The beginning stages of…

[Brief note – this is not intended as any kind of commentary or criticism about the hugely controversial and emotive issue surrounding beginning of life issues. If I seem flippant it is not my intention]

In preparation for the new job I’ve been doing a bit of reading. I’ve even covered the most feared of subjects – molecular biology. Remarkable what your brain can learn only to forget entirely, and how quickly it comes back when you read it again.

I’ve also covered some embryology which I find one of the more mind-boggingly amazing parts of our existence. Sure all kinds of mammals do embryology they just don’t grow up and study it and reflect upon it.

In work (Emergency medicine – my real work as I call it) we see lots of concerned young women who are in the really early stages of pregnancy (say 6-8 weeks) who turn up with some tummy pain and a bit of bleeding (say less than a period). They’re all concerned that they’re having a miscarriage. Which indeed many of them are. Once I’ve satisfied myself it’s not an etopic pregnancy – which is what will kill them if I miss it – they generally go home with some follow up with the gynae folk. Some of these women will go on to miscarry (though certainly not all) and I tell them this and explain that 20% of early pregnancies miscarry and 95% go on to have a normal pregnancy in the next couple of years.

But in reading about the staggeringly tiny collections of cells that go on to be embryos and foetuses and babies and toddlers and all the varied parts of our humanity – I was thinking surely lots of these pregnancies/conceptions never make it to a missed period (the usual reason people do the pregnancy test in the first place).

This study looked at just that (back when I was already 7 years past the most risky part of my life) measuring pregnancy tests daily on women who were trying to get pregnant (however you do that… I’ll ask Wylie…).

They found lots of sub-clinical pregnancies (enough to cause a big HCG rise – ie implantation – but failing before anyone missed a period) that mis-carried before anyone thought they were pregant. Overall 30% miscarried and 70% of these were before anyone thought they were pregnant.

When combined with another study it’s estimated that 50% of conceptions do not result in a live birth. This surprised me – I imagine because this is one of the things that I was told in medical school but wasn’t paying attention at the time. On reflection that was probably most of the time.

So maybe it is possible to be a little bit pregnant after all.

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August 2010
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