WEBVTT - 196. What To Do After A Positive Pee On A Stick 0:00:03.720 --> 0:00:06.800 Welcome to the kick your Expert led podcast, helping you 0:00:06.880 --> 0:00:11.280 explore and learn everything about getting pregnancy, birth, and becoming 0:00:11.280 --> 0:00:11.680 a parent. 0:00:12.039 --> 0:00:15.760 On the podcast and our online pregnancy program, grow My Baby, 0:00:15.960 --> 0:00:18.960 we share my experience of helping more than four thousand 0:00:19.000 --> 0:00:20.360 babies to be born and. 0:00:20.320 --> 0:00:23.279 Our experience of running a women's health clinic and parenting 0:00:23.360 --> 0:00:23.960 for boys. 0:00:24.160 --> 0:00:27.160 We're here to help everyone to feel empowered in pregnancy 0:00:27.320 --> 0:00:30.160 and birth with real life, practical information. 0:00:35.120 --> 0:00:38.800 Welcome everyone, I'm Bridget Maloney, and today we're going right 0:00:38.840 --> 0:00:41.960 back to one of our very first episodes, what to 0:00:42.040 --> 0:00:44.000 do after you get those two lines on a p 0:00:44.159 --> 0:00:48.480 and the stick. Often it's quite a daunting time you think, gosh, 0:00:48.479 --> 0:00:51.080 what I do next? And what we've done is we've 0:00:51.120 --> 0:00:53.720 broken it up into a can you actually trust the 0:00:53.760 --> 0:00:57.760 pe on the stick tests? Are they accurate? Or do 0:00:57.800 --> 0:01:00.319 you need to go and see a GP? And then 0:01:00.440 --> 0:01:03.720 when you go and see your GP, what information should 0:01:03.720 --> 0:01:06.480 you take to that visit? And so what we've done 0:01:06.520 --> 0:01:10.760 since the very start is we've developed a downloadable checklist 0:01:10.959 --> 0:01:13.000 that is free and you can get that from our 0:01:13.040 --> 0:01:16.679 website and it's a just pregnant check list and our 0:01:16.720 --> 0:01:21.120 website is grow mybaby dot com dot au. So hopefully 0:01:21.200 --> 0:01:24.760 you've picked up this episode because you're either wanting two 0:01:24.760 --> 0:01:26.840 lines on the p on a stick or you've just 0:01:26.920 --> 0:01:30.240 found one. So if you've just found one, congratulations, listen 0:01:30.280 --> 0:01:32.679 on and hopefully you'll get lots of good tips from 0:01:32.760 --> 0:01:39.800 this episode. All right, well, let's go back, you know what, 0:01:40.800 --> 0:01:44.800 eight months to when you first find out you're pregnant. Now, 0:01:44.880 --> 0:01:47.560 we all have a love hate relationship with these pe 0:01:47.680 --> 0:01:50.840 on the stick things. You know, every woman at some 0:01:51.000 --> 0:01:53.960 stage in her life when she's trying to start a 0:01:54.000 --> 0:01:58.440 family has got the box of p on the sticks. Yeah. Anyway, 0:01:58.560 --> 0:02:03.560 so we've done our We've got two lines. And by 0:02:03.600 --> 0:02:05.760 the way, it gets asked of us a lot, doesn't it. 0:02:05.840 --> 0:02:08.640 You know, even if there's a faint second line on 0:02:08.680 --> 0:02:10.799 a pe on a stick, you're pregnant. Yeah. 0:02:10.840 --> 0:02:14.519 Read the box to make sure what a positive test 0:02:14.560 --> 0:02:17.320 is supposed to look like. But on the two line ones, 0:02:17.720 --> 0:02:20.240 even a faint second line is pregnant. 0:02:20.360 --> 0:02:20.600 Yeah. 0:02:20.680 --> 0:02:24.320 The tests are extremely accurate and very very very sensitive. 0:02:24.760 --> 0:02:27.280 So they'll pick up levels of beta hCG, which is 0:02:27.280 --> 0:02:31.640 the pregnancy hormone, when the level reaches about five and 0:02:31.680 --> 0:02:35.200 in early pregnancy the level might be fifty thousand. Yeah. Wow, 0:02:35.280 --> 0:02:39.480 So they'll turn positive as soon as that pregnancy hormone 0:02:39.600 --> 0:02:42.960 is present in the urine, which is as early as 0:02:43.000 --> 0:02:45.000 a couple of days before the miss period. 0:02:45.800 --> 0:02:49.640 Wow. So I can actually start testing just days after conception. 0:02:49.880 --> 0:02:53.160 No, yeah, well a few days before the So povulation 0:02:53.280 --> 0:02:55.880 happens in the middle of the cycle and then the 0:02:55.960 --> 0:02:58.000 little time takes for sperm to meet egg and then 0:02:58.000 --> 0:02:59.600 a little time for them to get together and come 0:02:59.680 --> 0:03:02.000 down into the uterus and implant into the wall of 0:03:02.080 --> 0:03:06.560 the uterus. But there's some bitter hCG pregnancy hormone present 0:03:07.120 --> 0:03:10.040 even before the missed periods, So even before you know 0:03:10.120 --> 0:03:12.320 you're pregnant because you're over due. Yeah. 0:03:12.320 --> 0:03:14.840 Well yeah, all right. So we talked a little bit 0:03:14.919 --> 0:03:19.560 last podcast about you know, just any generic pregnancy test, 0:03:19.840 --> 0:03:23.240 So any cheap pregnancy test will pick that up. 0:03:23.400 --> 0:03:25.520 Yeah. They're pretty simple, and I mean there's some fancy 0:03:25.520 --> 0:03:28.160 ones that try and tell you how many weeks you 0:03:28.240 --> 0:03:30.120 might be pregnant and so forth. But let's say that's 0:03:30.120 --> 0:03:32.399 a couple who are trying for a pregnancy, and they're 0:03:32.440 --> 0:03:35.600 monitoring their dates and they know precisely when to look Okay, 0:03:36.040 --> 0:03:38.080 as soon as the periods chew on one day and 0:03:38.120 --> 0:03:40.720 it's not there, then that couple will look and all 0:03:40.720 --> 0:03:42.760 you need is a yes no test. Yeah, and it 0:03:42.800 --> 0:03:44.320 doesn't have to be fancy or expensive. 0:03:44.400 --> 0:03:47.320 Yeah, well, how exciting it is. Mostly it's exciting. I 0:03:47.360 --> 0:03:50.880 know that sometimes a positive pregnancy test isn't looked or 0:03:50.880 --> 0:03:54.120 hoped for, but mostly it's exciting. So you've got your 0:03:54.160 --> 0:03:58.160 positive pregnancy test. How long do you wait before you 0:03:58.200 --> 0:03:58.760 see your GP? 0:03:59.400 --> 0:04:01.800 Well, I think think that one of the will return 0:04:01.800 --> 0:04:03.360 to this again and again, but one of the great 0:04:03.480 --> 0:04:06.720 ideas is to have already been to see local doctor 0:04:07.080 --> 0:04:09.400 before you get that positive p hon a stick test, 0:04:09.920 --> 0:04:12.200 so that a lot of the things are already sorted out. 0:04:12.520 --> 0:04:14.320 And by that I mean that you've had a chat 0:04:14.360 --> 0:04:18.160 to the GP about being on some folate supplementation, that 0:04:18.320 --> 0:04:23.520 your protection against rubella has been has been checked or 0:04:23.560 --> 0:04:27.480 boosted if it was thought to be inadequate, and perhaps 0:04:27.560 --> 0:04:31.039 even had a conversation with the doc about care models, 0:04:31.720 --> 0:04:32.960 so that you know a lot about what to do 0:04:33.000 --> 0:04:36.480 when you when you when you already get that that 0:04:36.520 --> 0:04:39.240 positive test. But let's say it was a bit of 0:04:39.279 --> 0:04:43.360 a surprise and that that pre pregnancy visit hasn't happened. 0:04:43.400 --> 0:04:46.080 So the things that are important at that stage once 0:04:46.120 --> 0:04:48.599 you get that positive p test is that is that 0:04:48.640 --> 0:04:52.000 you're on some pregnancy multivitamin or at least some folate supplementation. 0:04:52.920 --> 0:04:54.760 And that's when we make a visit to go and 0:04:54.760 --> 0:04:58.600 see our GP and hopefully getting to see them at 0:04:58.839 --> 0:05:00.480 about the six weeks mark. 0:05:00.880 --> 0:05:03.320 Okay, And what is the six week mark? Is that 0:05:03.360 --> 0:05:05.919 from the first day of your last period. 0:05:06.160 --> 0:05:09.000 Yes, excellent. So that's a really important question. So let's 0:05:09.040 --> 0:05:10.680 make sure we're all on the same page about that. 0:05:10.920 --> 0:05:15.040 When we talk about six weeks pregnant, we mean six 0:05:15.080 --> 0:05:20.000 weeks from the last period, not six weeks since the 0:05:20.240 --> 0:05:23.480 ovulation or six weeks since intercourse or six weeks since 0:05:23.480 --> 0:05:26.640 we got the positive pregnancy test. We mean six weeks 0:05:26.680 --> 0:05:27.679 from the last period. 0:05:27.839 --> 0:05:28.279 Yeah. 0:05:28.320 --> 0:05:30.599 And this is an old fashioned idea of it. It dates 0:05:30.640 --> 0:05:32.680 back to the days where there were no ultrasounds and 0:05:32.720 --> 0:05:35.720 there was no great understanding of the hormonal basis of 0:05:35.760 --> 0:05:40.240 ovulation and so forth, so that all we knew were 0:05:40.240 --> 0:05:43.200 the dates. Yeah, And a woman was said to be 0:05:43.320 --> 0:05:45.719 ten weeks pregnant if there had been ten weeks since 0:05:45.760 --> 0:05:48.920 her period, because that's that's all we can know for sure. 0:05:49.000 --> 0:05:52.200 Yeah, that's right. So you go to your local doc. 0:05:53.080 --> 0:05:55.880 And we know from our experience in our practice that 0:05:55.920 --> 0:05:59.000 there are many many women who actually don't have a 0:05:59.000 --> 0:06:02.760 local doctor. You know, they've been for years. They've either 0:06:02.839 --> 0:06:05.600 moved around and they haven't sort of picked up on 0:06:05.640 --> 0:06:09.400 a GP that they go to regularly. And let's face it, 0:06:09.440 --> 0:06:11.120 so many women are just healthy and all you need 0:06:11.160 --> 0:06:15.080 to pop to the doctor for in those days is 0:06:15.160 --> 0:06:17.640 you know, maybe the treatment of the odd uti or something, 0:06:17.640 --> 0:06:20.680 and your head down to your bulk billing twenty four 0:06:20.680 --> 0:06:23.039 hour clinic and you haven't really built that rippor or 0:06:23.040 --> 0:06:24.279 that relationship with the doctor. 0:06:24.440 --> 0:06:27.679 Absolutely, and I think that's a pretty common scenario these days. 0:06:27.760 --> 0:06:31.400 So you really only need to see the local doctor 0:06:31.520 --> 0:06:35.040 that six week mark to have a talk about those 0:06:35.080 --> 0:06:38.280 big ticket things FOL eight and so forth, get some 0:06:38.320 --> 0:06:41.560 pregnancy blood tests, organized the first round of blood tests, 0:06:42.240 --> 0:06:47.280 and ideally arrange for an early scan, and that can 0:06:47.360 --> 0:06:50.640 be done through any local doctor. It's really nice if 0:06:50.680 --> 0:06:52.840 you've got an established local doctor who can go and 0:06:52.880 --> 0:06:57.080 see because building up a relationship with that person is 0:06:57.120 --> 0:06:59.560 a terrific thing to do, not only during the pregnancy, 0:07:00.160 --> 0:07:03.120 whether you're having your care as shared care with that 0:07:03.240 --> 0:07:06.159 doctor or shared care with a midwife, or shared care 0:07:06.200 --> 0:07:09.880 with a consultant obstetrician, the GP wants to see you 0:07:09.880 --> 0:07:13.040 in pregnancy and help to look after you. And then 0:07:13.080 --> 0:07:15.720 when you're got a newborn, you're never at the dock 0:07:15.800 --> 0:07:16.320 more than. 0:07:16.360 --> 0:07:19.320 Yeah, yeah, that's right. It seems like every sniffle you're 0:07:19.320 --> 0:07:23.600 down there because you really, you know, it's such unknown territory. 0:07:23.280 --> 0:07:27.400 You're nervous, and a rash and a running nose. You're 0:07:27.400 --> 0:07:29.480 at the dock a bit. And a lot of people 0:07:29.520 --> 0:07:31.760 get their vaccinations for the baby through the local dock 0:07:31.800 --> 0:07:35.160 as well. So if you're a client of an established clinic, 0:07:35.400 --> 0:07:37.320 even if it's not the same dock every time, it's 0:07:37.320 --> 0:07:40.440 at least the same practice. That's a really nice thing 0:07:40.440 --> 0:07:42.160 to be thinking about it this early stage. 0:07:42.480 --> 0:07:44.880 All right, So you've got an appointment with your local doctor. 0:07:44.920 --> 0:07:48.160 It's six weeks. What do you have to tell them? 0:07:48.480 --> 0:07:50.280 Well, what they want to know at that stage is 0:07:50.880 --> 0:07:53.320 just back to basics. Is your history? Is this your 0:07:53.360 --> 0:07:57.760 first pregnancy? Are you pleased to be pregnant? Before I 0:07:57.800 --> 0:08:00.080 was a specialist obstetrician, I was a GP for a 0:08:00.080 --> 0:08:03.560 little while many years ago, and that was the phrase 0:08:03.600 --> 0:08:07.320 that I'd worked out was a tactful way of opening 0:08:07.360 --> 0:08:10.840 the discussion. And if someone's not pleased to be pregnant, 0:08:11.320 --> 0:08:12.520 then it's a whole different discussion. 0:08:12.560 --> 0:08:13.640 Yeah, that's exactly right. 0:08:14.120 --> 0:08:16.679 So if we open with are you pleased to be pregnant? 0:08:16.800 --> 0:08:20.360 Then yes, of course, we've been trying to get pregnant 0:08:20.360 --> 0:08:22.600 for three or four months and tracking our povulation and 0:08:23.560 --> 0:08:28.320 we're thrilled. Then there'll be some early questions about the 0:08:28.440 --> 0:08:35.320 women's medical history and also histories for the partner family history, 0:08:36.080 --> 0:08:39.320 whether there's any body in the extended family here any 0:08:39.360 --> 0:08:44.520 unhealthy or unusual babies, whether the woman or her partner 0:08:44.559 --> 0:08:48.040 have any issues with drugs and alcohol. I think these 0:08:48.120 --> 0:08:50.960 days it's very important that we get in early and 0:08:51.000 --> 0:08:54.640 ask people about things like family violence. Family violence is 0:08:54.679 --> 0:08:58.600 a problem that gets worse in pregnancy, and. 0:08:58.520 --> 0:09:02.560 Then that might be kind of quite confronting for someone 0:09:02.559 --> 0:09:05.000 that's just come in with really happy news that they're pregnant. 0:09:06.320 --> 0:09:07.760 Why do you actually ask them? 0:09:08.000 --> 0:09:09.360 Well, we don't have to go You don't have to 0:09:09.360 --> 0:09:11.719 ask that up front, right, Okay, So what I say 0:09:11.720 --> 0:09:14.160 to my students is, don't forget to say congratulations, yeah, 0:09:14.200 --> 0:09:16.880 oh my god, and be happy, be happy for the patient. 0:09:17.240 --> 0:09:19.400 But at some point we do need to ask about 0:09:19.400 --> 0:09:25.000 those those serious things, those negative things. That's part of pregnancy. 0:09:24.480 --> 0:09:27.400 Care, right, I would imagine too. Another thing that you'd 0:09:27.400 --> 0:09:29.440 be asking about is their mental health. 0:09:29.640 --> 0:09:33.560 Absolutely, so people with a hit. Let's let's use that 0:09:33.600 --> 0:09:35.680 as a great example. A one with a history of 0:09:35.679 --> 0:09:38.520 depression anxiety, for example, which is common. She might be 0:09:38.559 --> 0:09:42.319 on a medication at that time, which is okay for 0:09:42.360 --> 0:09:44.640 her to be on in the first few weeks of pregnancy, 0:09:44.679 --> 0:09:47.000 but may not be an ideal thing to be on 0:09:47.120 --> 0:09:49.920 for the whole pregnancy. So we like to see her 0:09:49.920 --> 0:09:51.880 at the start, so we can say, fine, let's change 0:09:51.880 --> 0:09:54.240 it from drug X to drug why that's got a 0:09:54.280 --> 0:09:58.600 better pregnancy safety profile. We also know that pregnancy can 0:09:58.679 --> 0:10:02.800 be a challenging time for people, for anybody, but also 0:10:03.040 --> 0:10:05.480 for a woman with a history of depression and anxiety, 0:10:05.559 --> 0:10:09.160 So we would say, how are you coping? Are you pleased? 0:10:09.240 --> 0:10:10.120 Is your family pleased? 0:10:11.320 --> 0:10:13.760 Have you got any sort of support mechanisms? Absolutely? 0:10:14.600 --> 0:10:18.480 And then if the let's say that woman, she's been fine, 0:10:18.520 --> 0:10:20.960 she's been totally fine. Mental health for a couple of years, 0:10:20.960 --> 0:10:23.439 but before that she'd had some issues. Well, this might 0:10:23.440 --> 0:10:27.600 be the perfect time to reconnect with her psychologist, go 0:10:27.679 --> 0:10:32.680 back over the principles of the cognitive behavior therapy. Happy 0:10:32.679 --> 0:10:35.880 thoughts lead to happiness, not to go down negative thought spirals. 0:10:36.400 --> 0:10:39.920 And because the pregnancy itself, it's a funny time hormonally, 0:10:39.960 --> 0:10:43.160 it's a time of great change in flux, and you know, 0:10:43.440 --> 0:10:48.760 it's a time when mental health problems be really triggered. 0:10:48.800 --> 0:10:51.400 I could imagine you know it is you question everything 0:10:51.440 --> 0:10:54.760 and you're so anxious about you know, right now, but 0:10:54.800 --> 0:10:57.080 also the future. Like there's a lot coming onto your plate, 0:10:57.120 --> 0:10:59.120 isn't it. It's not just that you're growing a baby. 0:10:59.160 --> 0:11:01.120 It's like, you know, you're lifestyle is going to change, 0:11:01.120 --> 0:11:03.320 your relationship with your partner may or may not change, 0:11:03.320 --> 0:11:06.280 And all of those things seem to sort of just 0:11:06.360 --> 0:11:07.920 come in not a person. 0:11:08.120 --> 0:11:10.640 Yeah, and that's not those aren't things that are going 0:11:10.679 --> 0:11:12.840 to change for someone with a history of mental health problem. 0:11:12.880 --> 0:11:14.000 That's going to change everyone. 0:11:13.800 --> 0:11:16.800 Everybody, that's right, Yeah, all right. What other sort of 0:11:17.040 --> 0:11:20.280 medical history is your GP interested. 0:11:19.920 --> 0:11:22.559 In any health problems you've had in the past, be 0:11:22.679 --> 0:11:31.359 they medical, law, surgical, asthma, epilepsy, diabetes, thyroid, history of operations, tonsils, 0:11:31.520 --> 0:11:32.199 gall bladder. 0:11:32.360 --> 0:11:34.959 Really what would tonsils and gallbladder have. 0:11:34.920 --> 0:11:39.640 To do with Well, let's say, for example, I had 0:11:39.679 --> 0:11:44.040 my person has a history, I had my gall bladder 0:11:44.040 --> 0:11:47.440 out and I had a severe anesthetic compemation. We need 0:11:47.720 --> 0:11:50.680 we want to know that. We want to know what 0:11:50.880 --> 0:11:55.600 that was and how did you go? And let's say 0:11:55.720 --> 0:11:58.839 cut forward eight and a half months you have a 0:11:58.920 --> 0:12:02.240 cesarian section. I want to know what the anesthetic problem was. 0:12:02.320 --> 0:12:05.000 So everything's relevant. It might not seem so, but everything 0:12:05.040 --> 0:12:07.800 we're going to ask at that early stage is relevant 0:12:08.520 --> 0:12:11.880 and there will be a reason method in that madness. 0:12:12.400 --> 0:12:21.559 So absolutely, medical and surgical history, mental health history, lifestyle issues, drugs, alcohol, 0:12:22.920 --> 0:12:26.240 and it's all part about building a picture which even 0:12:26.280 --> 0:12:28.760 as early as that first visit and what's going on 0:12:28.840 --> 0:12:33.800 in your caregiver's mind is stratifying the risk. Is this 0:12:33.880 --> 0:12:38.880 a person with a complex medical history where the pregnancy 0:12:39.720 --> 0:12:44.199 is going to make a difference to the medical problems 0:12:44.200 --> 0:12:48.160 they've already got, Plus the medical problem is going to 0:12:48.160 --> 0:12:52.200 make a difference to the pregnancy. And that's a complex person. 0:12:52.240 --> 0:12:54.040 And we might say to that person, well, this is 0:12:54.040 --> 0:12:55.679 all looking a bit tricky. Perhaps we'll get you off 0:12:55.679 --> 0:12:58.959 to consultation with an obstrition straight away, because you've got 0:12:58.960 --> 0:13:02.880 a lot going on versus somebody who's totally fine, regular cycles, 0:13:03.000 --> 0:13:08.839 history of perfectly good health, normal childhood vaccinations, who's got 0:13:09.240 --> 0:13:13.320 noash's door. And you might say to that person, congratulations, fantastic. 0:13:13.400 --> 0:13:16.040 Let's organize a dating scan and you can go and 0:13:16.040 --> 0:13:20.760 book in at the public anti natal clinic in whenever 0:13:20.800 --> 0:13:23.120 they'll see you, yep. And if that's not till fifteen weeks, 0:13:23.120 --> 0:13:26.480 don't matter, okay, yep. So we're trying to work out 0:13:26.520 --> 0:13:30.240 the appropriate place to send people and the appropriate timeframe 0:13:30.280 --> 0:13:31.000 to send them there. 0:13:31.320 --> 0:13:34.240 So when you know, you often think that you have 0:13:34.280 --> 0:13:37.280 to go to the doctor because you need a blood 0:13:37.280 --> 0:13:38.800 test to confirm the pregnancy. 0:13:39.320 --> 0:13:41.720 Is that the case, Yeah, you don't. You don't need 0:13:41.760 --> 0:13:46.120 a blood test to confirm a pregnancy. So the urine 0:13:46.120 --> 0:13:48.559 test is extremely accurate. And if it says you're pregnant, 0:13:48.600 --> 0:13:52.239 you're pregnant. It doesn't say that you're not going to miscarry, 0:13:52.800 --> 0:13:54.640 or even that it's not a neck topic pregnancy that's 0:13:54.640 --> 0:13:56.719 stuck in the tube rather than the uterus, but does 0:13:56.760 --> 0:14:00.360 say you're pregnant. So the blood tests are not just 0:14:00.960 --> 0:14:04.720 to confirm that a healthy person with a normal pregnancy 0:14:04.760 --> 0:14:08.760 is pregnant. We already know that from the positive urine test, 0:14:09.200 --> 0:14:11.400 and an ultrasound at six weeks will show us that 0:14:11.440 --> 0:14:14.320 the pregnancy is in the uterus. My heart's beating, So 0:14:14.360 --> 0:14:18.800 that person certainly doesn't need a blood test that counts 0:14:18.880 --> 0:14:22.360 up the amount of pregnancy hormone. That's called a quantitative 0:14:22.800 --> 0:14:25.480 beta hCG, and that gives you a number like the 0:14:25.560 --> 0:14:29.160 number might be one thousand or twenty thousand. Those blood 0:14:29.160 --> 0:14:32.440 tests are for where the situation is not clear. So 0:14:32.600 --> 0:14:36.160 for example, we do an ultrasound at six weeks and 0:14:36.240 --> 0:14:38.840 the woman's pregnant, the uters is empty, and we think, okay, 0:14:38.880 --> 0:14:41.640 what are possibilities. It might be an ectopic pregnancy, might 0:14:41.640 --> 0:14:45.320 be somewhere else. It might be an early miscarriage, or 0:14:45.360 --> 0:14:48.880 it might be that we're earlier than we think and 0:14:48.920 --> 0:14:50.440 that just hasn't had a chance to show up in 0:14:50.480 --> 0:14:54.120 the uterus yet. Well, if we get a pregnancy hormone level, 0:14:54.560 --> 0:14:56.200 that will help us answer that question. 0:14:56.320 --> 0:14:59.080 Yeah, right, so that's that beta hCG. 0:14:59.680 --> 0:15:01.360 Yeah, and that might do two of those in a row. 0:15:01.440 --> 0:15:03.800 And if we do it on a Wednesday and it's 0:15:03.800 --> 0:15:06.320 a thousand, and we do it on a Friday and 0:15:06.960 --> 0:15:10.800 it's two thousand, then that's doubling normally every forty eight hours, 0:15:10.800 --> 0:15:13.360 and that's a sign of healthy. If it was falling 0:15:13.400 --> 0:15:16.120 over that forty eight hours, probably a miscarriage. Yeah, staying 0:15:16.160 --> 0:15:18.240 about the same over that forty eight hours might be 0:15:18.240 --> 0:15:21.440 a topic. So that's what those numbers are for. But 0:15:21.480 --> 0:15:24.320 they're not really to confirm a normal pregnancy, and they're 0:15:24.320 --> 0:15:26.840 not very useful to conform a normal pregnancy, because if 0:15:26.880 --> 0:15:30.560 you're ten weeks pregnant, the normal range of quantitative beta 0:15:30.680 --> 0:15:33.720 hCG might be five thousand, it might be might be 0:15:33.720 --> 0:15:34.320 twenty thousand. 0:15:34.360 --> 0:15:36.760 And it's different for every woman, isn't it. So there's 0:15:36.760 --> 0:15:39.240 no point in comparing yourself to anybody else. 0:15:39.680 --> 0:15:42.160 No, And it doesn't predict outcomes like that. 0:15:42.360 --> 0:15:46.160 Right, hCG, what does it stand for? What's that acronym? 0:15:46.280 --> 0:15:50.400 Oh B is for beta. That's just like the Greek alphabet. 0:15:50.400 --> 0:15:54.880 There's an alphab hCG and a beta HG and H 0:15:55.040 --> 0:16:01.760 is human, c is choreonic and choonic means is part 0:16:01.800 --> 0:16:05.760 of the early pregnancy. The cooreon is the outer sack 0:16:08.080 --> 0:16:10.480 and the G is something called going out a trophy, 0:16:10.480 --> 0:16:13.080 and that's just what the hormone's called. 0:16:13.400 --> 0:16:16.320 Right, Okay, good, because people do talk a lot about 0:16:16.480 --> 0:16:21.120 hCG and they sort of tend to, well, they're at 0:16:21.120 --> 0:16:23.240 that point where they're anxious about a miscarriage and they 0:16:23.240 --> 0:16:26.560 start talking about hCG and you know the levels of hCG. 0:16:26.640 --> 0:16:28.520 But the big thing that I'm getting from you right 0:16:28.520 --> 0:16:31.840 now is that it's just if it's doubling, and don't 0:16:31.840 --> 0:16:34.440 compare yourself to somebody else's hCG level. 0:16:34.600 --> 0:16:38.920 Absolutely so. In twenty nineteen, the management of what's called 0:16:38.920 --> 0:16:41.680 the uncited pregnancy, so we know the woman's pregnant, but 0:16:41.680 --> 0:16:43.960 we're not sure whether it's in the uterus where it belongs, 0:16:44.280 --> 0:16:48.760 miscarrying or a topic. The management of that is based 0:16:48.760 --> 0:16:54.600 on ultrasounds and interpretation of serial beta hCG, so having 0:16:54.640 --> 0:16:57.280 a few in a row and that's how the diagnosis 0:16:57.360 --> 0:17:00.480 is made. But if we're in this territory under an 0:17:00.480 --> 0:17:01.240 expert help. 0:17:01.160 --> 0:17:03.240 Yeah, a medical expert, and we should just sort of 0:17:03.440 --> 0:17:06.240 know that they've got that. Yeah, all right, So does 0:17:06.359 --> 0:17:10.320 every woman need or have a dating scan? 0:17:11.000 --> 0:17:13.400 It's a good question. You don't absolutely need a dating scan. 0:17:13.680 --> 0:17:17.960 If you're pregnant and there's no sign that anything's wrong, 0:17:18.080 --> 0:17:22.360 like you've got consistent pregnancy symptoms, there's no early pregnancy bleeding, 0:17:23.000 --> 0:17:26.040 then it is safe to assume that things are fine, 0:17:26.520 --> 0:17:30.240 and we probably tend to get a dating scan done. 0:17:30.920 --> 0:17:33.240 The dating scan probably doesn't tend to get done until 0:17:33.240 --> 0:17:35.720 it's done, for example, as part of down syndrome screen, 0:17:36.080 --> 0:17:38.520 which depending on what we're doing, might be ten or 0:17:38.520 --> 0:17:40.920 twelve weeks, and that might be the woman's first scan, 0:17:41.040 --> 0:17:44.920 and that's fine. But if if she wants a dating scan, 0:17:45.160 --> 0:17:47.320 or if one's thought to be necessary because there's some 0:17:47.600 --> 0:17:51.199 confusion about exactly what's going on, then from about six 0:17:51.280 --> 0:17:53.760 and a half weeks, you can see you can see 0:17:53.760 --> 0:17:56.080 the what's called the fiddle pole, which is a start 0:17:56.119 --> 0:17:57.879 of the baby and the heart beating. 0:17:58.160 --> 0:17:59.600 Oh, you can actually see the heart beating. 0:18:00.160 --> 0:18:01.720 Baby looks like a tony little jelly bean, and in 0:18:01.760 --> 0:18:02.960 the middle that's a beating heart. 0:18:03.119 --> 0:18:04.480 Yeap, oh cool, and not. 0:18:04.359 --> 0:18:06.680 Thing's only a few millimeters long, but you can quite 0:18:06.720 --> 0:18:07.840 clearly see that going on. 0:18:07.960 --> 0:18:10.840 And you have to go to an ultrasound clinic for that. 0:18:11.800 --> 0:18:14.240 Yep. So the GP will send you off to an 0:18:14.320 --> 0:18:18.200 ultrasound clinic, and a lot of obstetrician gynecologists like myself. 0:18:18.200 --> 0:18:21.520 I've got an ultrasound machine ourselves, and I might see 0:18:21.600 --> 0:18:24.280 people in very early pregnancy if they're worried, and scan 0:18:24.359 --> 0:18:24.879 them myself. 0:18:25.359 --> 0:18:27.080 And do you know whether that is bulk build or 0:18:27.080 --> 0:18:29.359 whether you can have a bulk build early dating scan. 0:18:29.560 --> 0:18:32.760 Yeah, so there are some ultrasound clinics that offer bulk 0:18:32.800 --> 0:18:35.840 billing and an early scan is not rocket science for 0:18:35.840 --> 0:18:39.040 them to do. So when your GP sends you for 0:18:39.040 --> 0:18:40.520 a scan, like anything else, you ring up to make 0:18:40.520 --> 0:18:42.639 the appointment and you ask very clearly how much it costs, 0:18:43.119 --> 0:18:45.240 and don't hesitate to shop around a little bit. 0:18:45.400 --> 0:18:47.720 Yeah. Yeah, that's right because there are lots of providers 0:18:47.720 --> 0:18:49.120 out there, isn't there certainly. Yeah. 0:18:49.200 --> 0:18:53.080 In the ultrasound world, there's big variation between For example, 0:18:53.119 --> 0:18:57.920 the ultrasound department of a public hospital, which is free 0:18:57.960 --> 0:19:01.360 to go to it has it might not have as 0:19:01.359 --> 0:19:04.480 many appointments for people because it's a busy public hospital 0:19:04.800 --> 0:19:08.639 clinic that's looking after the patients of that hospital, the 0:19:08.680 --> 0:19:11.520 inpatients of that hospital, but it's available to people for 0:19:11.560 --> 0:19:14.520 people to use as an ultrasound clinic. It's usually free. 0:19:14.880 --> 0:19:17.360 It might not have as many bells and whistles as 0:19:17.400 --> 0:19:21.479 a private clinic, but that's fine. Right up to the 0:19:21.680 --> 0:19:24.200 full service private clinical at the end of your street 0:19:24.240 --> 0:19:26.080 that we'll charge you in out of pocket costs, but 0:19:26.200 --> 0:19:28.399 they'll give you they'll give you photos and a video 0:19:28.440 --> 0:19:32.760 and a DVD and a USB with the pictures and everything. 0:19:33.119 --> 0:19:35.640 So pad, how do we even know like when our 0:19:35.680 --> 0:19:38.000 babies a jew Like, how do we have a date 0:19:38.040 --> 0:19:38.679 in mind for that? 0:19:39.240 --> 0:19:42.800 Yeah? So good question. This is about something called an 0:19:43.080 --> 0:19:46.199 ed D or an e d C, and an e 0:19:46.920 --> 0:19:51.400 d D is estimated date of delivery, So basically when 0:19:51.400 --> 0:19:54.399 the baby's due, and an e d C is a 0:19:54.760 --> 0:19:57.960 beautiful old fashioned term. That's an estimated date of confinement. 0:19:57.960 --> 0:19:59.919 Well confine, my gosh, I haven't heard that for you. 0:20:00.920 --> 0:20:04.520 Some of my senior colleagues in of cetric still say confinement. 0:20:05.119 --> 0:20:07.480 So that's back in the day when the pregnancy was 0:20:07.520 --> 0:20:09.040 shrouded in mystery. 0:20:08.920 --> 0:20:11.159 And you had to hide at home and never let 0:20:11.200 --> 0:20:12.040 your belly be shown. 0:20:12.119 --> 0:20:14.760 Yeah, so the woman would be confined to her house 0:20:14.840 --> 0:20:19.000 for presumably weeks before delivery and to hangover from those days. 0:20:19.160 --> 0:20:22.199 So basically the JEW date. There's two important ways to 0:20:22.240 --> 0:20:25.320 calculate that. One is based on the period dates, and 0:20:25.359 --> 0:20:30.120 that's extremely accurate if the woman had a nice, regular 0:20:30.240 --> 0:20:35.760 cycle leading up to conceiving, and it's very reliable that 0:20:35.880 --> 0:20:41.200 the baby's due forty weeks after the woman's last period. Again, 0:20:41.520 --> 0:20:44.159 when she not the date of sex and not the 0:20:44.200 --> 0:20:46.480 date of population, but the date of the period in 0:20:46.520 --> 0:20:49.440 the pre ultrasound the era, that's all on you. So 0:20:50.640 --> 0:20:53.359 you can just calculate, and you've seen your local doctor's 0:20:53.359 --> 0:20:55.840 got one of those wheels where you turn the wheel 0:20:55.880 --> 0:20:58.800 around to the known date of the first day of 0:20:58.800 --> 0:21:00.880 the last period, and then the error on the other 0:21:00.920 --> 0:21:04.160