Brief Answer:
It could be a case of missed abortion.

Detailed Answer:
Hello,

Thanks for writing to us.

If your wife had regular 28-30 day cycles prior to this pregnancy and is sure of her dates, then the sonogram picture is suggestive of an unhealthy pregnancy, a missed abortion. An irregular gestational sac points to an unhealthy sac; added to that fetal heart is not visible which should have been seen by now and the findings show a lag of gestational age by dates.

With this current picture, if there are no other symptoms like pain or bleeding, watchful expectancy can be maintained until another high resolution sonogram is taken usually after another week; simultaneous measurement of serum beta-hCG levels on alternate days can be useful to assess the prognosis as doubling titres indicate good progress of pregnancy. If there is an abortion, the titres show a decline.

Absolute bed rest, avoidance of all forms of stress including sexual intercourse and healthy diet should be followed. Please have a follow up with your consultant to discuss further management.

Hope I have answered your query. Please feel free to contact if you need further clarifications. I will be happy to help.

regards,
Shanti.V.

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Brief Answer:
early evacuation is good for missed abortion

Detailed Answer:
Hello,

Thanks for writing back.

If the ultrasound findings and your doctor's clinical opinion suggest a missed abortion, it is indeed good to proceed for abortion without waiting any further. If the diagnosis is doubtful, you may wait as suggested for one more week to see if the pregnancy is progressing as sometimes there is a failure to detect the fetal heart in very early stages. Measurement of serum beta-hCG titres helps in doubtful cases; it is the pregnancy specific hormone and its declining levels suggest a missed pregnancy while doubling titres on alternate days indicate a viable pregnancy.

As the sonographer has opined that it is a missed pregnancy, you should discuss with your consultant on further management; a clinical opinion is necessary to plan further treatment. Meanwhile, you can get the blood counts, bleeding time and clotting time as a precaution. A missed abortion may lead to abnormal bleeding and clotting times and this has to be monitored.

Hope I have answered your query. Please get back if you have any more queries. I will be ready to help.

regards,
Shanti.V.

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Brief Answer:
Metformin is a category B drug used when needed.

Detailed Answer:
Hello,

Thanks for writing again.

Melmet contains Metformin, used to treat insulin resistance and thereby induce ovulation in polycystic ovary disease. It is a category B drug and this means that the drug may be given during pregnancy if absolutely necessary as studies do not show any untoward effects. Rest of the drugs are safe to use.

If your wife had been treated for PCOD prior to conceiving she would need Metformin throughout pregnancy; Duphaston is given as a precaution in such cases when progesterone deficiency is suspected. Folic acid is given to prevent neural tube defects while aspirin is given to prevent pregnancy induced hypertension (PIH).

Hope all your queries have been answered. Please feel free to contact if you have any more queries.

Wish you good health.

regards,
Shanti.V.

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