Dr Fred Kavalier: A Question of Health

Pregnancy worries

Pregnancy worries

I have had some bleeding in the first few weeks of pregnancy, and I am worried that this may have affected the baby. Two ultrasound scans have been normal, but I know scans can't pick up everything. Could the bleeding cause abnormality in my baby?

Bleeding in the early part of pregnancy is common. Sometimes it is the first sign that a miscarriage is about to happen. If so, it soon becomes obvious. But if the pregnancy continues uneventfully after one or more episodes of bleeding, you should feel reassured that all is well. It is usually impossible to discover why bleeding has occurred. Occasionally an ultrasound scan shows that the placenta has begun to separate from the wall of the uterus. This doesn't matter, as long as it heals itself and the bleeding stops. It is true that ultrasound scans can't pick up every abnormality, but they are an excellent way of monitoring the growth of babies, and if two scans show that things are progressing normally, that is strong evidence that the baby hasn't been affected by an interruption in blood supply. To prevent further bleeding, the traditional advice is to take it easy for a couple of weeks.

An alternative to Viagra

Are there any new treatments for impotence available? When Viagra was introduced I wanted to try it, but was advised against it because of a heart condition. I was told that other things were going to be introduced, but since then I have heard nothing.

Several new drugs for impotence are in various stages of development. One, Uprima (also known as apomorphine hydrochloride) is already available in the UK. It tends to have more side effects than Viagra (also known as sildenafil), and it must also be used with caution by men with heart problems. But it would be worth discussing it with your doctor. It is a small tablet that you dissolve under your tongue, and starts to work within about 20 minutes. Two other similar drugs, Cialis and Nuviva, are expected to be released soon in the US. Nuviva is said by its manufacturers to be more potent that Viagra, and Cialis is said to have a longer-lasting effect – up to 24 hours after a single dose. There is no information yet about when they might be available in the UK, but once they are released in the US, European licensing usually follows quickly.

Are tests proof positive?

How accurate are home pregnancy tests? I have had two tests, a week apart. The first was negative, the second positive. The first was done on the day my period was due (according to the instructions). When my period failed to start, I repeated the test.

The urine pregnancy tests that you can buy in pharmacies are highly accurate. They detect a hormone in the urine called human chorionic gonadotrophin (hCG). This hormone is normally only produced in pregnancy, so it is very unusual to get a positive test if you are not pregnant. Tests that say you are not pregnant when you are ("false negatives") are more common. There are three possible causes. If you don't follow the instructions carefully, the result may be unreliable. Second, you must use a specimen of urine that contains as much hCG as possible, so the test should be done on the first urine that you pass in the morning. If you use a specimen during the day, it may be too dilute for the test to accurately detect the hCG hormone. In your case, you probably did the first test too early. After an egg is fertilised there is a period of time – up to about 14 days – when levels of hCG in the urine may be too low for home tests to detect. After 14 days, which is about the time when your next period is due, the test's accuracy rises to more than 99 per cent.