chatwithketch

Q: Good day Doc, can sexual intercourse open the cervix at 39 weeks of pregnancy?

A: An open cervix, also known as a weakened cervix or cervical incompetence is a condition in which the mouth of the womb is open leading to a risk of miscarriage. This may be caused by a previous injury to this area, typically after a surgical procedure. The weakness of the muscle can cause the mouth of the womb (cervix) to open too early during pregnancy, leading to a miscarriage.

Having said that, if the cervical incompetence is not a pre-existing condition, sex is generally considered safe during pregnancy. If your doctor has noted some medical issues that may cause some restrictions on sexual intercourse, he will communicate that.

Some issues that may cause a doctor to issue some restrictions on sexual activity, apart from cervical incompetence, include:

• Threat of a miscarriage
• History of pre-term labour
• Unexplained bleeding in pregnancy

If you’re not sure whether you belong to any of these groups or not, please ask your obstetrician.

Now, there also some risky activities during sexual intercourse in pregnancy:

• If you indulge in oral sex, hubby please do not blow into your wife’s vagina as this can lead to an air bubble being lodged in a blood vessel causing problems in mother and/or baby
• Having STI with an infected partner can lead to STI in pregnant mum. This infection can be transmitted to the baby. So, hubbies be sure that you stay faithful
• Anal sex is also discouraged.

Some have asked the question, ‘what if my pregnant wife gets pregnant again?’ Well, theoretically, this Is not possible because during pregnancy ovulation is supposed not to occur. Essentially, for pregnancy to happen, an egg was fertilized and once this happens, there’s a signal that goes to the ovary stopping it from releasing eggs since clearly, there’s no more need 😀 In some rare cases, however, after pregnancy has occurred, the ovary still releases an egg which ends up being fertilized leading to pregnancy in an already pregnant woman. This situation is called super-fertation. However, the incidence of this is very rare that it is not considered standard practice to tell pregnant couples to avoid sexual intercourse during pregnancy to avoid this. In fact, there appear to be just about 10 documented cases worldwide.

So, if the obstetrician had not documented incompetent cervix in that patient before, sexual intercourse at 39 weeks is unlikely to cause it. Where in doubt, please consult your obstetrician.

All the best 😀

Q: Good morning Dr. May you kindly illuminate on recommended quantity of fluid one is required to take each day  My concern is that after taking a glass of water, 5 mins later, I am going to bathroom. Is there something wrong with me?

A: Thanks for writing in. Water is important for life and we use it for very important functions daily: taking a bath, washing clothes, washing dishes, cooking and of course, drinking. The water we drink is very critical for a lot of bodily functions like digestion, excretion (when we urinate, pass faeces and sweat), movement of nutrients all around the body, keeping your joints nice and supple etc. If you also consider the fact that a healthy body contains about two-thirds, water, then it is clear that we can’t joke with our fluid intake per day.

Five tips to help you with this:

• Though, there are recommended amounts to take daily, it really depends on your activity level (notice how much more water you appear to need after a hectic workout?), where you live (notice how much water you also seem to drink when you live or visit the tropics as opposed to when you live in or visit a temperate region) and your health condition (for instance, people with UTI need to drink some more water).
• Generally, we are encouraged to drink 8 8-ounce glasses of fluid per day. This is approximately 2 litres of water per day.
• Any fluid counts e.g. milk, fruit juices, beverages etc. But try to remember that these other fluid sources, other than water, may contain calories that you probably don’t need
• An easy way to check whether your body is getting enough water in a day is to check your urine colour. If it’s dark yellow, you’re probably not getting enough. If it’s pale yellow in colour, you’re doing good
• If you don’t like the taste of plain water, you can jazz it up with a slice of lemon or limeand if you don’t like the taste of plain milk, like most children, you can add some flavor like vanilla to it.

Water is necessary for life itself. Be sure that you’re drinking sufficient quantities of this daily.

Hi Dr. It has been 11 months since I quit injection (contraception???) but I don’t go on my period. What can I do to get help?

A: Family planning injections work by thickening mucous in the cervix, preventing sperm from getting into the womb (uterus) or by preventing the ovaries from releasing eggs every month (ovulation) and so the person taking the injections can’t get pregnant.

Taking these injections affect women differently. In the first few months, there be excessive bleeding during periods, followed by a period of lighter periods. This may yet be followed by a period of irregular or no periods especially in women who have taken these injections for up to a year. Irregular periods should be discussed with your doctor to ascertain the cause. It may be due to the drug or due to an infection which needs to be treated. Prolonged periods can also be treated.

When these injections are stopped, it takes a while for ovulation to be restored because these injections are long lasting. It can be as long as 2 to 3 months. In some other cases, this can last for about a year or even up to 2 years. This has nothing to do with the duration for which the injection was taken. Typically, contraceptive injections are not suitable for women who wish to have children within a short period of time.

So, visit your gynecologist to confirm that there is no other cause of ‘missing period’ other than those suggested above.

All the best! Have a great weekend!

Q: Hello Dr. I have been to a high blood pressure routine check for 3 weeks and yesterday I was diagnosed for it. I know I take in lot of salt and fatty food. I’m not ready for the treatment because they said once I use it I won’t have to stop it. Dr. is it possible to avoid treatment and regain normal pressure if I reduce fats and salt in my diet? My last blood pressure was 180/90 and they said I might have a stroke. How can I avoid this doctor?

A: High blood pressure used to be defined as blood pressure reading of 140/90mmHg or more. Not anymore!
The new guidelines by the American College of Cardiology and the American Heart Association state that only blood pressure readings below 120/80mmHg can now be considered normal blood pressure.
A systolic blood pressure reading between 120 and 129mmHg is considered elevated blood pressure.
Stage 1 high blood pressure is between 130 to 139mmHg systolic blood pressure reading and between 80 to 89mmHg diastolic blood pressure reading.
Grade 2 high blood pressure is any reading above 140/90mmHg

Do you understand what systolic and diastolic blood pressures mean? Here are a few facts to guide you:

• Blood Pressure is the pressure with which blood pushes against your vessels as it passes through your body. A normal blood pressure allows blood to flow and deliver oxygen and food to different parts of the body.
• We measure blood pressure with two numbers (ie, 124/84 mmHg). The first number is called the systolic blood pressure and the second is called the diastolic blood pressure. These two numbers are written as ‘systolic/diastolic’ followed by the unit of measurement.
• Systolic blood pressure is your highest blood pressure measurement and is recorded when your heart contracts.
• Diastolic blood pressure is your lowest blood pressure measurement and is recorded when your heart relaxes and fills with blood

For elevated blood pressure, the new recommendations point to non-drug interventions like the follow:

• Reduce your risk generally by imbibing lifestyle modifications:

• Be physically active for 30 to 60 minutes on most days of the week. Try walking, biking, swimming, dancing or any other physical activity that you enjoy. Remember that even a little bit of physical activity is better than no activity at all.

• Eat a lot of fresh fruits and vegetables, low-fat dairy products and other foods low in fat and salt. Avoid fast foods, canned foods or foods that are bought prepared, as well as any foods where you can see the fat in them.

• If you are a man and take more than two alcoholic drinks each day or a woman and you take more than one alcoholic drink, drinking less will help to lower your blood pressure. A regular-sized bottle or can of beer or a regular-sized glass of wine are each equal to a single alcoholic drink.

• Keeping your body weight within a healthy range also prevents high blood pressure. If you are overweight, losing about 10 lbs (5 kg) will lower your blood pressure, and reducing your weight to within a healthy range will lower your blood pressure even more.

• It is important to stop smoking if you have high blood pressure. Smoking increases the risk of developing heart problems and other diseases. Ensuring that you live and work in places that are smoke-free is also important.

• Other lifestyle modifications include weight control, diet watch (portion control, use of less salt, using less oil in our foods and when we do use oil to focus on the heart healthy oils) etc

Changing your diet to the type described above can bring down systolic blood pressure by as much as 11 points, and each additional healthy habit you adopt can bring it down another four to five points.

For stage 1 hypertension with no cardiovascular disease and low risk for developing it, lifestyle changes still work.

However, 1) the presence of cardiovascular disease and stage 1 hypertension or  a combination of no existing cardiovascular disease but a significant risk of developing it, or stage 2 hypertension means that lifestyle changes have to be combined with medications.

How do you know your risk of cardiovascular disease? Click on this link and assess yours. It’s easy to use.

Therefore, I suggest, you have a long discussion with your doctor but be guided by him/her. If after careful monitoring, your blood pressure falls into any of the combinations that mean you should take medicines, please start on them. Taking a pill a day is a small price to pay to be here for your family and enjoy your life. And don’t forget the lifestyle modifications. Salt should be used very sparingly and the only way to this is really re-training our taste buds to ‘accept’ less salt as tasty. Remember that you can use spices to ‘jazz’ up your food.

All the best!

Good morning, DOCTOR. I am 3 months pregnant and last night I started bleeding. I don’t know what to do. Is it normal to bleed at this stage of pregnancy or am I losing my child?

A: Bleeding during pregnancy can be worrying whether it’s a little or a lot. However, it may not necessarily be the sign of a problem. Bleeding can occur in early pregnancy, close to or about the same time as the menstruation would and thus be mistaken for a period. This bleeding could be due to implantation as the fertilized egg implants itself in the uterus (womb). Other causes of bleeding in early pregnancy include ectopic pregnancy, miscarriage and infections.

For more information on ectopic pregnancy and miscarriage, please click on these links: https://chatwithdrketch.com/2014/08/07/daily-health-tips-what-are-my-options-after-ectopic-pregnancy-and-failed-ivf/

Daily Health Tips: Miscarriage And Infertility Re-visited

Bleeding in pregnancy may not necessarily be an emergency but because there are other causes of these episodes of bleeding, which are potentially life threatening like ectopic pregnancy, bleeding in pregnancy should always be checked out in the hospital. Better safe than sorry 😀

All the best!

Q: Good day Ma’am. Please ma’am, I am supposed to be on my menses though it’s just coming as a stain on my pad but it is darkish red. Please what’s wrong and what can I do? I am afraid please

A: Towards the end of a period, the blood usually becomes dark due to older blood not being expelled fast enough from the body. It is not usually a cause for concern and should not prevent pregnancy. If, however, the dark colour is present all through the menstrual period, please see your doctor. Better safe than sorry.

Issues that can cause a decrease in flow include pregnancy (the supposed period may be an implantation bleed). Implantation bleeding is typically a small amount of light bleeding that occurs about 10 to 14 days after conception. This is thought to be due to implantation as the fertilized egg implants itself in the uterus (womb). This usually occurs in early pregnancy, close to or about the same time as the menstruation would be seen and is thus often mistaken for a period. But, it is usually lighter than menstrual…typically without clots. It would stop on its own and does not require further treatment. If the bleeding is heavier, associated with cramps or any other complication, please see your doctor. As a rule of thumb really, any bleeding in pregnancy should be investigated as they may be due to more serious conditions like ectopic pregnancy, miscarriage and infections.

Other causes of decrease in menstrual flow include: crash dieting (when you want to lose all the weight you added in 5 years in one week :D), intense physical activity, Polycystic Ovary Disease (PCOD), imbalance of hormones and use of contraceptives. Previous instrumentation like Dilatation and Curettage (D and C), where the procedure was too ‘vigorously’ done can result in a condition called Asherman’s syndrome which manifests as reduction in menstrual flow. In the same way that stress can delay a menstrual period, it can also cause a reduction in flow.

You must work with your gynaecologist in order to manage this. If the cause is PCOD, focus will be on the treatment; if due to intense exercise, reducing intensity will be helpful; if due to crash dieting, focus on eating a proper balanced diet will help etc. Your gynaecologist will carry out a detailed examination and investigation to arrive at the cause and advice on treatment.

Q: How are you doctor. Can l ask? Which contraceptive can l take so that l can see my menstruation while breastfeeding. Here in South Africa after birth they inject depo and l heard many people saying it’s not right. Which one should l opt for?

A: Well, a breastfeeding mother should definitely not be taking any medication without speaking to her doctor. That’s for sure! 😀 This is because drugs that you take will also end up in breast milk. Most times, the concentration of these medicines in breast milk is so small that it hardly causes any problems in the baby but in some instances, they could get very concentrated in breast milk, putting the baby at risk. So, all medication choices, be they contraceptives or otherwise, must pass through your doctor.

A very common question I get asked is if breastfeeding mums can get pregnant. The answer is yes. If you’re exclusively breastfeeding, feeding your baby on demand (every 4 hours), you’re within 6 months of your baby’s birth and your menstrual period has not returned after the birth of your baby, you stand a better chance of not getting pregnant during this period. However, this is not a reliable method.

Birth control pills can help prevent pregnancy at this time. Pills that contain estrogen may lead to reduction in breast milk supply (PS: recent research suggests otherwise and yes, combination pills contain estrogen). Therefore, it’s a good idea to avoid such pills at this time or better still be guided by your doctor. Pills that contain only progestin (like the minipill) is a better idea as it does not affect breast milk supply. Depo is a type of minipill but it’s all about the timing of the medications. It’s usually taken at the same time daily. It’s best to start this discussion about your suitability for this contraceptive before you have your baby or immediately after so that your doctor can advise as to when you should start taking the pills. Don’t go starting on the pills without your doctor’s say-so because started too early, it could have adverse effects. Barrier contraceptives like condoms, diaphragms etc can also serve the purpose of preventing pregnancy before you start on the minipill.

There are, of course, other methods of birth control available eg Intra Uterine Device (IUD), implants, patches etc also exist and you may want to discuss these other options with your doctor as you conclude breastfeeding.

Return of menses following delivery is varied between individuals. Some women would see theirs a few weeks after, some others after a few months or even a year, while in others there is no return of menses before another pregnancy begins.

Different women also report different changes with their menstrual periods after childbirth. Some report longer periods. Others report shorter periods; some others report less pain and others observe absolutely no change at all 😀

However, the pattern of your menstrual cycle prior to your previous pregnancy (if it was regular or irregular) also plays a role. The duration of your labor and the presence of complications like bleeding after delivery could all play a part in the return of your period.

Exclusive breastfeeding and presence of underlying infection could also delay the return of menses. Breastfeeding women are less likely to have frequent or prolonged bleeding on the minipill but taking the pills might delay the return of your period even longer.

Have a great week ahead 😀