Is stomach pain during pregnancy normal?

My wife, who is one month pregnant, has severe stomach pain which I fear may lead to another miscarriage. Last year, she suffered a miscarriage at two months. I am blood group O+ and my wife is B-. What could be the cause? Jimmy

Dear Jimmy,

Getting pregnant and carrying the baby to term is challenging for a couple that any pain a pregnant woman feels may be feared to be the beginning of a miscarriage. In many cases, this is not the case. Feeling pain in any part of a pregnant woman’s abdomen may result from many things, including peptic ulcers that may also affect a woman who is not pregnant.

Pain in the lower abdomen in early pregnancy may be due to an expanding womb, pregnancy in the wrong area, especially in a fallopian tube, infections in the urinary tract or constipation, which is common in pregnancy. It could also be due to the stretching of womb ligaments that tether the womb in place and in a few cases, a sign of a pending miscarriage.

If a woman who is blood group Rhesus negative gets pregnant by a man who is blood group Rhesus positive, this baby may be Rhesus positive. If the baby’s blood leaks into the mother’s blood, as may happen during delivery, an ectopic pregnancy, a miscarriage or after a blood transfusion, the mother may form antibodies against the next baby’s blood with certain consequences, including pregnancy loss. 

Being Rh-negative does not cause miscarriages but one may be at risk of miscarrying if she has ever had a miscarriage or delivered a Rhesus positive baby or had Rhesus positive blood transfusion. These can make the woman produce antibodies against Rhesus positive blood. When the woman gets pregnant with a baby with rhesus positive blood, the baby’s blood is likely to be attacked and destroyed, leading to the baby being born with almost no blood but dangerously high levels of bilirubin. In extreme cases, a pregnancy loss may occur. Here, risk can be minimised by getting Anti D shots after a miscarriage or delivery or waiting for at least two years before getting pregnant again.

Much as you think your wife might miscarry because your blood group is Rhesus positive, there may be other common factors such as chromosomal abnormalities that may cause a miscarriage and, hence, require to be looked into and prevented in the next pregnancy through properly attending prenatal, antenatal and postnatal clinics. A woman’s risk factors of miscarriage, including advanced maternal age, previous miscarriages and health conditions such as unmanaged diabetes, infections and an incompetent cervix, among others, would then be investigated.

To minimise the risk of having a miscarriage, folic acid should be taken every day, beginning at least three months before getting pregnant. One should also adopt a healthy lifestyle by eating a balanced diet and avoiding alcohol, caffeine or smoking. After a miscarriage, one should wait at least two years before getting pregnant again since this reduces the amounts of antibodies in the blood and minimises the effect of Rhesus isoimmunisation and makes the woman ready physically and mentally for pregnancy.

Two-dose injection of Anti D (given in the 28th and 34th weeks of pregnancy) should be given to your wife during pregnancy although this will only protect your next pregnancy and not the baby you are carrying. Anti D, however, may require to be given if you get a miscarriage, if you have ectopic pregnancy, or if you terminate the pregnancy. Still in this case, only the subsequent pregnancy will be protected.

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