Q: I am a 29 years old married woman who conceived twins 4 years back but had a miscarriage at 9 weeks of pregnancy so a dilation and curettage (D&C) was done. I was diagnosed with hypothyroidism at the same time. Since then, I am taking replacement therapy with Thyronorm 25 mg. The following year I conceived again but had a spontaneous abortion. Eight months back I successfully delivered a baby boy through an elective caesarean section because my blood pressure was high (160/110 mmHg) at 37th week. I have an intramural fibroid measuring 8 cm on the anterior wall of the uterus. Now, I am pregnant again since 2 months. The ultrasound scan showed no gestational sac, however, my urine pregnancy test was positive. The doctor suggested a re-scan after 2 weeks and advised to take Utrogestan 200 mg vaginally everyday and folic acid. I do not have any symptom of pregnancy other than missed period. Is Utrogestan safe while breast-feeding my 7-month-old son? Will the gestational sac appear in 2 weeks? Is it safe to continue the pregnancy with a 7-month-old-son? Will it affect my health in any ways?

A:

1. Utrogestan has no effect on baby if you are breast-feeding, as maximum concentration is in uterus.
   
   
2. I would advise you to get a blood test for HCG. If it is positive, and more than 1500 IU you must ensure by transvaginal ultrasound scan (TVS) by an experienced sonologist that the pregnancy is not ectopic (outside uterus). In fact, in such an event if there is no gestational sac within uterus, the blood test needs to be repeated after 48-hrs and results will help guide further management. Also a TVS is better than trans-abdominal scan for visualising early pregnancy – gestational sac may just be within uterus.
   
   
3. It is too late to think about it now. You should have used some good contraceptive. However, if the pregnancy is normal (intrauterine) I suggest you stop breast-feeding your baby. Also, the 8 cm fibroid may cause problems - spontaneous abortion, preterm labour, or other problems related to fibroid (red degeneration), or if pregnancy goes to term – mal-presentations, and problems due to fibroid post delivery. However, many women continue with pregnancy till term without problems - so you may be one of those.