Questions and doubts

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Obstetrics FAQ

If I want to become pregnant, when do I have to start taking folic acid?

It has been proved that the ingestion of 400 micrograms of folic acid from the month before conception until the first three months of pregnancy reduces the risk of neural tube defects (spina bifida, anencephaly). Since only 50% of pregnancies are planned, every woman at childbearing age who is at risk of becoming pregnant (without any birth control) should take folic acid.

I want to get pregnant, when should I have intercourse?

Ovulation occurs 14 days before the first day of the period (cycle’s first day), the luteal phase of the cycle is very regular, so if you have cycles of 28 days the ovulation will take place the 14th day of the cycle. To become pregnant you should have sex daily or every 48 hours around the ovulation day, considering the egg is viable for 12 to 24 hours and sperm can remain viable up to 3 days. When a couple begins their gestational desire the time to get pregnant varies from 1 to 12 months (at 12 months, 80% of couples have achieved pregnancy). So when a couple has been trying for more than 12 months they should consult with their gynaecologist to start a study of sterility.

What medication can I take if I have a cold during pregnancy?

In general terms, you should confirm with your obstetrician that any medication you will take is safe for the fetus. As analgesics, Paracetamol and Buscapina are safe during pregnancy. You should go to your GP if fever to assess whether antibiotic treatment is needed. It is very important when a pregnant woman´s temperature is above 37,9º to take Paracetamol in order to lower it, since hyperthermia could be detrimental for the fetal neurological development. Mucolytics (Fluimicil) and cough syrups can sometimes be prescribed but always under medical indication and supervision. The doctor should assess the risk-benefit ratio for any medication prescribed.

Can I dye my hair, have a manicure done or use depilatory products during pregnancy?

Yes, you can. There are vegetable dyes which are preferable to the chemical ones used in permanent or semi-permanent formulas, but the chemical ones can also be used. You can also paint your nails and continue plucking. The only things relatively contraindicated in pregnancy and lactation are laser hair removal and photoepilation, although nowadays there are no serious studies in pregnant women.

Can I use anti-cellulite creams during pregnancy?

No, It is better to use an anti-stretch marks cream specific for pregnancy. If you have already used an anti-cellulite cream you do not need to worry because it is highly unlikely that this has had any harmful effects on the fetus, although there are no randomized studies in pregnancy.

Can I drink coffee, tea or infusions while pregnant?

Too much caffeine (6 cups of coffee a day) has shown to increase the risk of abortion. You can consume tea and coffee in small amounts (1 or 2 cups a day). If you are a lover of this kind of drinks it is better to have them decaf. Most herbal teas and infusions can be taken without any problem during pregnancy and they contribute to the total fluid intake which is very important at this moment (2,5 - 3 l a day).

Is it safe to travel by plane while pregnant?

If pregnancy is proceeding normally you can fly till the moment that the air company allows you to do so (around 32 -36 weeks), it depends on the company and on the destination. The company normally applies for an obstetrician’s certificate stating that it is not a high risk pregnancy. You have to remember to do exercises to prevent traveler's syndrome (thrombosis), walk down the aisle and make a good hydration on long trips because the risk of thrombosis is somehow higher in pregnancy. There is no risk to pass under a metal detector while pregnant.

I am pregnant and I suffer insomnia. What can I do?

Insomnia is very common in pregnancy, you have to acquire good habits before bedtime, relaxing activities and do not have heavy meals before bedtime. Neither consume exciting drinks before sleeping like coffee, tea, coke. It is important to establish a time routine, relaxing infusions can help, chamomile, valerian, limeflower tea.

Replaces the non- invasive prenatal diagnosis (NIPD) the amniocentesis?

No, the NIPD in maternal blood is a screening technique for chromosomal abnormalities of chromosomes 21, 18, 13, and X/Y as the first trimester screening test (EBA), with the particularity of having higher sensitivity for the diagnosis of Down syndrome increasing with this test from 90 to 99%. It must be taken into account that with invasive tests all chromosomes are analyzed and Down syndrome (trisomy 21) is only 50% of the fetal chromosomal abnormalities. If in the NIPD we got a high-risk result we have to perform an amniocentesis to confirm the diagnosis. This test is not covered by the health insurance company and prices range from 700 to 900€ depending on the laboratory, the results take from 14 to 21 days. For more information consult your obstetrician.

Is it useful perineal massage? When should I start?

The daily perineal massage with primrose oil is useful to distend the perineum in order to try to avoid an episiotomy (cut in the perineum which is done in some vaginal deliveries to prevent a perineal tear) during delivery. You should begin from 32-33 weeks until the delivery day, it may be done by yourself or your partner.

Since when the delivery is safe?

The term includes from 37 to 42 weeks, in our area the 8% of deliveries are pre-term (before 37 weeks gestation). We must distinguish the early preterm delivery (<32 weeks) from the late preterm delivery (32-36.6 weeks), the latest showing better perinatal outcomes. If for any reason an elective termination of pregnancy is required the ideal time for the baby to be born is from 39 weeks of gestation.

Gynecology FAQs

What’s the difference between vaginal ring and oral contraceptive pill?

Both have hormones (Estrogen and Progesterone) but the main difference is the route of administration, the pill is taken by mouth and should be taken daily while the ring is per vaginal introduction and you should change it only once a month. With the pill you can have gastric problems such as nausea or abdominal pain and hepatic problems such as interference with metabolism of the pill by alcohol or some antibiotics that can decrease its effects. The ring with its vaginal absorption means that such problems don’t exist and it is more difficult to forget it, because you only have to change it once a month not daily like the pill. The side effects of contraceptive hormones such as fluid retention, headaches, circulation problems, etc. are the same in both due to the fact that they have the same hormonal composition.

If I use hormonal contraception for a long time, will I have any problems to get pregnant?

Not at all. Hormonal contraception does not affect fertility, it only regulates your periods. It works by giving a rest period to the ovaries while you take the hormones by mouth (pill), skin (sticker) or vagina (ring). When you stop using them, the ovaries restart their activity as it was before.

What do I have to do if I have spotting while on the pill or if my period is late?

If you have been using contraceptive hormones for a while without any problems and suddenly one month you have spotting, not to worry because the contraceptive hormones can be affected by external factors such as stress, alcohol….They can affect the metabolism of the pill and cause spotting.
If this happens two or more following months, just contact us.
If this spotting happens the very first time that you take the pill, it isn’t unusual because with the first blister pack of pills, the body must adapt itself to the hormones. After the first month that should stop.
If taking the pill properly (not forgetting any tablet), your period don’t come, that is ok because it means the effect of the pill keeps the endometrial lining so thin that it does not bleed. You should keep taking the pill without worries.

What happen if I forgot to take the pill?

If you forget one tablet, you should take it as soon as you notice and the next one, take it when is due. If it’s been more than 12 hr and/or you are in the middle of the blister pack, you should use an alternative method of protection because the pill is not safe enough.

Who can benefit of the Human Papiloma virus (HPV) vaccine?

Any woman at any age can use it. This vaccine acts against the Papiloma Virus, more specifically against the subtypes 16 and 18; they both cause 70% of cervical cancers. HPV is a sexual transmitted virus so any woman who has intercourse can have it. The vaccine is 100% effective in non sexual active women (virgins) but any women with a PAP smear negative, basically do not have an active HPV and can use the vaccine.

In the annual checkup, should we be tested for high risk HPV or just do a PAP smear?

In the annual checkup, we should only do PAP smears. People with pathological smears are the ones to consider for testing of high risk HPV.
We only have treatment for the cervical pathology so we only can treat the effects of the virus in the cervical tissue. We don’t have treatment for the virus itself so to test for it, if there is not an abnormal smear, is of no use.
Basically, the important thing is to have an annual PAP smear and if it is normal, forget about HPV.

If they perform a Hysterectomy on me, do I get menopause or does it come earlier?

If you have a hysterectomy without the removal of the ovaries, you do not have the menopause but your periods stop because the uterus is the organ that bleeds every month following orders from the ovaries.
Menopause is the finalization of your periods for over a year due to the definitive end of the ovarian activity. While the ovaries work, even if you don´t have the uterus, you have a cycle so you are not in the menopause because it depens on the ovaries not in the uterus.
In case of hysterectomy, the diagnosis of menopause is for hormonal blood results plus the menopausal symptoms you present.

What’s the difference between Arthritis and Osteoporosis?

The general believe is that if you have pain in your bones, it’s because you have osteoporosis. That’s a big mistake. Osteoporosis is a decrease on the mineralization of the bones. This is due to a decrease of the introduction of calcium in the bones because of the disappearance of estrogen from the circulation that occurs at the time of menopause, when the ovaries stop working.
The consequence of a decreased mineralization is an increased risk of bone fractures but it never causes pain.
On the other side, arthritis is the erosion of the articulations due to the time passing by… It happens to everybody (with a major or minor intensity) from a certain age. The principal symptom is pain and it has nothing to do with bone density.

If I have Thrush, can I pass it to my partner?

Candidacies (Thrush) is not a sexual transmitted infection, any woman at any age can have it, even children. The fungus called Candida lives in the vagina as part of the flora and in normal conditions you will not pick it up in a vaginal swab, but if there is a change in the vaginal pH it goes towards increasing Candida and it can give you thrush.
Some situations will favor the appearance of thrush such as increased humidity in vagina (swimming pool, beach), stress, antibiotics, and so on.
If you have thrush and you have intercourse, you can pass it to your partner at that moment, so if a woman has it and is sexually active, we advice treatment for both, her and her partner, as a prevention.

If I have polycystic ovaries, can I become pregnant?

The polycystic ovary is an ovary that does not ovulate regularly so the periods are irregular but they keep coming. If you ovulate then you can become pregnant but with the polycystic ovary, sometimes it’s difficult to know the day of the ovulation because it varies from one month to the other, but if your periods come once a month, you should get pregnant.

How often should I have a Mammography?

Once a year from the age of 40.
The mammography is the elective screening technique for the diagnosis of breast cancer. This is the most frequent cancer in women. Breast cancer is related to age with less than 5% of cases occurring before the age of 40. It is advisable to have an annual mammography trying for an early detection if it occurs.