Pregnant: Now What?
Congratulations! It’s so exciting to fall pregnant after trying for so long. When some people fall pregnant they are taken completely by surprise, particularly if they have experienced previous failed cycles. Many patients are well aware that there is a risk of miscarriage (especially the older you become) and so initial excitement can be replaced with terror at the thought of losing the pregnancy. If there are any concerns don’t hesitate to contact the doctors or nurses at Life Fertility Clinic for advice.
BOOK AN OBSTETRICIAN
A priority these days is to book an obstetrician as soon as you are pregnant. With the dwindling work force of obstetricians it can be quite difficult to have a doctor take care of you for delivery, especially if you are over 7 weeks pregnant. You will be at an advantage over the normal population, as we will normally diagnose your pregnancy earlier than most people. This will allow you to be at the top of the queue when booking your spot with your obstetrician. Most of these doctors will only take on 25-30 patients per month and they ‘close their books’ once this number of bookings have been taken. The popular obstetricians are booked the quickest. You can get your referral from Life Fertility Clinic, but these referrals will only last for 3 months. You are better off getting your GP to refer you to an obstetrician so that your referral lasts for 12 months, covering your confinement or delivery. Usually your obstetrician will want to see you before your 12 week scan, but your gynaecologist at Life Fertility Clinic usually deals with early pregnancy issues.
CONTINUE YOUR PROGESTERONE
Often you will be prescribed progesterone gel or pessaries for luteal or endometrial support. Continue your progesterone if you are already on it when pregnancy is diagnosed, until you are able to talk to the nurses or your doctor. Often you will continue the progesterone until 10-12 weeks of pregnancy. Sometimes, especially when there is bleeding (or a threatened miscarriage), your doctor will increase the dose of progesterone. There may also be a change from the gel to pessaries (this is usually a cost consideration). Progesterone is not harmful to the pregnancy so if in doubt continue with the progesterone until you can talk to the nurses or doctors at Life Fertility Clinic.
TAKE FOLIC ACID
The role of Folic Acid in preventing neural tube defects (eg spina bifida) is without question and it is recommended to take Folic Acid daily until 3 months of pregnancy. This is when the spinal cord has finished development and the vitamin is no longer required.
By definition any bleeding in early pregnancy is abnormal but the phenomenon is very common. The so called ‘implantation bleed’ as the embryo burrows into the lining of the uterus is common and real. There is little that can be done to prevent this bleeding but physical rest, extra progesterone (double whatever dose you are on until you can contact a doctor or nurse) and no intercourse is all good advice. Pathological pregnancies will also present as bleeding. These include ectopic pregnancy and miscarriage. As it is difficult to see a pregnancy less than 5 ½ weeks on vaginal ultrasound and we will often rely on serial blood tests (every 2 days) to work out if a pregnancy is normal or otherwise prior to this time. After 5 ½ weeks, the diagnosis of fetal well being will often rely on ultrasound. As a rule your doctor will always expect and exclude the worst in early pregnancy. In medical school doctors are taught, ‘every woman is pregnant until proven otherwise, and every pregnant woman has an ectopic pregnancy until proven otherwise’. The principle is to confirm a normal pregnancy first and foremost.
Pain with associated bleeding is more serious than pain alone in early pregnancy. It is far more likely to be associated with a miscarriage or an ectopic pregnancy than pain with no bleeding. It is very common to experience pain, like period pain, as the uterus grows in a normal pregnancy. Consult your doctor if you are uncertain what is happening. Blood tests and/or an ultrasound will confirm that all is well. Pain relief in the form of paracetamol with or without codeine is appropriate in early pregnancy. If you have pain and bleeding avoid food or water until your doctor reviews you. This is because you may need an anaesthetic for further investigations or to remove an ectopic pregnancy.
Nausea in pregnancy can be the classic ‘morning sickness’ but can occur at any time. Nausea typically begins at around 7 weeks into the pregnancy and subsides around 11 weeks. This roughly corresponds to the rise and fall of hCG, or hormone of pregnancy. Typically doctors will prescribe antiemetics such as Maxolon and Zofran to treat the condition. Vitamins of the B group can be of assistance as well.
THREE WEEKS AFTER DIAGNOSIS
At the clinic we prefer to see patients 3 weeks after the pregnancy is diagnosed. This will typically occur at 7 weeks of pregnancy and allows us to confirm a single viable intra uterine pregnancy. A single vaginal ultrasound can virtually eliminate the diagnoses of a twin pregnancy, a miscarriage or an ectopic pregnancy. It is important to realise that with IVF sometimes 2 embryos are returned to the uterus and as such, seeing one viable intrauterine pregnancy does not eliminate the possibility of an ectopic at the same time (heterotopic ectopic). Your doctor will be alert to this possibility but any unusual symptoms you have should be reported to Life Fertility Clinic.
NOTIFICATION AND FOLLOW-UP
Don’t forget that it is important that your pregnancy be reported to Life Fertility Clinic, so our success rates can be compiled and reported to the National Perinatal Statistics Unit (NPSU). It is also important for the same reasons that you let us know about the outcome of your pregnancy. (Stay in touch – we love hearing how ‘our’ kids get on in the future as well!). We would also like to know of less favourable outcomes such as miscarriages so that we can report these outcomes and offer support.
CONGRATULATIONS, AND GOOD LUCK
We often wonder what it means when people say ‘good luck’ with a pregnancy. Perhaps it means ‘we hope you are blessed with a child that sleeps through the night!’. From those of us that have children, we wish you sincerely ‘good luck’! Life will never be the same again!
For more information or queries regarding any of the services offered at Life Fertility Clinic, please contact us.