Making Babies: Early Pregnancy Complications

0:00Lunchtime Live with Andrea Gilligan on News Talk. Making babies on Lunchtime Live, Professor Shane Higgins, consultant and obstetrician and gynecologist at the National and maternity hospital at Hollis Street is with me in studio today. Shane Housethings, of course we were done at Hollis Street last Wednesday for a special program and great to be able to see, you know what happens inside the facility like it's a huge operation. Yeah, and look, there was phenomenal feedback from patients and staff. It was great to have an audience in the room and thank you and your crew for coming down and paying us a visit. Now, we're here today to talk about some of the early pregnancy problems that people encounter. How common are they, first of all? Oh, very, very common. You know, we deliver over 7,000 babies a year in Hollis Street, but there'd be at least another 1,500 pregnancies that don't survive, that patients who have miscarriages, ectopics, later pregnancy losses.

1:01So it's very common and I think that's one of the things I say to my patients is, you know, they're often fearful of talking about the experience of a miscarriage. I say, you'll be absolutely surprised at how many of your friends and relatives have had miscarriages if you're brave enough to speak to them about it. And that's just how common it is. What are we talking about? Well, you're primarily, so I suppose the complications that people don't want to experience are things like miscarriage and ectopic pregnancy. But then there's other things like hyperemesis, excessive nausea, vomiting and pregnancy, which a lot of patients, in fact, all patients will tolerate as long as the pregnancy is going well. It makes them very unwell for some of them. But the ones that we kind of generally talk about in terms of early pregnancy complications would be pregnancy loss through miscarriage and ectopic. And I know you were talking to Brenda Casey last week and we have a bereavement service and it's important also that patients access these services. It's not just an early pregnancy. It is the loss of a baby. It's the loss of something very precious to a couple. And I think they need to be given the additional unnecessary supports to allow them to recover

2:07from that. And tell us about this, maybe the symptoms. And I'm just trying to think maybe of people listening today that have gone through. There's some, I'm sure it's difficult to hear or perhaps if you are pregnant. It is worth maybe highlighting some of the symptoms that people should look out for. Well, until you've had your first ultrasound scan, you won't be certain as to where the pregnancy is and whether it's well or not. And that's why a lot of patients will go for early pregnancy scans at eight or ten weeks just to give them that reassurance. But typically the symptoms associated with that type of complication would be pain in your lower tummy, cramping and some bleeding. And if you have either of those symptoms and you've missed a period and you have a positive test, then it is important that you go to your local maternity unit to the early pregnancy service there and get a scan to establish whether the pregnancy is viable and to establish if it's in the right place. And I suppose singling ectopic pregnancies out if you have pain and either the left lower tummy or the right lower tummy, it's even more important that you go and get the pregnancy

3:08assessed because there that's a pain at typically associated with an ectopic pregnancy where the pregnancy is developing outside the body of the uterus and most commonly we find it in the philopian tube. And that's what happens during the ectopic. That's what happens. And the topic of the pregnancy means it's not growing in the body of the uterus or it could be in the cervix, it could be in a scar from a previous zaryn section. Philopian tube, ovary or even an abdominal pregnancy where the pregnancy is attached to some other part of the abdominal cavity. And why does that happen? Well we know it's associated with certain things like the use of the interuser and contraceptive device, smoking, history of pelvic inflammatory disease, endometriosis. But in a lot of cases we just don't see any known association with it. So the egg and sperm are released, or the sperm travels through the female uterus into the philopian tube where it meets the egg coming from the ovary in the opposite direction. Fertilization takes place. And then the tube must carry that fertilized egg into the body of the uterus where it attaches to the wall of the uterus.

4:09So you can imagine how it can go wrong and it's quite surprising that it doesn't go wrong more frequently than it does. But if that doesn't go according to plan then the pregnancy will end up attaching itself, as I said, most commonly to the philopian tube, but it can attach elsewhere. And it's a very serious, you can call it, guinea or obstetric complication because the philopian tube isn't built, isn't made to contain a pregnancy. So the pregnancy would quickly erode through the wall of the philopian tube and cause quite significant and very dangerous bleeding. But I presume if you're having an ectopic pregnancy, you'll know about a pain wise, well, yeah. Well, that's typically the presenting complaint. It's got pain on your left or right lower tummy. And you've got maybe some vaginal bleeding, but that pain can be indicative of the fact that the philopian tube is about to rupture and that's where the very heavy intra-dominal bleeding can take place. Textures wandering, Shane. I've had one early miscarriage and one chemical pregnancy. I'm wondering what are my chances of conceiving again.

5:10I'm 34 and trying for two years. Excellent is what I would say to you. There's a term that's used to describe patients who have a consecutive successive pregnancy losses and they are called recurrent miscarriers. And historically, it used to be three consecutive losses. And it's only when you start to reach that number that it has an impact on the chances of a subsequent pregnancy being successful. So until you've had a number of pregnancy losses, your chances of a successful pregnancy are very high. And you almost shouldn't kind of worry about getting pregnant again. Just do so early pregnancy scan. There are some medications that are now being used in patients who've had pregnancy losses like aspirin and progesterone. So speak to your GP or your obstetrician or midwife about those medications. What's a chemical pregnancy? Chemical pregnancy is where you come in, you've missed a period, you have a positive test. On a urinary HCG test and then you have a period a few days later. So you have no clear features, no clear determination of where the pregnancy was.

6:12And it's almost failed before you get to that stage where you can go for scan. So it's very, very early positive test followed by a period and then a negative test. Texter wondering, his wife had an awful hyper-emesis with her son. We would love a second child, but I don't know if it's going to be realistic considering just how well she was the first time. Is there anything that can be done though to try and prevent it? There's nothing you can do to try and prevent it, but I would caution the listener. It doesn't always recur in successive pregnancies. And we've all, anyone who's looked after patients will know patients who have dreadful pregnancies and then very good pregnancies or the other way around. There's a lot of treatment that can be afforded to the patient during the pregnancy. It's just a venous fluids, electrolyte correction, vitamin complex, medication like caribans, stemmital, they're all medications that can be used. If you're going down that sort of replacement pharmacological route, there's the homeopathies, there's acupuncture, acupressure, ginger, all of those things.

7:13You don't know what's going to work and you don't know if anything is going to work, but there's a lot of treatments that can be offered to patients who are suffering from excessive nausea and vomiting. Just a question, just a comment, we experienced a pre-prone with our daughter who was born pretty sick past a way just three days later and another miscarriage too. We found Hollis Street amazing. The support we got was great. We now have two daughters, four years and eight months, I just wanted to make the comments that the work they do is amazing. And I wanted to say thank you. Is this listener's thoughts? Thank you very much. Very much. A very difficult experience. Another text you're wondering, bleeding in early pregnancy, is that always a sign of miscarriage? Not necessarily. We make an assumption when somebody comes in with bleeding in early pregnancy that it's coming from inside the uterus and where the pregnancy is attached. But we also make every effort to try and see if there's a local cause like a cervical erosion or a cervical polyp. And they can be also contributing to the vaginal loss of the patient's experience. But even patients where you don't find another cause and you assume it's coming from inside

8:14the uterus, they don't all end in miscarriage either. And you made that point because there's more text on that too, that even if you've had an ectopic pregnancy previously or you've had a miscarriage, it doesn't necessarily mean that'll happen again. Absolutely not. Obviously, if you've had a history of pelvic inflammatory disease or another reason as to why you might have an ectopic, that may increase your risk of an ectopic in a subsequent pregnancy. But it doesn't mean for certain that it's going to happen. All I would caution patients about is getting an early scan to ensure that the pregnancy is in the right place, eyes in the body of the uterus. And just a final question, listeners wondering Shane, at what point in the pregnancy will I feel the baby? I'm currently nine weeks pregnant, but I actually don't feel pregnant at all. And I'm wondering if I should be worried. No, no. And again, I often say to patients, one day you'll have symptoms and you're feeling nauseous and you've been vomiting. And then the next day you're feeling fine. That does not mean the pregnancy is encountering any problems. In terms of feeling the baby move for patients who are pregnant for the first time, it's often

9:1520 to 24 weeks before you feel the baby move for patients who have been pregnant before. They often appreciate that move because they know what they're looking out for much earlier, even 10, 12 weeks. But don't be alarmed if you're not feeling the baby move, particularly if it's your first pregnancy and you're only at the end of the first semester. But if you're worried, go and get a scan in your local hospital. They'll give you all the reassurance you need that everything's fine. Professor Shane Higgins, consultant, obstetrician and gynecologist at the National Eternity Hospital at Hollisreed, Shane, thanks a lot. I'm showing this here. I'll make him baby.