Q: My 23 years old wife is 12 weeks pregnant. Our first child was only 5 days old when he died and next time she had an abortion at 3 months of pregnancy. What precautions should she take this time? What are the tests required? She has slight pain in her lower abdomen and is taking folic acid, iron and calcium regularly. Please advise.

A:With two previous mishaps, you first need to understand that despite those, the chances of pregnancy continuing and reaching term are high, over 90%. But there is a slightly higher risk of loss again, as compared to normal pregnancies. To prevent that she needs to undergo tests like urine culture, VDRL, HIV, TORCH, APL/ACL antibodies and ultrasound scan to make sure that the uterus and baby are normal- at about 18-20 weeks and again in the third trimester. She also needs to have her blood sugar tested now, and later and after 28 weeks a glucose tolerance test (GTT) is required to rule out chemical diabetes. Anything positive needs treatment and follow-up with a trained gynaecologist, in a good centre with nursery facility. As pregnancy advances, after 28 weeks-32 weeks, she may need tests to check fetal condition regularly like cardiotocograph (CTG), Doppler and scanning for early diagnosis of any fetal problem like a slow heart beat or breathing- in which case a preterm delivery is conducted to save the baby. All these need not cause stress or worry, as these are to ensure a good outcome, which is anyway most likely.