WOMENS-HEALTH Messages for May, 1997: Re: Spotting and Pregnancy and Pap tests

Re: Spotting and Pregnancy and Pap tests

From: Edwin Shackeroff,M.D. (anonymous@obgyn.net)
Mon, 26 May 1997 03:04:53 -0500 (CDT)

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In reply to: anonymous@obgyn.net: "Spotting and Pregnancy and Pap tests"

At Sun, 25 May 1997, anonymous@obgyn.net wrote: >
>I had my first prenantal and of course that pap test. Well I spotted
>after and i know that's noimal then I was passing b row discharge the next
>two days after. No cramping or anything. I also am fighting off the ful
>:( so it makes me worry cause the cramps are from my butt :) blush :)
>I had bowel problems. But my question is since I have two miscarriages
>and my discharge is back to normal.... can I breath normally :)
>
>I am so happy that this might be a "normal" pregnancy...
>
>Thanks
>
>Monique (morning sickness :( but happy

Dear Monique, You describe a situation very commonly seen in every OB/GYN office. I would like to share some information I give almost daily to paitents. It does seem to help.

First of all, a small amount of bleeding after a Pap smear is the rule rather than the exception, especially in pregnancy when the cervix is more vascular (has more blood vessels). I usually warn my patients in advance, and this usually avoids unnecessary worry. I usually characterise the anticipated bleeding as "less serious than bleeding when you floss your teeth".

Regarding other bleeding in the first trimester of pregnancy, that is common as well. Most of the time it will resolve, and reduced activity is frequently advised until it does (patients should inform their doctors if this occurs). Some of the time this bleeding can represent the early stages of a misscarriage or perhaps an ectopic (tubal) pregnancy.

The main points helpful for patients to understand about a first trimester misscarriage (spontaneous or missed abortion) are (1) it a very common part of pregnancies, from one in every ten to one in five. (2) There is usually nothing the individual has done to provoke it, i.e. no need for guilt. (3) There is nothing really to prevent it. (4) The same odds exist for each and every pregnancy. (5) Although there is an uncommon condition called "habitual abortion/misscarriage", the commonness of a misscarriage makes the diagnosis of this condition valid after three misscarriages in succession.

I like to point out that as a medical problem, a misscarriage is relatively minor. However as an emotional problem, it is not minor, and the stages of grieving and adjustment should be dealt with for psychological health and well being. The above mentioned points seem to help greatly when faced with dealing with guilt. I had a patient tell me through copious tears that she was sure getting sick from buttered popcorn (eating something she shouldn't) provoked her misscarriage that occurred shortly afterwards. In asking all patients about this, most relate a situation analogous to the buttered popcorn. Relief comes when getting that medically nnecessary deamon out simply by speaking about it and knowing medical facts. I alos find that strong doses of reassurrance in subsequent pregnancies are helpful to the emotions.

Monique, chances are strongly in favor of your continuing this pregnancy without another misscarriage. I wish you well.

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In reply to: anonymous@obgyn.net: "Spotting and Pregnancy and Pap tests"

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