Q&A: Nothing has been done to put me under high risk attendance
I am 29 years old and I am currently ten weeks and two days pregnant. I have had two miscarriages previously. My first pregnancy was at eight weeks and my second was at ten weeks. I use public clinics because I don't have the money to use medical aid facilities. The clinic I go to now is the same clinic that I attended when I had the miscarriages. I went to book msyelf in now, before I was six weeks pregnant and they told me that I must come back much later on. I am very disappointed because nothing has been done to put me under high risk attendance and I am very worried because I used to have sore breasts and nausea but now I don't have any pregnancy symptoms... since I was six weeks pregnant. I am due for a private sonar soon but until then I feel like a sitting duck. What can I do?

Dr Bronwyn Moore (gynaecologist) answers:

I am sorry to hear about your pregnancy complications. The anxiety you are feeling must be terrible. You were absolutely right to present for booking early in pregnancy, that is what high risk women are asked to do. Both your pregnancy losses were in the first trimester, and this is the most common time for pregnancy loss to occur. Recurrent pregnancy loss is defined as having three consecutive miscarriages, and so in many healthcare systems (locally and abroad) no extra testing is indicated in cases such as yours. The reason for this is that the chances of the tests showing anything is low, and the chances that a third pregnancy will be successful is high. The only way to besure what is happening in this pregnancy is to have a scan done, either through your clinic, or at the nearest government hospital. Having said that, there are some tests that should be done in all pregnancies, so please check that all your antenatal bloods are up to date, including a syphilis and HIV test, at your first visit. It seems that in your pregnancies the foetus has been seen on sonar and then at a later date it is noticed that there is no foetal heartbeat. This is called a missed miscarriage or missed abortion. Most of the government hospitals have clinics for women with recurrent miscarriages, and if you book in there, a full workup can be done. There are tests that are best done while you are not pregnant, so book with the gynae clinic for review even if there has been a problem with this pregnancy. Ask specifically for testing for auto-immune problems (ANF), antiphospholipid testing (ACLA and LA) and thrombophilia screening. Women with these abnormalities often have a poor obstetric history, and the condition is only found when a workup for miscarriage is done. They have an increase in blood clotting that affects the placenta and starting a blood thinning injection early on often improves things. By the time you are seen you will be 12 weeks. I suggest you start taking Ecotrin, one a day, in the meantime.

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