Frequently Asked Questions
Please note the information on this website is for patient education, is not exhaustive and aims only to put a clinical balance to some common concerns in pregnancy.
You must consult your obstetrician or regular health care provider regarding any specific questions or concerns you might have regarding your pregnancy.



"How serious is vaginal spotting or bleeding?"

Dr Bopp says, "Bleeding under 20 weeks is considered a "threatened miscarriage". You need to notify your doctor of any bleeding or spotting.

Any bleeding after 20 weeks should be reported to your doctor, remember that the cervix is softer and light staining or spotting after intercourse is not uncommon.
Any bleeding associated with cramping needs to be reviewed urgently.

You must know your blood group because if it is "negative" you may need a special injection (anti-d) – check with your doctor if you don’t know your blood group.

For reasons I completely understand, (because it's so common and it hurts so much) talking about miscarriage is a bit taboo in pregnancy!

Here we go:

Fact: Overall about 1 in 5 pregnancies spontaneously miscarry and usually this happens before 14 weeks.

Fact: The older you are the more likely it is to occur.

Fact: There is nothing you can do to stop it if it’s going to happen.

Fact: There is nothing you do in normal day to day living that makes it happen.

Fact: You may not even know it’s happened.

Fact: In the majority of miscarriages there is something very wrong with the foetus and your body has become aware of this. Reproduction is a very hit and miss process If there are 3 miscarriages or more further investigation is worth considering.

MISCARRIAGE IS NO-ONES FAULT

If you have more questions please ask at your next appointment.


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"How much weight should I put on?"
Dr Bopp says, "It usually doesn’t matter! The average weight gain in pregnancy for the whole pregnancy is often quoted at 10-12 kg.
I have seen someone book in at 60 kg and be 130kg when baby delivered. I have seen someone book in at 70kg and be the same weight the day before twins weighing 3.5 kg each were born.
Most hospitals and specialists stopped weighing mums and testing urine 15-20 years ago. If you are a slight build (under 50kg) or overweight we may keep a closer eye on weight gain but generally how much weight is put on during the pregnancy has little correlation to baby's weight and wellbeing.
Excessive weight gain can be associated with gestational diabetes which we screen for between 26 and 28 weeks."


"Haemorrhoids – more like asteroids!"
Dr Bopp says, "With pregnancy all blood vessels engorge; sinuses, veins in the legs and varicose veins are common (and often reduce considerably after delivery). The blood vessels in the head can work differently causing migraines. Haemorrhoids are varicose veins of the bottom and these can also occur on the vulva when pregnant. Local medicated creams and treatments are usually safe to use."


"Nose Bleeds – Bleeding Gums?"
Dr Bopp says, "It's the same process as for varicose veins – the pregnancy hormones dilate and soften blood vessels. Gums can bleed more easily when you clean your teeth and nose bleeds can occur spontaneously. Even without the antisocial activity of having a pick!"


"The toddler jumped on my belly – will it hurt the baby?"
Dr Bopp says, "No, the baby is inside a bag of fluid inside the uterus under several tissue layers including the muscle of the abdominal wall. Bumps and trips and falls are very unlikely to hurt the baby. If there is any bleeding or contractions seek medical advice.
Remember to always wear a seat belt in the car as the most common cause of death of a baby in a car accident, is death of the mother who is not wearing a seat belt!"


"Is this mole changing?"
Dr Bopp says, "Pigmented skin lesions such as freckles and moles normally get darker in pregnancy."
Pregnancy

"When does morning sickness stop?"
Dr Bopp says, "Usually by the end of the first trimester things settle down but this does vary from woman to woman and pregnancy to pregnancy. Some unlucky mums have it most of the way through. One consolation is, its thought ‘the sicker you are the stronger the baby!'
Morning sickness isn't always in the morning and may be worse with twin pregnancies. There are several medications (such as Maxolon) that can help and have been used safely in pregnancy for decades. If there is constant nausea and vomiting or bad diarrhoea on top of morning sickness, seek medical attention as dehydration may require intravenous fluid treatment."


"What’s with the Headaches?"
Dr Bopp says, "Often the sinuses in the front of the head become engorged in pregnancy and sinus pain is common and often worse if there are pre existent sinus problems. This can lead to a frontal headache. Migraines may appear for the first time in pregnancy or may become more frequent. Muscular or tension headaches are also common. Remember -Brain tumours are exceedingly rare! Paracetamol is safe in pregnancy- take only as directed. It is best to avoid anti-inflammatories such as neurofen. If headaches persist or are troublesome alert your doctor.


"What can I eat - what should I avoid"
Dr Bopp says, "Whether or not you are pregnant it's sensible to be careful with food storage and preparation. Everywhere you look in pregnancy you see Listeria! screamed from the roof tops. Listeria is extremely rare. In the last 15 years I have seen more women with cervical cancer in pregnancy than Listeria .
Common sense says eat fresh food and well cooked food, prepare food carefully and cleanly. Avoid non pasteurised dairy, soft cheeses, pate, diced chicken. You should always be careful of anything that's left out in the open in the deli or in self serve food halls. If you've prepared it fresh or its in a tin or vacuum sealed it should be fine. Remember to eat plenty of fibre and keep up the fluids to avoid constipation in pregnancy."


"Am I too big / too small?"
Dr Bopp says, "You’re never the right size! Everyone including your friends will tell you that you're too big or too small!
Throughout your care with ultrasound and clinical assessment we check your baby's size and progress. No-one can tell baby's size just by looking at your tummy from across a room."


How can I best prepare for pregnancy?
In an ideal world every couple would aim to be as healthy and prepared as they can before trying to conceive. If you have a known medical condition such as diabetes its best to be seen before you try to fall pregnant to maximise your health and give yourself the best chance of an uncomplicated pregnancy. Here are a few simple points

  • Cigarettes/Smoking: please cut down as much as possible - preferably stop smoking completely! Smoking is so last century!
    There is only badness associated with smoking, for fertility and in pregnancy. Miscarriage, low birth weight and premature babies are all associated with smoking in pregnancy and there is some evidence that children of smokers are less likely to achieve their full behavioural and intellectual potential.

  • Alcohol: please reduce this also. There is no 'safe level' so the best option is to stop drinking completely. This will also benefit fertility.
    There are well established risks to baby’s development if you drink during pregnancy.

  • Supplements:

    • Folate or Folic Acid
      It is recommended that folic acid should be taken for a minimum of one month, preferably 3 months, before conception and for the first 12 weeks of pregnancy. The recommended dose of Folic acid is at least 0.4mg daily to aid the prevention of neural tube defects (NTD) like spina bifida. Where there is an increased risk of NTD (e.g. antiepilepsy medication, prepregnancy diabetes, previous child or family history of NTD), a 5mg daily dose of folate should be used.

      Women at increased risk of folate deficiency (e.g. multiple pregnancies) should take 5mg of folic acid throughout the pregnancy.

    • Iron
      The iron demands of pregnancy and breast feeding are particularly pronounced due to the increase in mothers blood volume, blood loss around the time of delivery and the demands of the developing baby and placenta. Iron supplementation will generally be recommended for women at particular risk of iron deficiency. This includes vegetarians and women with a multiple pregnancy. Routine Iron supplementation is not recommended in every pregnancy.

    • Calcium

      If you avoids dairy in your usual diet (e.g. lactose intolerant) and do not consume alternative high calcium food (e.g. calcium enriched soya milk), calcium supplementation is recommended at 1000mg/day.

    • Iodine
      Iodine deficiency appears to be increasing in frequency. This may in part be related to a reduction in salt intake (hence reduced iodised salt intake) and concerns about excessive mercury with consumption of deep-sea fish.

      Women who are pregnant, breast feeding or considering pregnancy should take an Iodine supplement of 150 micrograms each day.

    • Other Minerals
      There is little evidence to support "routine" supplementation of other minerals in pregnancy such as magnesium, fluoride, zinc or rare minerals.

    • Other Nutritional Supplements
      There is not enough evidence to support the use of other nutritional supplements in pregnancy like omega-3 fatty acids or Fish Oil. In the absence of such evidence, the best advice would be to avoid such supplements, particularly in the first trimester of pregnancy where any unanticipated adverse effect would be most likely to occur.

    Summary
    Most standard pregnancy and lactation multivitamin preparations are adequate for the majority of pregnancies. The most common exceptions will be the vegetarian/vegan needing additional iron and women for who high dose (5 mg) of folic acid or pharmacological doses of Vitamin D are recommended.

What tests are done before and during pregnancy?
Ideally every woman should be seen for a pre-pregnancy check by her GP or Obstetrician- in the real world this rarely happens! There are a set of routine tests that are done for every women before or in early pregnancy. These tests are the antenatal screen (ANS)

  • Full Blood Examination = 'blood count'

  • Blood group and antibody screen
  • Where the blood group has already been performed it does not need to be repeated. However, the antibody screen should be repeated at the beginning of each pregnancy. If your blood group is “negative” this is important in pregnancy

  • Rubella (German Measles) antibody status
    All women should have their rubella antibody measured for each pregnancy.

  • Syphilis serology

  • Midstream urine
    To exclude infection

  • HIV
    All pregnant women should be recommended to have HIV screening at the first antenatal visit

  • Hepatitis B serology
    All pregnant women should be recommended to have Hepatitis B screening in pregnancy.

  • Hepatitis C serology
    All pregnant women should be recommended to have Hepatitis C screening in pregnancy.

  • Varicella (chicken Pox)
    Consideration should be given to checking varicella antibodies at the first visit where there is no history or uncertain history of previous illness.

  • PAP smear - Cervical cytology
    There is no evidence to suggest that a PAP smear in pregnancy is harmful.

Other routine tests in pregnancy:

  • Chromosomal Screening
    The "Neck thickness" or "Nuchal" Ultrasound in First trimester for Trisomy 21 (Down syndrome) and other chromosomal abnormalities
    Combined first trimester screening.

    This test must be done when the fetus is between 11 weeks - 13weeks and 6 days. This involves a blood test from 9-12 weeks gestation and is followed by an ultrasound. The ultrasound measures the foetal nuchal translucency & combined, these two tests provide a risk factor for the development of Down Syndrome.

  • Obstetric Ultrasounds Scan
    All women should be offered an obstetric ultrasound before 20 weeks gestation. This will include an ultrasound for fetal morphology and placental localisation usually between 18-20 weeks gestation. Other scans may be indicated depending on individual circumstances and to assess/confirm dates.

  • Gestational Diabetes
    Screening for Gestational Diabetes Mellitus is recommended in all pregnant women and this is usually performed between 26 to 28 weeks. If the results are found to indicate Gestational Diabetes, further blood tests will need to be done.

  • Group B Streptococcal Disease (GBS)
    Our practice is to treat with anti-biotics in labour those at risk

  • Blood Group Antibody Testing
    Further screening is recommended for Rh negative women at approximately 28 weeks gestation. Screening of Rh positive women at 28 weeks gestation is at the discretion of the clinician/managing health service.

  • Iron Deficiency
    The haemoglobin level and platelet count should be repeated at 28 weeks gestation. If anaemia is detected, further investigation is warranted.

  • Cytomegalovirus/Toxoplasmosis
    Selective testing for cytomegalovirus and toxoplasmosis is recommended only for those women at a substantially increased risk of acquiring an infection.
    Ideally such patients should be tested prior to pregnancy.

More Frequently Asked Questions to come. Please check back with us soon.