Download A positive pregnancy test: What now?

A positive
pregnancy test:
What now?
Melbourne IVF’s guide to early pregnancy
A Guide to Early Pregnancy
This booklet aims to provide relevant
information relating to the first twelve
weeks of your pregnancy.
You can obtain additional information
from your Fertility Specialist, the Early Pregnancy
Management Nurse at Melbourne IVF or from
various external sources such as antenatal
clinics, your General Practitioner, The Royal
Women’s Hospital Health Information Centre
or the obstetrician of your choice.
Dr Lyndon Hale
Medical Director,
Melbourne IVF
Important dates to remember
Date
Commencement of last menstrual cycle
Date of embryo transfer
First pregnancy Ultrasound
Expected date of birth
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First Pregnancy Ultrasound
Following your positive pregnancy test
result, an ultrasound (vaginal or abdominal)
is recommended at approximately
6-7 weeks gestation or earlier if
requested by your Fertility Specialist.
This ultrasound is necessary to identify
the following;
• A pregnancy within the uterus
• Exclude an ectopic pregnancy
(pregnancy located outside of
the uterus)
• The number of gestational sacs
• A fetal pole
• Measure the size of the fetus(s)
• Detect a heartbeat(s)
Possible outcomes of your
first pregnancy ultrasound
•Viable clinical pregnancy
A pregnancy is visualised within the
uterus and a heartbeat is detected.
•Ectopic pregnancy
A pregnancy located outside the
uterus. The most common location for
an ectopic pregnancy is the fallopian
tube; however it may be located in
the cervix, ovary or abdomen. Ectopic
pregnancies occur in approximately
1-2% of all IVF pregnancies.
The clinical signs of an ectopic
pregnancy may include: slowly rising
pregnancy hormone levels, vaginal
bleeding and/or left or right sided
lower abdominal pain.
Please contact your Fertility Specialist or
the Early Pregnancy Management Nurse
at Melbourne IVF immediately if you have
any concerns.
If you have severe pain, you should
attend your nearest Emergency
department or an Emergency
department of your Fertility Specialist’s
choice. An ectopic pregnancy cannot
continue and surgery may be required.
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Early diagnosis will help to minimize
any tubal damage and the ectopic
pregnancy may be removed surgically
by laparoscopy (keyhole surgery). This
is usually a surgical day procedure.
Alternatively, a drug called Methotrexate
may be used to avoid surgery. Your
Fertility Specialist will advise the most
appropriate treatment option for you.
•Blighted ovum
A blighted ovum occurs when a fertilised
egg implants into the uterus but an
embryo does not develop. This is most
commonly due to a chromosomal
abnormality in the embryo. A blighted
ovum will eventually result in a
miscarriage, however this may not occur
for several weeks. Your Fertility Specialist
will discuss the most appropriate
treatment for you.
•Missed abortion
The pregnancy sac and fetus are
visualised but no fetal heartbeat is
detected. A missed abortion is most
commonly due to a chromosomal
abnormality in the embryo.
This will eventually result in a miscarriage,
however may not occur for several
weeks. Your Fertility Specialist will discuss
the most appropriate treatment for you.
•Early failed pregnancy/biochemical
pregnancy
A biochemical pregnancy occurs when
hCG (pregnancy hormone) is detected
in the blood but fails to rise at the
appropriate rate over a period of time.
It indicates that early implantation has
occurred, however the embryo has not
continued to develop. This outcome is
most commonly due to a chromosomal
abnormality in the embryo. Your Fertility
Specialist will discuss the best treatment
for you.
Further information is available at
www.thewomens.org.au/healthinformation/pregnancy-and-birth/
pregnancy-problems/early-pregnancyproblems/
•Counselling support following
pregnancy loss
Our experienced counsellors are
available to support you during
this difficult time. You can make a
counselling appointment by contacting
Melbourne IVF and speaking to a Patient
Liaison Administrator on (03) 9473 4444.
Your antenatal pathway
At this early stage, you are advised to
make your first antenatal appointment.
Choosing a hospital or obstetrician is an
important decision.
In order to schedule your first antenatal
appointment you will require a referral
from your General Practitioner. At this
appointment you may wish to discuss
any lifestyle factors that may affect you
or your baby throughout the pregnancy.
Your Fertility Specialist is available to discuss
appropriate antenatal care options for you.
Common symptoms of
early pregnancy
Common symptoms in early pregnancy
include:
•Tiredness
It is common to feel tired during the first
twelve weeks of pregnancy. At this time,
your body is going through significant
hormonal and physiological changes.
•Breast Changes
Due to hormonal changes that
are occurring at this time, you may
experience the following: tender, swollen
and enlarged breasts, darkened nipples
and breast veins may become more
visible. These symptoms may vary and
fluctuate between individuals.
•Nausea & vomiting
Nausea and vomiting may be
experienced at any time of the day
or night and the severity varies between
individuals.
Strategies for managing nausea
and vomiting during pregnancy:
1. Maintain fluid intake
It is important to maintain adequate
hydration. Water, ginger ale/tea or
soups may assist with symptoms of
nausea. It is recommended to avoid
caffeinated and sweet carbonated
beverages which can be dehydrating.
2.Regular small meals
If you experience nausea and vomiting
in the morning, you may wish to keep
dry biscuits at your bedside to eat prior
to getting up. Eating small, regular,
healthy meals throughout the day
may also help overcome nausea.
Ginger or Vitamin B6 tablets can be
beneficial to treat nausea.
You can consult your pharmacist for
further advice on non-prescription
preparations. If symptoms persist
please consult your General
Practitioner or Obstetrician.
•Urinary frequency
As the uterus enlarges it compresses the
bladder increasing the urge to pass urine.
It is important not to decrease your fluid
intake. Urinary tract infections are more
common in pregnancy. If you experience
any burning or stinging when passing
urine, or if there is any visible blood in
your urine, please consult your General
Practitioner.
3
4
•Constipation
Constipation is common during
pregnancy. To avoid constipation,
increase your fluid intake and consume
a diet high in fibre which includes fresh
fruit and vegetables, whole grain foods
and cereals. If constipation persists,
please discuss this with your Pharmacist
or General Practitioner.
•Dizziness/fainting
Dizziness and fainting is commonly
experienced in pregnancy. Avoid
standing for prolonged periods of time
as this may increase the risk of this
occurring. Persistent fainting should be
discussed with your General Practitioner
or Obstetrician.
•Back aches & pains
Abdominal discomfort and back pain
are common symptoms in pregnancy.
Paracetamol or paracetamol with
codeine (remember that codeine
increases the risk of constipation) may be
taken in pregnancy in accordance with
manufacturer’s instructions. If symptoms
persist discuss your concerns with your
General Practitioner or Obstetrician.
•Heartburn
Heartburn is common in pregnancy.
To help alleviate these symptoms you
can avoid foods that cause discomfort,
elevate the head of your bed and
avoid consuming large meals at night.
If symptoms persist please consult your
pharmacist, General Practitioner or
Obstetrician.
•Vaginal bleeding
Bleeding is common in early pregnancy
and does not always result in miscarriage.
Therefore it is important not to cease any
of your prescribed medications and to
notify the Melbourne IVF Early Pregnancy
Management Nurse, your Fertility
Specialist or Obstetrician.
If you experience bleeding and severe
abdominal pain, you should immediately
report this to the Melbourne IVF Early
Pregnancy Management Nurse, your
Fertility Specialist, Obstetrician or General
Practitioner. If your concern is after hours,
please attend your nearest Emergency
department.
For further information regarding
common concerns in pregnancy
please refer to www.thewomens.org.
au/healthinformation/pregnancy-andbirth/a-healthy-pregnancy/commonconcerns-in-early-pregnancy/
General health and
Lifestyle factors
•Medications
It is important to discuss with your
Obstetrician or General Practitioner the
safety of any medication (including
natural supplements) that you take
during your pregnancy.
For more information regarding
medications during pregnancy or
lactation call The Medicines Information
Service at the Royal Women’s Hospital,
Monday to Friday 9.00am to 5.00pm
on (03) 8345 3190.
•Alcohol
There is no known safe level of alcohol
use in pregnancy.
For further information and support
regarding alcohol and pregnancy,
please contact The Women’s Alcohol
and Drug Service at the Royal Women’s
Hospital on (03) 8345 2000 or visit:
www.thewomens.org.au/health.../
womens-alcohol-and-drug-service.
•Smoking
It is strongly recommended that you do
not smoke during pregnancy or lactation.
For further support and information
call Quitline on 13 78 48 or visit:
www.quit.org.au.
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•Sex
Unless your Obstetrician or General
Practitioner advises you otherwise,
sex is safe during pregnancy.
•Exercise
Regular and moderate exercise is
recommended as part of a healthy
lifestyle. Good exercise patterns
developed prior to pregnancy will assist
your body in coping with the pregnancy,
childbirth and postnatal period.
Moderate, low impact exercise during
pregnancy can be beneficial for you and
your baby. Some women find meditation,
yoga, pilates, swimming and relaxation
classes helpful. Certain contact sports
eg: weightlifting, boxing, judo may
be unsuitable for pregnant women.
Check with your General Practitioner
or Obstetrician if you are unsure of any
aspect of exercise during pregnancy.
Important points to remember when
exercising:
• Avoid overheating
• Avoid spas, saunas and steam baths
• Maintain adequate hydration – water
is the best choice
• Perform regular pelvic floor exercises
There are many antenatal exercise
programs available in the community.
Prior to undertaking any new exercise
program, please advise your General
Practitioner or Obstetrician.
•Diet
It is recommended to eat a
well-balanced diet.
For further information visit:
www.thewomens.org.au/healthinformation/pregnancy-and-birth/ahealthy-pregnancy/food-nutrition-inpregnancy.
•Folate
Folate, also known as folic acid, is
important during pre-conception and
for the first three months of pregnancy.
It must be taken as a supplement for the
entire pregnancy as it reduces a baby’s
risk of developing neural tube defects
such as spina bifida. The recommended
dose of Folic Acid is 500mcg daily.
However, if you have a family history of
spina bifida, or you have epilepsy and
are taking antiepileptic medication,
please consult your General Practitioner
or Obstetrician for further advice on
your required dose of Folic Acid.
•Air travel
If you are planning a flight during your
pregnancy, please consult your General
Practitioner or Obstetrician to discuss.
•Listeria
Listeria infection is relatively uncommon
however, pregnant women are at risk of
this infection. It is caused by ingesting
food contaminated with Listeria
Monocytogenes. Prevention is better
than cure, therefore it is best to avoid
high risk foods and always handle and
store food safety. If you have concerns
please consult your General Practitioner.
Listeria can be treated with antibiotics if
treatment is commenced promptly.
For further information please email
infectious.diseases @ health.vic.gov.au
or refer to www.foodstandards.gov.au.
•Animals
Toxoplasmosis is an infection caused
by a parasite found in some animal
faeces (most commonly cats). A blood
test can identify if you have immunity to
toxoplasmosis. This infection can affect
a developing baby if contracted during
pregnancy. There are several food
sanitation and safety steps you can
take to prevent becoming infected.
6
Please note, it is safe to have animals
during your pregnancy as long as you
follow the guidelines below.
These include:
• Wash hands after handling raw meat
• Cook meat thoroughly until
juices run clear
• Do not eat rare or medium rare meats
• Wash vegetables to remove
any traces of soil
• Wash hands thoroughly before eating
• Avoid unpasteurised milk or
dairy products
• Wash cooking utensils follow
contact with raw meat
• Wear gloves when gardening
• Avoid contact with cat faeces or soil
• Ask someone else to handle
kitty litter trays
• Ensure litter trays are cleaned daily
Miscarriage
A miscarriage is a pregnancy loss before
20 weeks. Most miscarriages occur within
the first twelve weeks of pregnancy,
approximately 20% of all pregnancies result
in miscarriage. The chance of miscarriage
increases with maternal age, as follows:
Your doctor will discuss the most
appropriate management for you.
This management will depend on how
many weeks pregnant you are and the
type of pregnancy loss you have had.
In some cases, testing the products of
conception for possible chromosomal
abnormalities may be beneficial for your
ongoing management and you may wish
to discuss this with your doctor.
After a miscarriage you may be required
to have regular blood tests to ensure your
pregnancy hormone (beta hCG) levels
are decreasing. The blood test will usually
be ordered weekly until there is a negative
result. Further IVF treatment cannot be
commenced until this has occurred. For
further information visit www.thewomens.
org.au/health-information/pregnancyand-birth/pregnancy-problems/earlypregnancy-problems/miscarriage/
Our experienced counsellors are available
to support you during this time. You can
make a counselling appointment by
contacting Melbourne IVF and speaking
to a Patient Liaision Administrator on
(03) 9473 4444.
• Under 35 years of age – 15-20%
• 35 – 45 years of age 20-40%
• Over 45 years of age 50%
There is no significant difference in
miscarriage rates between assisted
conception and naturally conceived
pregnancies. There is no way to prevent
an impending miscarriage from happening.
It is not a result of too much exercise,
lifting, having sex, eating the wrong foods
or drinking alcohol. The main cause of
a miscarriage is a random chromosomal
error causing abnormal development
in the fetus.
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Anti D
Antenatal screening
In a pregnancy where the mother is a
Rhesus negative blood group and the
father is Rhesus positive blood group,
it is possible that the fetus will also be
a Rhesus positive blood group. If this is
the case, the mother’s immune system
can recognise the fetal cells as foreign
and may develop Rhesus D antibodies.
Although there are limited issues with this
scenario in the first pregnancy, if these
antibodies remain in the woman’s system,
they can cause problems in subsequent
pregnancies. To prevent this from
occurring, Anti D is administered (as an
injection) within 72 hours of the following
circumstances occurring:
If you decide to undertake prenatal
testing you will need to see your
General Practitioner, Fertility Specialist
or Obstetrician early in your pregnancy
to discuss the most appropriate test and
risk factors.
• vaginal bleeding during your pregnancy
• miscarriage
• termination of pregnancy
• a medical procedure such as chorionic
villious sampling (CVS), amniocentesis,
or external cephalic version
Your fertility specialist or obstetrician will
advise you whether you require Anti D.
Special considerations with
advanced maternal age
Complications increase with advanced
maternal age. Older women are at a
higher risk of spontaneous miscarriage
as well as a higher risk of carrying a baby
with chromosomal abnormalities. Women
over 35 years of age are more likely to
have a pre-existing medical condition
such as diabetes and hypertension and
are at greater risk of developing obstetric
complications, such as preterm delivery,
gestational diabetes, pre-eclampsia,
placenta praevia and small for gestational
age babies.
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For further information please refer to the
Murdoch Children’s Research Institute
website www.mcri.edu.au/Downloads/
PrenatalTestingDecisionAid.pdf.
References
Resources
•Preparing for Pregnancy
The Women’s Hospital, Victoria
•Australian Breastfeeding Association
www.breastfeeding.asn.au/
breastfeeding-helpline
•Early Pregnancy Loss Support
Sands, Victoria
•Listeria – The Facts
Department of Health Services, Victoria
•Medications in Pregnancy
The Royal Women’s Hospital Medication
Information, Victoria
•Ultrasound Screen for Down syndrome
Chorionic Villus Sampling &
Amniocentesis
Women’s Imaging Centre, Victoria
•Smoking & Pregnancy
Quitline, Victoria
•Family Planning Victoria
Website: www.fpv.org.au/
•National Perinatal Depression Hotline
Telephone Support: 1300 726 306
www.panda.org.au/
•Royal Women’s Hospital Medication
Information Service
Telephone: (03) 8345 3190
•SANDS (Stillborn and Neonatal Death
Support)
www.sands.org.au/
•Women’s Health Information Centre
(RWH)
Telephone: (03) 8345 3045
Toll Free: 1800 442 007
•Vic Health
www.health.vic.gov.au/maternity
•Quitline
Telephone: 13 78 48
www.quit.org.au
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