Before You Get Pregnant- A Gift to Lockdown Newlyweds

In spite of all the challenges we are facing, life must still go on, right? For some, it's a new chapter as newlyweds, ready to welcome an addition to the family.  But what are the dos and don'ts before you get pregnant?
The first don't is don't get pregnant unless and until you are ready for it. Pretty obvious, right? But it's not as easy as it sounds, for you will most likely get pregnant unless you take measures to stop it. I am not recommending that you use contraceptives as a newlywed, but if you have a medical reason for delaying or preventing pregnancy, then, by all means, use it. Need help on how to choose the most suitable contraceptive? Chat me up on my blog.
If you haven't started taking folic acid and you plan to get pregnant, please don't delay it any further. You need it for blood formation, and to prevent some abnormalities in your baby, including spina bifida and heart problems.  Typically, the 1mg tablet daily is sufficient. If however, you are on anticonvulsants, have sickle cell anemia, diabetes mellitus, or have had a child with spina bifida, then you should take the 5mg tablet daily. Folic acid is best commenced at least 3 months before conception.
It helps to keep a record of your menstrual cycle. This is important so you can note the last menstrual period in order to date pregnancy accurately. It will also help you suspect pregnancy once you miss a period.
If you are on any medication, please discuss with a health professional to know if taking it may harm your pregnancy or not. Several medications shouldn't be taken in pregnancy, including vitamin A supplements for acne, antibiotics like tetracycline, antihypertensives like captopril, anticonvulsants like sodium valproate, and countless others. The list is endless, so its best to discuss it with your doctor. Some medications need to be discontinued at least 3 months before getting pregnant. The same goes for herbal concoctions. Since we don't know many of the ingredients, its best to stay away from them before conceiving. It's also common to mistake early pregnancy symptoms for regular malaria and typhoid, for which you may be given several medications. Please be sure they are safe for use in pregnancy before ingesting. Better still, get a pregnancy test done first, before anything else.

Intercourse may be challenging and some couples may need lubricants. The best lubricants are actually available in your kitchen. Yes, you heard me right. Vegetable oil is the best lubricant with minimal effect on sperm function. Of course, over the counter lubricants are also available, but be sure that they are safe to use if you are trying to get pregnant.
Lastly, I have had several newlyweds expressing concern after noticing some vaginal discharge following intercourse. This may last for a few days and is perfectly normal. It's just some semen trickling down.
To all the newlyweds, congratulations. Do send in your comments, questions and clarifications.

Rhesus negative, first trimester miscarriage and the need for Rhogam

A question was asked on the need for Rhogam following a first-trimester miscarriage in a Rhesus negative mother, to which I replied viz-

"Thank you for your email. If you are unsensitized(this is confirmed by a blood test in the hospital called indirect Coomb's test), then you qualify for Rhogam. However, you have had a very early miscarriage, in the first trimester. If it was spontaneous, not induced, and did not warrant any intervention like MVA and D and C, then you do not need Rhogam."

Abnormal vaginal discharge with irregular bleeding, not responding to mycoten and fluconazole

 A question was asked on abnormal vaginal discharge with irregular bleeding, not responding to oral and vaginal antifungals. Find below, my reply.

"Thank you for your email. By abnormal cycle, I believe you mean she has irregular bleeding. She seems to have received treatment only for fungal infection. In any case, irregular bleeding with abnormal vaginal discharge may be signs of chronic pelvic inflammatory disease. She needs complete workup including samples taken from the mouth of the womb(cervix) and vagina to check for the exact organisms causing this. She will then be given antibiotics based on the result. She should try and complete the treatment to completely get rid of the infection. If she is more than 21 years old and sexually active, she should get a pap smear done too."

I should add that if results point to a fungal infection, then causes of depressed immunity should be ruled out, including diabetes mellitus. 

Vaginal Discharge and When to Worry

Vaginal discharge is perhaps the most common complaint in gynecological practice. A lot of people confuse normal discharge for abnormal discharge, use medications, and end up worse, sometimes with real abnormal discharge as a consequence of wrong medication use.
From birth, up until menopause, women experience vaginal discharge. This is perfectly normal. At birth, babies may have vaginal discharge due to the withdrawal of hormones of pregnancy. The next time vaginal discharge becomes obvious is probably at the onset of puberty. This continues until the onset of menses. From then on, the discharge becomes cyclical, changing in quantity and consistency at different times of the cycle. During this period, the cyclical nature of discharge may be disrupted by pregnancy or the use of family planning pills. Usually, vaginal discharge tends to reduce significantly after cessation of menses.
Abnormal vaginal discharge can be seen in any age group. In childhood, a common cause is the presence of a foreign body in the genital tract. Some worm infestation could also cause vaginal discharge. So can poor perineal hygiene. In all such cases, sexual abuse must be ruled out. After puberty, the most common cause of vaginal discharge is infections. Vaginal discharge can occur even without sexual exposure (it may not be sexually transmitted). This is as in the case of candidiasis and bacterial vaginosis. Others may be sexually transmitted, as in the case of chlamydia and trichomoniasis. Whatever the cause, vaginal discharge is abnormal when it is excessive, malodorous, itchy, discolored, or associated with abdominal pain and fever. Failure to adequately treat vaginal infection could lead to complications like chronic pelvic pain and infertility.
Vaginal infection in pregnancy could lead to disastrous consequences like preterm birth, breakdown of episiotomy and cesarean section site wounds, and even infections in the newborn.
It is recommended to seek medical advice for any vaginal discharge you are not comfortable with. Observe good perineal hygiene including cleaning from front to back. Avoid using unorthodox medication, douching, and prolonged use of antibiotics. Ensure you comply with treatment offered by health professionals, including partner treatment for sexually transmitted infections.
Thanks for reading. I hope you find it useful. Looking forward to your questions, comments, observations, and clarifications.