Dear Doctor ‘P’ 17

Send your questions to:
pregnant@integraladvisory.com
Answers are provided jointly by our team of doctors

Is my baby safe?
A pelvic ultrasound showed I had right salpingitis, inflammatory disease” inflammatory disease (PID) and fluid In the posterior cul-de-sac (Back part of the uterus). After one week I took an obstetric ultrasound which showed I was pregnant. It also showed that I had bilateral ovarian cysts and prominent free fluid in the posterior cul-de sac. Can these complications harm my baby?
I am worried. Sometimes I bleed and get sharp pains. The doctor advised I take bed rest for two months. I am now five months pregnant and under medication. Is my body safe, and will these complications and the many drugs I am on affect my child?

PID is an infective disease that affect the uterus and fallopian tubes. You are very unlikely to conceive while you have PID because the affected organs are the same ones which facilitates conception. However, if infection sets in at the time of ovulation and fertilization occurs, it is possible for the tubes to be affected and inflammatory reaction in the tubes to occur after the passage of the fertilized egg. In this case, one will have a PID in pregnancy.

Worth noting is that when you are expectant, the protecting membranes which are the amniotic membranes and a thick mucus plug prevent micro-organisms from ascending to affect the internal reproductive organs. Thus, you may not be suffering from PID. The symptoms may be arising due to ovarian cysts other than the infective conditions. The management of the cysts would depend on how large they are.

The fluid on the back top of the uterus could be as the result of the inflammatory condition caused by ovarian cysts. Bleeding is a high sign of threatening abortion. It should managed as a separate condition. Consult a gynaecologist to determine whether the pregnancy is viable. Normally, a scan will be done to see whether the pregnancy is growing then if it is, that is considered as viable pregnancy. The scan will also detect low placenta which may cause bleeding. The overall safety of the baby depends on the antenatal care given. The bleeding and sharp pains should not be taken for granted however. No drug is absolutely safe in pregnancy but the safest are usually used for an expectant mother.

Miscarriage, premature birth and cot-death

I had a miscarriage last year in April, at three months pregnant. Before long I conceived again. And in June this year, at six months pregnant i started discharging a liquid. This went on for three days, and on the fourth day which was on 11th June, I delivered a baby boy (premature). He was placed in the nursery till 17th of July when i was discharged but on 21 st July the baby died. What is the problem with me?

There are number of possibilities that cause miscarriage in the second trimester. One of these could be a lose of cervix, medically known as cervical incompetence. It would have been appropriate for you to have a check up before conceiving a second time to determine the cause of the first miscarriage. Visit a gynaecologist before you get pregnant again.

The doctor will evaluate if your cervix has tears on it or whether it is loose. If anything is amiss, a Mcdonald stitch(a stitch around the cervix) is recommended to support the cervix. The stitch is inserted when the mother-to-be is 12 or 14 weeks pregnant, and removed at 38 weeks. It is important to start attending clinic immediately you confirm you are pregnant. Another probable cause of your miscarriage could be that you had uterine fibroids, or any other febrile complication that affects the reproductive health.

Our Team Of Experts

Dr. Riasio Omuga Lecturer. School of Nursing Sciences, University of Nairobi
Consultant Obstetrician/Gynaecologist
Based at Doctors’s Plaza, Clinic no.18,Kenyatta National Hospital

Dr. David Kiragu
Consultant Obstetrician/Gynaecologist
Based at KAM Health Services
IPS Building. 1st Floor. Kimathi Street. Nairobi

Dr. Weston Khisa
Consultant Obsetctrician/Gynaecologist
Based at Hurlingham Family Health Clinic
Nyaku House. Hurlingham. Nairobi

Dr. Kituyi Adelaide
Consultant Paediatrician
Based at Afya Royal Clinics
Uchumi Hyper. Mezz Floor. Ngong Road. Nairobi

Fertility after circumcision

I was circumcised while young and I would like to know if circumcision can interfere with a woman’s fertility as I plan to get pregnant someday.

Circumcision can narrow the birth canal, interfering with with the progress of delivery while at its 2nd stage . The vulva will also heal with the scars and fibrosis and interfere with vulva expansion during expulsion of the baby. However, if you deliver in the hospital all these can be taken care of.

Docs body-size matter?                                                                                                                                                          I would like to know if body size matters when a woman Is giving birth. Is it of importance whether one is small or big bodied? And is it advisable for a small bodied woman to have a normal delivery, or is it best to opt fora C sect ion?

Small sized women tend to have a small pelvis. Chances that they will deliver enough a C-section are high. However, some big sized women have been found o have a small pelvis . Some small sized women have also been found to have adequate pelvis space ll is important to determine size of pelvis and foetus at 56 weeks of pregnancy, to prepare for birth.

I still look pregnant
I delivered a month ago. I am wondering whether my tummy will go back to normal. After delivery it did not shrink as it should have. One month later I still look pregnant. Please advise me on what I should do. Is some
thing wrong with me? I am a first time mother.

After pregnancy, it takes up for six weeks for a mother ‘s body to go back to near normal pre-pregnancy state. Your body might not regain its original shape completely. Scheduled physical exercises however can strengthen abdominal muscles and reduce tummy size. Seek the help of your physiotherapist.

END: PG17/6