Expert advice on pregnancy issues

Professor Jauniaux is consultant obstetrician in foetal medicine at The London Clinic and Professor in Obstetrics and Fetal Medicine at University College London.

An appointment with their Early Pregnancy Screening Service would normally cost you £300 (including scan and consultation).

Here they answer the questions you posed, according to their specialisms:

Pre-eclampsia: will it strike second time round?

Q: I suffered from pre-eclampsia with my first pregnancy. It kicked in at 31 weeks and my baby was delivered by Caesarean at 36 weeks. That was three and a half years ago and I am now two months pregnant with my second child. I am aged 33. Am I likely to suffer pre-eclampsia again and is there anything I can do to prevent it?

Prof Jauniaux: The risk is lower than in the first pregnancy but still exists. A 36-week delivery suggests mild to moderate pre-eclampsia for which there is no preventive treatment. Aspirin could be suggested but that needs to be discussed with the GP and consultant obstetrician at the local hospital.

Mr Davies: Pre-eclampsia is more common in your first pregnancy and much less likely to occur in subsequent pregnancies. There has been a lot of research looking into the subject. For some women a small dose of aspirin (75mg) is safe and may be helpful. It would also be helpful for your doctor to arrange regular ultrasound scans in pregnancy checking that the baby is growing well. There is also a special scan at 24 weeks that looks at the blood flow through the placenta. It is called a uterine artery Doppler test and can be used to predict pre-eclampsia.

What is a transvaginal scan?

Q: My partner and I found out last week that we are pregnant. We have been trying for more than a year and my periods are pretty irregular so we are not sure how far gone I am. The doctor suggested sending me for a scan to check. Am I likely to have a transvaginal scan? What is the procedure for that and is there a danger it could put my baby at risk?

Prof Jauniaux: Before 9 weeks, a transvaginal scan will be needed to obtain a better view of the pregnancy and may be essential to date the pregnancy and exclude an ectopic pregnancy. This is a safe and very accurate examination, normally performed by a specialist doctor or sonographer in an early pregnancy unit.

Mr Davies: Congratulations on your good news. Early pregnancy ultrasound scans are safe and are performed by the transvaginal route as it is the best way of identifying a viable early pregnancy. The best time for the scan to be performed is after six and a half weeks from your last menstrual period.

How long to leave conception after my miscarriage?

Q: I had a miscarriage back in September and was seen at the local hospital. The womb was empty and not as thick as it should have been. There was no embryo in the fallopian tube and no explanation was given as to what could have happened. Since then my husband and I have tried to conceive but with no luck whatsoever. I am irregular and have alternate 30+ and 40+ day cycles. A scan of my ovaries two years ago found one enlarged ovary (not large enough to be polycystic) and hormone levels relatively normal (tested high for prolactin, then on a second test the level was fine). I am 28 years old. How long should my husband and I leave ttc (trying to conceive) before seeking medical help? Do we wait a year which is the standard or should we go before this due to my cycle irregularities? Thank you for any advice given.

Mr Davies: I am sorry to learn that you had a miscarriage last year. It is still possible that your irregular periods may be due to polycystic ovaries. It would be important for you to do a repeat hormone test in the few days of your menstrual cycle, normally day 2 or day 3. Once the results of your hormone tests are known then you may benefit from fertility medication such as clomid. This treatment should be monitored by an ultrasound scan in conjunction with a fertility specialist. It would also be helpful for your husband to perform a semen analysis to exclude any other concerns. The main problem with an irregular menstrual cycle is that it can be very difficult to predict when ovulation will take place.

How can I regulate my cycle?

Q: My periods are irregular but never normally any longer than 6 weeks. I am currently 6 wks and 2 days into my cycle, I did a pregnancy test last week but it was negative. I’ve had a few symptoms but my concern is that the symptoms are in my head as I've had negative results. My main question is how to regulate my cycle to help me get pregnant. Myself and my husband have been trying for 6 months with no luck and I'm beginning to get concerned.

Mr Davies: Most women experience a period every 26 to 32 days. There may be a number of reasons why your period is delayed. One of the commonest reasons is polycystic ovaries. It would be important for you to have hormone tests in the few days of your menstrual cycle, normally day 2 or day 3. To help you get pregnant it is important to be ovulating regularly. Once the results of your hormone tests are known then you may benefit from fertility medication such as clomid. All fertility treatment must be prescribed by a fertility specialist and monitored carefully. It is also important to look for other causes of infertility and it may be helpful for your husband to perform a semen analysis.

Are ovulation sticks any good?

Q: Do you recommend using ovulation sticks? Should I use them throughout my period or just the days when I think I might be ovulating? I suspect I ovulate quite early in my cycle, but what signs should I be looking for and how reliable are they?

Mr Davies: Ovulation sticks can be helpful in timing intercourse. They are quite expensive and should be used when ovulation is likely to be. This is normally 14 days from the onset of a period. For example, women with a 28 day regular menstrual cycle will ovulate on day 14 and should start testing for ovulation on day 12. It sounds as if you have a shorter menstrual cycle and you should start testing on day 10. The signs of ovulations include an increase in cervical mucus which is often stringy. Your temperature will rise by 0.5 – 1% after ovulation. You may also have some abdominal discomfort around the time of ovulation.

PCOS: how to improve my baby chances?

Q: I have been trying to conceive for two years now, I have been diagnosed with PCOS and so have been prescribed Clomid to help me with ovulation. I managed to conceive using the tablets in December of last year, but later miscarried in January. I had a very long and traumatic miscarriage which went on altogether for around 5 weeks. Since then I have taken two courses of clomid on days 2-6 and have been using ovulation sticks which tell me I am ovulating, but to no avail. I have been for my day 21 blood tests but as my gynaecologist is away I have been told I will probably not get my results back until May. I have spoken to other people who are going through the same sorts of things as myself, and have discovered that they have been observed throughout their cycles with scans and blood tests from the beginning to end. As my gynae is unavailable I can not ask him whether I should be having scans also. I am desperate to have a child and although I am slightly overweight I have been enrolled at my gym for several months now and so have lost quite a bit of weight, I am only 22 so my age should not really affect my fertility should it? My partner has also had sperm tests which all came back as normal. Is there anything else I can do to up my chances? Should I be having scans throughout to note whether I’m on track to conceiving. Also, I was told that as my miscarriage lasted so long that it was probable that more than one egg had been released due to my tablets and more than one egg had been fertilized; is there a higher risk that this sort of thing will happen again?

Mr Davies: I am sorry to hear about your miscarriage. I would certainly recommend that your clomid cycles are monitored with an ultrasound performed between day 10 and day 12 of your menstrual cycle. This is an important method of checking your response to clomid. The other treatment that might be of benefit is Metformin. It is a diabetic drug and helps make the body more sensitive to insulin which improves the hormonal environment in which the ovaries work. This should be discussed with your doctor. There is some research showing that Metformin may reduce the risk of miscarriage.

Movements and niggles: is this normal?

Q: I'm 28 weeks pregnant and worried that my baby's movements aren't normal. Sometimes he moves around all the time but other times he hardly moves for hours. Is it normal to have such a variation? Am I being paranoid or should I speak to my midwife?

Prof Jauniaux: A foetus normally moves more than 10 times a day ie they sleep most of the time. Less than that the local day assessment unit should be contacted.

Mr Davies: Your baby’s movements can vary from day to day with some busy and some quiet times. If you are at all worried then your midwife will arrange for the baby to be monitored, called a carditocograph (CTG). Sometimes a growth ultrasound scan can be arranged by your obstetrician.

Q: I've just found out I'm pregnant - about 4-6 weeks I thnk and I'm delighted but the nerves are starting to set in. I've been suffering from really bad stomach cramps and I'm worried something is wrong. Is this normal or should I be concerned?

Prof Jauniaux: Ligament and pelvic pain are very common in early pregnancy. When associated with bleeding they should warrant an ultrasound examination.

Mr Davies: Congratulations on your pregnancy. It is common to experience some tummy cramps in early pregnancy. If they are really painful it would be important to see your doctor. An early pregnancy ultrasound scan can be done from six and a half weeks from your last period. This is often very reassuring.

Q: How long after coming off the Pill is it normal to resume my periods? It is five weeks since I stopped taking it and still nothing. I'm pretty sure I'm not pregnant but wonder how long it will take for my cycle to right itself. I am 34 years old and have been on the Pill for 10 years.

Mr Davies: It can take up to 8 weeks for the periods to resume. If they are delayed beyond this time then it would be helpful for your doctor to arrange for you to have some hormone tests.

Are 4-D scans really safe?

Q: I am six months pregnant and planning to go for a 4D scan to see my baby inside the womb. I know this is quite a new technique. Is it safe? Are there any circumstances under which I shouldn't have one? I had a miscarriage a year ago and don't want to do anything that might harm the foetus.

Prof Jauniaux: 4D is real-time 3D. 3D has existed for nearly 15 years and when performed as part of a routine scan is not known to be associated with any side effects to the fetus. However, the examination of the fetal head should be limited to what is strictly needed. Obviously outside a medical context, this is essentially a fun scan and often an expensive exercise.

Mr Davies: A 4D scan is relatively new type of scan. It is in fact a 3D scan with the added dimension of time. There have been no reports of any babies being harmed by this type of scan.

When will my periods resume?

Q: How long after coming off the Pill is it normal to resume my periods? It is five weeks since I stopped taking it and still nothing. I'm pretty sure I'm not pregnant but wonder how long it will take for my cycle to right itself. I am 34 years old and have been on the Pill for 10 years.

Mr Davies: It can take up to 8 weeks for the periods to resume. If they are delayed beyond this time then it would be helpful for your doctor to arrange for you to have some hormone tests.

An early pregnancy consultation at The London Clinic is designed for women in their first 12 weeks of pregnancy who have concerns from bleeding, vaginal discharge or abdominal pains, or who have had problems in pervious pregnancies.

It is also suitable for women who are worried about their pregnancy and want reassurance that all is progressing well.

The London Clinic’s Early Pregnancy Screening Service can be contacted direct on 020 7034 6329; thelondonclinic.co.uk

If you have an urgent query or it is an emergency, call your hospital, GP or NHS Direct on 0845 4647.