📢 Calling all expecting mothers

Thank you for asking a very relevant and an important question. Not all second trimester pregnancy losses are associated with a cervical insufficiency and hence it is very important to see the right expert for a proper evaluation and diagnosis as the causes are multifactorial. If one is truly confirmed to have cervical insufficiency, my advice is for you to see the right expert. Vaginal pessaries such as Arabin are not recommended as it is associated with a higher risk of infections. There are many different types of cervical cerclage and Shirodkar cerclage, or a high vaginal cerclage is not proven to be superior to a low vaginal cerclage. If you see the right expert, than there would be able to advise you on the best treatment and interventions that you need. Not everyone needs a Shirodkar cerclage. It is important to see the right expert for a proper diagnosis and advice.

Having a past HSV infection does not render your pregnancy to be at high risk. The only concerns are related to new, recent infections or recurrent HSV infections during pregnancy. Since you already had have a past infection, the chances of you transmitting this to your baby is very low and vaginal delivery is the recommended mode of delivery. If you have reinfection, that you may need Acyclovir from 36 weeks onwards although vaginal delivery is still recommended.

Thank you for your very relevant question. Yes, having multiple pregnancies, especially twins is considered a high risk pregnancy and you need aspirin, calcium, vitamin D3 supplements and a specialist care and follow up. Being obese, especially if your BMI is above 35 kg/m2 also increases your pregnancy risk and complications. It is best to see a high risk pregnancy expert, ideally a maternal fetal medicine specialist.

Having severe infections is associated with preterm delivery while certain infections may also be transmitted to the fetus, such as congenital syphilis. Hence, prevention is always the cure. It is recommended to screen everyone for asymptomatic bacteriuria by having a urine culture taken early in the pregnancy and secondly to screen when one have symptoms of painful urination. Sexually transmitted diseases is associated with preterm delivery and the risk of fetal transmission hence it is best to inform your doctor if you are at risk and to prevent such infections before and during pregnancy. If you are at risk, these can be tested early in the pregnancy, midway and also just before delivery.

There are numerous causes if recurrent pregnancy losses and in fact, it remains unexplained in 1 in 100 couples. Some common causes associated with recurrent pregnancy losses are vitamin D3 deficiencies, diabetes, poorly controlled thyroid diseases and antiphospholipid syndrome. Some couples may also benefit from a genetic screening to exclude heritable genetic conditions. The management strategies depends on what is the underlying cause. Folic acid and Vitamin D3 supplements are recommended and it is also important to see the right expert, ideally a maternal fetal medicine expert to ensure that essential causes are excluded while one has an individualised approach.

Yes, having a or multiple ceasarean sections makes your eventual pregnancy a high risk pregnancy. It is important to know the type of caesarean section, the indication and if there were any complications during the surgery. There is a risk of having a repeat caesarean section, uterine rupture and placenta accreta spectrum disorders in future pregnancies for all mothers who had a caesarean section. Hence, it is best to see a specialist to monitor your labour and to be delivered in a tertiary hospital.

Dear Laura Wayne, thank you for asking a very important question. Pursuing a vaginal delivery will of course always be the prefered option unless there is an obstetric or a medical reason to perform a caesarean section. Your obstetrician should be able to advice on the safest options of delivery. If there are no obstetric reasons for a caesarean section, vaginally delivery is always prefered. Caesarean sections are four times riskier, with a higher risk of bleeding, infections and event developing clots or DVT. It is also more painful, not to forget that it takes a longer time to recover it also associated with a longer hospital stay. Having a caesarean section also makes your pregnancy a higher risk in future pregnancies. Hence, it is only advisable if there is a strong reason or real benefit to have a caesarean section. Vagina delivery is often the prefered option unless in certain conditions.

Thank you Chloe Spears for asking a very important question related to mental health. It truly does. Although there is no direct association of stress on the pregnancy, significant mental health issues, such as depression, anxiety, bipolar or schizophrenia does have an impact on the pregnancy with regards to compliance, fetal growth, developing gestational diabetes and the risk of progression, especially post delivery. Maternal medicine experts should be able to address these issues and if one had a past history, or a family history of current symptoms of mental health issues, it is best to reveal this to your doctors who may be able to advise, support and also assist in many ways possible. Interventions such as cognitive behavioural therapies, talking therapies and even most medications are safe during pregnancy and breastfeeding. Do not suffer in silence.

Soalan yang sangat penting, terima kasih Puan @Nora Yaacob. Kehamilan yang berisiko tinggi adalah kehamilan dikalangan wanita yang mempunyai masalah kesihatan yang kronik, seperti kencing manis, darah tinggi, penyakit buah pinggang, anak kembar, umur melebihi 40 tahun, thalassemia, anemia yang teruk, kehamilan IVF dan BMI melebihi 40 kg/m2. Golongan yang kedua yang dikategorikan sebagai kehamilan berisiko tinggi adalah golongan yang pernah mengalami komplikasi sewaktu mengandung, contohnya kelahiran pra-matang, keguguran yang kerap, pre eclampsia dan placenta accreta spectrum disorders. Itu antara contoh-contoh kehamilan yang berisiko tinggi. Sekiranya seseorang ibu tidak pasti sama ada dia berisiko tinggi ataupun tidak, mereka boleh dapatkan kepastikan ataupun nasihat dari doktor pakar mengenai risiko kehamilan mereka.

Excellent question Rose Smith. Although it is not the same across the board for every high risk pregnancy, some of the common implications to the baby are fetal growth restriction and preterm deliveries which does have some term risk to the baby in terms of future metabolic and cardiovascular risk. However, certain interventions and optimizations can reduce these risk, such as by taking 150mg of aspirin for certain selected group of patients. That is why it is important to see an expert early in the pregnancy or before conception, in the pre-pregnancy state to minimise this potential risk.