Doctor's Column: I’m pregnant and not sure the baby has a heart

Dear doctor, my doctor did a pregnancy scan and told me that there was a sac in my uterus but no heart and that the baby was a missed pregnancy. I went to another doctor who told me to wait because a scan at seven weeks may fail to show a heart. Which doctor should I believe?
Jessica

Dear Jessica, both doctors are correct because a gestational sac which holds the embryo first appears at about four weeks of pregnancy and is the earliest ultrasound finding in pregnancy. Later, at around six weeks, the heartbeat may appear, though it may take even up to seven weeks for some ultrasounds to detect the heart.

However, in many cases, if the heart is not visible by seven weeks’ time, it might mean that a calamity could have befallen the embryo but it has not yet been expelled through a miscarriage. If an embryo is dead but has not yet been expelled, this is known as a missed abortion.

In some cases, the heartbeat may be present but fail to be detected because in Uganda, the scanning is mostly done through the abdomen.

This kind of scanning may be less accurate, especially if the womb is facing backwards or the abdomen is larger. Also, sometimes a woman may unknowingly give the wrong date of the last menstrual period meaning that the embryo could be younger than assumed and therefore the heart may not have shown up yet.

Having a check-up through the vaginal canal may detect the heart earlier or may help avoid some of the misses but most of our scans are the type where the scan is done through the abdomen.

Waiting therefore may reveal whether the heart is there or whether the embryo could be dead and the heart is therefore not beating.

Dear doctor, when I was pregnant, I vomited so much since it was a boy, that I took waragi as a friend advised, and it helped. Will this always happen to me? I’m afraid of getting pregnant again yet I have only one baby.
Eleanor Katushabe

Dear Eleanor, vomiting is a common accompaniment of pregnancy in its early stages, sometimes starting before a missed period, peaking at around six weeks and to the relief of many pregnant women, lessening by around 16 weeks. Although it is usually part of the so-called morning sickness, in many women it may occur at anytime of the day or may be mild while in others it may be very serious, requiring hospitalisation.

Since it occurs during early pregnancy, at the time when the foetus’ organs are forming, it may deter intake of foods which may cause damage at this crucial time. Taking alcohol at this time only serves to enhance birth defects on top of increasing a likelihood of miscarriages and delivering prematurely among many other problems, to the unborn child.

The hormone which shows that someone is pregnant, bHCG, a rise in the female hormone (oestrogen), an enhanced sense of smell and hence the increased sensitivity to odour, and infection by a germ that causes peptic ulcers (Helicobacter Pylori) are all thought to contribute to nausea and vomiting during the early stages of pregnancy.

Though any pregnant woman can suffer from morning sickness, those pregnant for the first time or pregnant with two or more babies, have had nausea and vomiting during a previous pregnancy or when taking birth control pills, those who have a history of travel sickness or migraine headaches, or those with relatives with a history of the problem, may be at particular risk. In fact, it is women who are pregnant with a girl instead of a boy who are more likely to vomit in pregnancy.

Eating small, frequent meals and snacks throughout the day so that the stomach is never empty, getting up slowly when seated or in bed rather than jumping right up, avoiding foods that take long to digest and smells that trigger vomiting, drinking fluids between, instead of after meals, can help.

You need not fear the vomiting but rather visit your doctor for more advice.

Dear doctor, I have problems holding in urine. In fact, my bladder always feels full and I am unable to hold the urine for a long time. Could my bladder be having any problem?
Fredrick