuries.
- The bowel may not work well after the operation; this is usually temporary. Treatment may include a drip to give fluids into the vein and no food or fluids by mouth.
Things to do before you come to the hospital
It is important for you to have all the tests ordered at your outpatient clinic appointment completed prior to coming to the hospital these include blood tests and an ECG and chest X-ray, if you are more than 50 years old
You may be required to have a bowel preparation, which will empty your bowel prior to the surgery.
You should stop eating and drinking at the following times on the day of your surgery unless otherwise notified
At midnight if your procedure is in the morning
At 6 am if your procedure is in the afternoon.
You will need to shower and dress in clean clothes prior to coming into hospital. It is important that you do not shave your operation site as this increases the risk of wound infection.
Please remove all body jewelry.
After your surgery
When you wake from the anesthetic, you will be ready to be transferred, in your bed, for recovery.
Having an anesthetic can make you feel sick and may cause vomiting. You will have a drip in your arm which is necessary to maintain fluid intake and provide pain relief. This will remain in until you can tolerate food and fluids and your pain control is changed to oral medication.
Your nurse will take frequent observations of your vital signs e.g. temperature, pulse, blood pressure.
You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.
If you have pain or nausea, please tell your nurse. Effective pain management is important.
You will have a urinary catheter in place. The catheter will normally be removed the day following your surgery.
Recovering at home
What to expect
You may have a blood-stained vaginal discharge which is similar to a light period. This will gradually reduce to nil over 4-6 weeks as your internal wounds heal
You may need to take some simple analgesia for pain/discomfort, especially on waking and settling at night
You may feel fatigued
You may require up to four to six weeks off work. You should have returned to normal activity by two to three months, depending on the type of surgery, although full recovery may take longer
After the operation, you will no longer have a period
For the majority of women, hysterectomy surgery does not have a negative effect on sexual function
What to avoid
For the first two to three weeks lift nothing greater than two kilograms. Increase gently as tolerated over six weeks.
It will take about three weeks before you should drive a car. Only when you know you can act confidently with emergency breaking should you attempt driving the car.
Avoid sexual intercourse for six weeks to allow healing to take place.
Avoid inserting anything into the vagina for six weeks to allow time for healing to take place (e.g. use sanitary pads and not tampons).
It is important to avoid constipation and straining immediately after your surgery as this will assist healing and improve your comfort.
Contact your doctor if you develop any of the following complications:
Your wound becomes red or inflamed, painful.
You have heavy vaginal bleeding—heavier than a normal period.
You have offensive vaginal discharge.
You develop a fever i.e. temperature of about 38° C, or you are feeling unwell.
You have pain that is not relieved by simple analgesia.
You are having difficulty passing urine or opening your bowels.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Fibroids are benign (non-cancerous) tumours of the womb (uterus). They are also known as myomas. They are growths of smooth muscle and fibrous tissue. The size of fibroids can vary from as small as a pea to that of a melon. At least one in five women develop a fibroid at some stage of their life, usually between the ages of 30-50 years old.
Fibroids are named according to where they are found in the womb. There are three types:
Intramural fibroids are found in the wall of the womb and are the most common type of fibroids found in women.
Subserosal fibroids are found growing outside the wall of the womb and can become very large. They can also grow on stalks (called pedunculated fibroids).
Submucosal fibroids are found in the muscle beneath the inner lining of the womb wall.
The majority of women with fibroids show no symptoms. However, if symptoms develop, they may experience one or more of the following:
Heavy or painful periods- in some cases this can lead to anaemia
Discomfort, or swelling, in the lower abdomen, particularly if the fibroids are large
Urinating frequently, usually if the fibroids are pressing on the bladder,
Constipation which can be caused by the fibroids pressing on the rectum (large intestine leading to your anus), and
infertility Very rarely, fibroids can cause problems during pregnancy and labour
As fibroids rarely have symptoms, they are often found during a routine gynaecological (vaginal) examination. If fibroids are suspected, an ultrasound scan can be used to confirm a diagnosis. A trans-vaginal scan is sometimes used to diagnose fibroids. It involves a small scanner being inserted into the vagina to take a close-up image of the womb.
Fibroids near your inner lining, and those within the cavity of your womb, can be seen directly using a hysteroscope (small telescope used to examine the inside of your womb). To look at the size and shape of the outside of your womb a laparoscope (small flexible tubing used to look inside the abdomen) is used.
If you do not have any symptoms from your fibroids, treatment may not be necessary. Some women with minor symptoms, such as heavy periods, choose not to have treatment as their day-to-day life is not affected. After the menopause, fibroids often shrink, and your symptoms will either disappear or ease slightly.
To treat fibroids, your GP may recommend medication. However, in more severe cases, surgery can be considered.
- Treatment with medication
- Tranexamic acid these tablets are taken from the start of your period for up to four days. The tablets work by helping the blood in your womb to clot, which reduces the amount of bleeding.
- Anti-inflammatory medicines such as ibuprofen and mefanamic acid help to ease your periods and are taken for a few days during your period. They work by reducing your body’s production of a hormone-like substance, called prostaglandin, which is linked to heavy periods. They are also painkillers but are not a form of contraceptive. Common side effects include indigestion and diarrhoea.
- The contraceptive pill is often taken, during your period, to prevent your menstrual cycle (period) from occurring. Some contraceptive pills also help to reduce any period pain you may experience.
- Levonorgestrel intrauterine system (LNG-IUS) is a small plastic device that is placed in your womb and slowly releases the progestogen hormone called levonorgestrel. It prevents the lining of your womb from growing quickly so your bleeding becomes lighter. Possible side effects of LNG-IUS include; having irregular bleeding that may last for more than six months, acne (inflamed skin on the face), headaches, and breast tenderness. The most effective medication to treat fibroids is an injected hormone medicine called
- Gonadotropin releasing hormone agonist (GnRHa). GnRHa works by preventing your menstrual cycle (period), but it is not a form of contraceptive. However, it does not affect your chances of becoming pregnant after you stop using it. Common side effects include menopause-like symptoms, such as hot flushes, increased sweating, and vaginal dryness. Osteoporosis (thinning of the bones) is a less common side effect.
- Surgical procedures Surgical procedures, for treating fibroids, are usually considered for large fibroids (>5cm) or if medications are ineffective in relieving symptoms. Common surgical procedures that are used to treat fibroids include:
- Myomectomy involves surgery to remove the fibroids from the wall of your womb. A myomectomy is an alternative to having a hysterectomy, particularly for women still wishing to have children. However, the procedure may not always be possible as it depends on your individual circumstances, such as the size, number and position of your fibroids.
- Hysterectomy involves surgery to remove the womb. A hysterectomy is not usually necessary unless the fibroids are very large or you have severe bleeding. A hysterectomy may be advised in order to prevent fibroids recurring.
- Endometrial ablation is removal of the womb lining. It is usually only carried out if your fibroids are near the inner surface of your womb. The affected womb lining is removed, which may be done in a number of ways, including using laser energy, a heated wire loop, microwave heating, or hot fluid in a balloon.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Menopause is the time in your life when you naturally stop having menstrual periods. Menopause happens when the ovaries stop making hormones. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years.
The years leading up to menopause are called perimenopause. Cycles may become longer than usual for you or become shorter. You may begin to skip periods. The amount of flow may become lighter or heavier. Although changes in menstrual bleeding are normal during perimenopause, you still should report them to your doctor. Abnormal bleeding may be a sign of a problem.
What are the other signs and symptoms of menopause?
Some women do not have any symptoms of perimenopause or have only a few mild symptoms. Others have many symptoms that can be severe. Common signs and symptoms include the following:
Hot flashes - A hot flash is a sudden feeling of heat that rushes to the upper body and face. It may last from a few seconds to several minutes or longer. Some women have hot flashes a few times a month. Others have them several times a day. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day.
Sleep problems - You may have insomnia (trouble falling asleep), or you may wake up long before your usual time. Night sweats may disrupt your sleep.
Vaginal and urinary tract changes - As estrogen levels decrease, the lining of the vagina may become thinner, dryer, and less elastic. Vaginal dryness may cause pain during sex. Vaginal infections also may occur more often. The urethra can become dry, inflamed, or irritated. This can cause more frequent urination and increase the risk of urinary tract infections.
What types of bone changes can occur after menopause?
During the first 4–8 years after menopause, women lose bone more rapidly. This rapid loss occurs because of the decreased levels of estrogen. If too much bone is lost, it can increase the risk of osteoporosis. Osteoporosis increases the risk of bone fracture. The bones of the hip, wrist, and spine are affected most often.
What do other health risks increase during perimenopause and menopause?
The estrogen produced by women’s ovaries before menopause protects against heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. Midlife also is the time when risk factors for heart disease, such as high cholesterol levels, high blood pressure, and being physically inactive, are more common. All of these combined factors increase the risk of heart attack and stroke in menopausal women.
What is hormone therapy?
Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, a hormone called progestin. Estrogen plus progestin sometimes is called “combined hormone therapy” or simply “hormone therapy.” Taking progestin helps reduce the risk of cancer of the uterus that occurs when estrogen is used alone. If you do not have a uterus, estrogen is given without progestin. Estrogen-only therapy sometimes is called “estrogen therapy.”
How is hormone therapy given?
Estrogen can be given in several forms. Systemic forms include pills, skin patches, and gels and sprays that are applied to the skin. If progestin is prescribed, it can be given separately or combined with estrogen in the same pill or in a patch. With systemic therapy, estrogen is released into the bloodstream and travels to the organs and tissues where it is needed. Women who only have vaginal dryness may be prescribed “local” estrogen therapy in the form of a vaginal ring, tablet, or cream. These forms release small doses of estrogen into the vaginal tissue.
What are the benefits of hormone therapy?
Systemic estrogen therapy (with or without progestin) has been shown to be the best treatment for the relief of hot flashes and night sweats. Both systemic and local types of estrogen therapy relieve vaginal dryness. Systemic estrogen protects against the bone loss that occurs early in menopause and helps prevent hip and spine fractures. Combined estrogen and progestin therapy may reduce the risk of colon cancer.
What are the risks of hormone therapy?
Hormone therapy may increase the risk of certain types of cancer and other conditions:
Estrogen-only therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer.
Combined hormone therapy is associated with a small increased risk of heart attack. This risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy.
Combined hormone therapy and estrogen-only therapy are associated with a small increased risk of stroke and deep vein thrombosis. Forms of therapy not taken by mouth (patches, sprays, rings, and others) may have less risk of causing deep vein thrombosis than those taken by mouth.
Combined hormone therapy is associated with a small increased risk of breast cancer.
There is a small increased risk of gallbladder disease associated with estrogen therapy with or without progestin. The risk is greatest with oral forms of therapy.
Can plant and herbal supplements help with menopause symptoms?
Plants and herbs that have been used for relief of menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness. Also, the way that these products are made is not regulated. There is no guarantee that the product contains safe ingredients or effective doses of the substance. If you do take one of these products, be sure to let your doctor know.
Can vaginal moisturizers and lubricants help with menopause symptoms?
These over-the-counter products can be used to help with vaginal dryness and painful sexual intercourse that may occur during menopause. Vaginal moisturizers replace moisture and restore the natural acidity of the vagina and can be used every 2–3 days as needed. Lubricants can be used each time you have sexual intercourse.
What can I do to stay healthy after menopause?
A healthy lifestyle can help you make the best of the years after menopause. The following are some ways to stay healthy during midlife:
Exercise—Regular exercise slows down bone loss and improves your overall health. Weight-bearing exercise, such as walking, can help keep bones strong. Strength training strengthens your muscles and bones by resisting against weight, such as your own body, an exercise band, or handheld weights. Balance training, such as yoga and tai chi, may help you avoid falls, which could lead to broken bones.
Routine health care—Visit your doctor once a year to have regular exams and tests. Dental checkups and eye exams are important, too. Routine health care visits, even if you are not sick, can help detect problems early.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Combined oral contraceptive pills or “the pill” are a form of daily birth control. The pills contain two naturally-occurring hormones, an estrogen and a progesterone. There are many different types of pills available, each with slightly different types of hormones and hormone concentrations. Pills work to prevent pregnancy by preventing the egg from being released from the ovary, and also by changing the cervical mucous to prevent sperm from reaching an egg.
Pills must be taken every day, at the same time each day, to work properly. Pills are less effective when not taken perfectly. Try to associate taking your pills with something else that is regular and routine. For the typical woman using the pills, it is 91% effective at preventing pregnancy (9 pregnancies in 100 women using the pill for year).
What to do in the case of missed pills:
- If you miss one pill, take the pill as soon as you remember even if it means taking two pills together. Continue taking your pills as usual. No back-up contraception is needed.
- If you miss two pills, take the pill as soon as you remember even if it means taking two pills together. Do not take any earlier missed pills. Use condoms or abstain for the next 7 days.
- If you have had unprotected intercourse, ask your health care provider about emergency contraception.
Advantages of pills:
- Decreased pain with periods and/or lighter menstrual periods
- May improve PMS (premenstrual syndrome) symptoms
- Can decrease risk of uterine (endometrial) and ovarian cancer
- Ability to become pregnant returns quickly when you stop taking the pill
Disadvantages of pills:
- Must take a pill every day, at the same time each day
- Some women experience side effects such as breast tenderness, nausea or change in mood or libido. Most of these symptoms improve with time
- The pill may interact with certain epilepsy (anti-seizure) or anti-retroviral medications
Risks of using pills:
- Venous thromboembolism - Very rarely, a blood clot can develop in the veins of the legs or in the lungs. These conditions can be life-threatening. Use of the pill increases the chance of developing a blood clot slightly. the risk of having a blood clot while taking the pill is approximately 1 in 500.
- Stroke or heart attack - Very rarely, younger women can have a stroke or heart attack. Use of the pill can increase the chance of this happening slightly if you also have other risk factors (such as high blood pressure, smoking or a certain type of migraine headaches).
- High blood pressure - The pill can slightly increase your blood pressure. For most women, this increase is small and does not affect your health.
Pills cannot be used by women who:
- Smoke and are 35 years or older
- Have high blood pressure (hypertension)
- Have certain types of migraine headaches
- Have a history of blood clot (DVT or PE), or if you or a family member have certain blood disorders which can increase the risk for a blood clot
- Currently have, or have a history of breast cancer
- Have a history of stroke or heart disease
- Have abnormal vaginal bleeding that has not been evaluated
- Have liver disease
- Have severe diabetes (with eye, nerve or kidney problems)
- Have recently given birth (within 3-6 weeks)
Tell your doctor if you have any of these risk factors or conditions, or of any other past or current medical problems or concerns. Your clinician will evaluate your history to help you decide if pills are the correct choice for you.
Warning signs – Call your healthcare provider or right away if you:
- Think you are pregnant
- Have been, or might have been, exposed to sexually transmitted disease
- Have unusual pain or swelling in the legs, unusual pain in your chest, or difficulty breathing
- Have sudden change in vision, severe headache, weakness, numbness or difficulty speaking
- Have new or worsening headaches
- Have depression or change in mood
Hi, I'm pregnant for 21 weeks. I took folic acid tablets till 3 months and stopped. Should I continue or stop? I have a doubt. Please help me.
My wife took the unwanted pill for the third time. She had continuous bleeding for 9 days and daily spotting another week. What is the reason?
If you lose a baby before 24 weeks of pregnancy, it is called a miscarriage. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10–20 in 100 (10–20%) pregnancies ending this way. Late miscarriages, after 3 months of pregnancy but before 24 weeks, are less common: 1–2 in 100 (1–2%) pregnancies end in a late miscarriage. When a miscarriage happens three or more times in a row, it is called recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.
Why does recurrent miscarriage and late miscarriage happen?
Sometimes there is a reason found for recurrent and late miscarriage. In other cases, no underlying problem can be found. Most couples are likely to have a successful pregnancy in the future, particularly if test results are normal.
There are a number of factors that may play a part in causing recurrent and late miscarriage:
- Age, the older you are, the greater your risk of having a miscarriage. If the woman is aged over 40, more than 1 in 2 pregnancies end in a miscarriage. Miscarriages may also be more common if the father is older.
- Antiphospholipid syndrome (APS- a syndrome that makes your blood more likely to clot) is uncommon but is a cause of recurrent miscarriage and late miscarriage.
- Thrombophilia (an inherited condition that means that your blood may be more likely to clot) may cause recurrent miscarriage and in particular late miscarriages.
- Genetic factors, about 2–5 in 100 couples (2–5%) with recurrent miscarriage, one partner will have an abnormality on one of their chromosomes (the genetic structures within our cells that contain our DNA and the features we inherit from our parents). Although this may not affect the parent, it can sometimes cause a miscarriage
- Weak cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy. This can be difficult to diagnose when you are not pregnant. It may be suspected if in a previous pregnancy your waters broke early, or if the neck of the womb opened without any pain.
- Developmental problems of the baby may lead to a miscarriage but are unlikely to be the cause of recurrent miscarriage.
- Infection that makes you very unwell can cause a miscarriage. Milder infections that affect the baby can also cause a miscarriage. The role of infections in recurrent miscarriage is unclear.
- An abnormally shaped uterus may contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage.
- Diabetes and thyroid problems can be factors in miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control.
- It has been suggested that some women miscarry because their immune system does not respond to the baby in the usual way. This is known as an alloimmune reaction. There is no clear evidence to support this theory at present. Further research is needed.
Are there any other risk factors?
Being overweight increases the risk of miscarriage. Smoking and too much caffeine may also increase the risk. Excessive alcohol is known to be harmful to a developing baby and drinking five or more units a week may increase the risk of miscarriage.
The chance of a further miscarriage increases slightly with each miscarriage. Women with three miscarriages in a row have a 4 in 10 chance of having another one. This means that 6 out of 10 women (60%) in this situation will go on to have a baby next time.
Why are investigations helpful?
Finding out whether there is a cause for your recurrent miscarriage or late miscarriage is important as your doctor will be able to give you an idea about your likelihood of having a successful pregnancy. In a small number of cases there may be treatment available to help you.
What investigations might be offered?
- For APS- APS is diagnosed if you test positive on two occasions 12 weeks apart, before you become pregnant again.
- For thrombophilia- If you have had a late miscarriage you should be offered blood tests for certain inherited thrombophilias.
- To check you and your partner’s chromosomes for abnormalities. You may be offered this test if your baby has been shown to have abnormal chromosome
Tests for abnormalities in the baby You should be offered tests to check for abnormalities in your baby’s chromosomes. This is not always possible but may help to determine your chance of miscarrying again. If you have had a late miscarriage you may also be offered a postmortem examination of your baby. This will not happen without your consent and you will have the opportunity to discuss this with your health team beforehand.
Tests for abnormalities in the shape of your uterus. You should be offered a pelvic ultrasound scan to check for any abnormalities in the shape of your uterus. If an abnormality is suspected, further investigations may include a hysteroscopy (a procedure to examine the uterus through a small telescope which is passed through the vagina and cervix) or a laparoscopy (a procedure in which a surgeon uses a fine telescope to look inside the abdomen and pelvis).
What are my treatment options?
Treatment for APS
If you have APS and have had recurrent miscarriage or a late miscarriage, treatment with low-dose aspirin tablets and heparin injections in pregnancy increases your chance of having a baby. Aspirin and heparin make your blood less likely to clot and are safe to take in pregnancy.
Having APS means you are at increased risk of complications during pregnancy such as pre-eclampsia, problems with your baby’s growth and premature birth. You should be carefully monitored so that you can be offered treatment for any problems that arise.
Treatment for thrombophilia
If you have an inherited tendency to blood clotting (thrombophilia) and have had a miscarriage between 12 and 24 weeks of pregnancy, you should be offered treatment with heparin. At present there is not enough evidence to say whether heparin will reduce your chance of miscarriage if you have had early miscarriages (up to 12 weeks of pregnancy). However, you may be still offered the treatment to reduce the risk of a blood clot during pregnancy.
Your doctor will discuss what would be recommended in your particular case.
Referral for genetic counselling
If either you or your partner has a chromosome abnormality, you should be offered the chance to see a specialist called a clinical geneticist. They will discuss with you what your chances are for future pregnancies and will explain what your choices are. This is known as genetic counselling.
Monitoring and treatment for a weak cervix
If you have had a miscarriage between 14 and 24 weeks and have a diagnosis of a weak cervix, you may be offered an operation to put a stitch in your cervix. This is usually done through the vagina at 13 or 14 weeks of pregnancy under a general or spinal anaesthetic. Your doctor should discuss the surgery with you.
If it is unclear whether your late miscarriage was caused by a weak cervix, you may be offered vaginal ultrasound scans during your pregnancy to measure the length of your cervix. This may give information on how likely you are to miscarry. If your cervix is shorter than it should be before 24 weeks of pregnancy, you may be offered an operation to put a stitch in your cervix.
Surgery to the uterus
If an abnormality is found in your uterus, you may be offered an operation to correct this.
Taking progesterone or human chorionic gonadotrophin hormones early in pregnancy has been tried to prevent recurrent miscarriage. More evidence is needed to show whether this works.
Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and may carry serious risks (including transfusion reaction, allergic shock and hepatitis).
What if no cause is found?
Where there does not appear to be a cause for recurrent miscarriage or late miscarriage, there is currently no evidence that heparin and aspirin treatment reduces the chance of a further miscarriage. For that reason this treatment is not recommended in these circumstances.
What does this mean for us in the future?
You and your partner should be seen together by a specialist health professional. Your doctor will talk to you both about your particular situation and your likelihood of having a further miscarriage and a successful pregnancy. If a cause has been found, possible treatment options will be offered to you to improve your chance of a successful pregnancy.
For couples where no cause for recurrent miscarriage has been found, 75 in 100 (75%) will have a successful pregnancy with this care. It is worth remembering that the majority of couples will have a successful pregnancy the next time even after three miscarriages in a row.
When you’re ready to take the plunge into parenthood, there’s no way to predict exactly how soon you’ll see a positive pregnancy test. If you’re in pretty good health, and having regular sex without birth control, you should expect to conceive in your first year of trying. In general, about half of couples will get pregnant within 6 months, and about 70%-80% will get pregnant within 1 year. But you and your partner can boost your odds of being parents-to-be by knowing the dos and don’ts of fertility. Set yourself up for success with these guidelines.
Him: Keep Tabs on Your Health
There’s a big connection between your overall health and your reproductive health, so making time for a quick health check can go a long way for your fertility.
Good diet, regular exercise, a healthy body weight, better sleep patterns, less stress -- all those things have been correlated with semen quality. Your doctor can help you make any changes you might need to be your healthiest self, as well as address any issues that might be a barrier to baby-making. Avoid hot baths and saunas- The testicles are a few degrees cooler than the rest of the body, because that's a better temperature for sperm production, so anything that warms them up can potentially be an issue. It takes your body 2-3 months to make new, mature sperm. Another heat source to watch out for: laptops.
Her: Learn How to Read the Signs
All pregnancies start when egg meets sperm. So they need to be in the same place at the same time. To help that happen, you can keep track of when your ovaries release an egg, called ovulation, and have sex during that time frame.
If your cycle is regular (with periods coming 26 to 32 days apart), that may just mean having sex on days 8-19 after your period. If you have irregular periods, you may not be able to rely on the calendar alone to know when you’re ovulating. However, there are other ways your body tells you it’s go-time.
To start, take note of your daily discharge. Cervical mucus increases and becomes very thin, stretchy, and clear as you approach ovulation. Watch for a consistency like egg whites.
You can also track your basal body temperature (BBT), which is your body’s temperature when it’s fully at rest. A rise of 0.6 degrees or more for over 10 days is a sign that you’ve ovulated. But your most fertile time is 2-3 days before that boost. When you track it for a few months, you’ll get an idea of when you might ovulate on your next cycle. For a more precise measure of those pre-ovulation days, you can buy an ovulation predictor kit from the drugstore. It tests your urine for hormone levels that spike a few days before ovulation.
Watch your weight: extra pounds make you more likely to have irregular menstrual cycles, or to not ovulate at all. Losing even a small percentage of body weight can increase fertility and decrease health risks during pregnancy.
Being too thin impacts fertility, too. Not only are you more likely to have irregular periods if you’re underweight, you’re also at risk for preterm birth once you do get pregnant, and your baby is more likely to be born at a low birth weight.
It's fine to get in some moderate activity. But engaging in strenuous, vigorous and extreme exercise might impact your menstrual cycle, leading to infertility. So, pass on the marathon when you're trying to get pregnant.
Both: Timing of intercourse
Once you’ve got a handle on your fertile window, set a good schedule for sex. We recommend couples have sex about every other day from a few days prior to ovulation until a few days after. Doing it more often doesn’t hurt your odds, but there are some studies that show it may lower a man's sperm count.
Before trying to concieve, review your medications with your doctor to be sure they don’t affect your fertility -- or won’t cause harm to a future baby.
Birth control pills use these hormones to prevent pregnancy. But if you’ve recently stopped taking them, there’s no need to fret about a post-pill waiting period. Your body should be ready to conceive right away, even if you took them for years. The length of time you used any form of birth control doesn’t affect your ability to get pregnant. Taking a daily folic acid supplement not only helps prevent birth defects, it may increase fertility as well.