Dear Doctor ‘P’ 22

Send your questions to: pregnant@intecjral-advisory.com

Answers are provided jointly by our team of doctors

Our Team of Experts

Dr. Blassio Omuga
Lecturer, School of Nursing Sciences. University of Nairobi
Consultant Obstefrician/Gynaecologist
Based at Doctors’ Plaza, Clinic No. 18, Kenyatta National Hospital

Dr. David Kiragu
Consultant Obstefrician/Gynaecologist
IPS Builging, 1st Floor, Kimathi Street, Nairobi

Dr. Njoki Fernandes
Resident Obstefrician/Gynaecologist
Based at Kenyatta National Hospital

REVERSING STERILISATION
I have The same problem as Mary featured in Pregnant’s (Diary of a nurse—reversal of tubal-ligation) May 2007
edition. It told about the reconnecting of fallopian tubes. What advice do you give, and where should I seek for this
service in Uganda? And what does an ectopic pregnancy refer to?

Tubal ligation is a permanent method of sterilisation. People undergoing the operation make up their minds never to have any more children. However, problems could occur like in Mary’s case and cause them to opt for reversal. If you must reverse, it is possible. However, tubal ligation may not be perfect. This causes arrest of a fertilised egg from moving from the fallopian tube to the uterine cavity for further development. This abnormal site where the fertilised egg has to grow is an ectopic site. The pregnancy is thus referred to as an ectopic pregnancy because it does not grow inside the uterus. The space is narrow and small. This causes rupture and bleeding into the abdominal cavity as the foetus grows and can cause death. Upon reversal, you must be closely monitored to ensure such a pregnancy does not occur. Alternatively, a more reliable option is to undergo in vitro fertilization, which offers a setter guarantee. See any senior gynaecologist in Mlago lospital or any other main hospital in Uganda.

PROLONGED LOCHIA

I gave birth via a C-section seven weeks ago. My lochia (discharge the uterus following childbirth or abortion) is a greenish-yellow mucus. Is this normal?

Your condition is known as ‘lochia serosa’. This is the second last  before lochia becomes lochia alba, then disappears between four to eight weeks. Experiencing lochia at seven weeks is still normal. However, it may be a sign of genital infection especially smelly or accompanied by a dull, persistent lower abdominal pain and fever. Greenish discharge is a bad sign. Consult with a doctor or midwife for a clinical examination.

ABNORMAL DISCHARGE
I am one month pregnant and I have an abnormal vaginal discharge. I have had the flow for three days now and it is accompanied by spots of blood. Please advice. I am confused.

Abnormal vaginal discharge may be yellow, smelly and irritating. Spots of blood may result from inflammation of the vaginal walls. Please consult with a doctor for clinical evaluation.

HIV AND BREAST FEEDING

Can a healthy HIV positive mother breastfeed her baby even if it’s for only a few months?

I hope by ‘a healthy HIV positive mother\you mean you have no symptoms of disease, your immunity has been rested and found to be alright, and the amount of virus (viral load) Is zero. In such instances, the risk of transmitting HIV infection to the newborn is small. Breastfeeding must be exclusive. That is, no additional food should be given to the baby and weaning must be ‘abrupt’—breastfeeding should be stopped after a few months and must not be mixed with weaning feeds. Women who are on combined ARV drugs will often have undetectable viral load and should be given an option not to breastfeed. Formula feeding is a choice: if formula feeding is difficult to access and sustain, breastfeeding may be a better option than attempting unaffordable alternatives. In such instances, poor quality formula feeding may confer greater risk to the health of the infant than the risk of transmitting HIV through breastfeeding.

PREGNANCY BLOOD TEST
I would like to know how soon one can know that she is pregnant without waiting to miss her periods.

One can do a pregnancy test using a blood sample, instead of the common urine test. With the blood test check for ‘BHCG’ using a highly sensitive procedure. This is the hormone we test for in an ordinary pregnancy test. This will generally be diagonised within five days from the time of conception. It is expensive however and is therefore not usually performed for routine purposes.

END: PG22/8