Q: I have a bad obstetric history (BOH). I am currently pregnant and as per my LMP it should be about 9 week plus. I went for a scan which shows single intrauterine pregnancy of 6 weeks +2 days SD, with a mid segment posterior wall intra-mural fibroid 4.2x3.0 cm. Fetal nod could not be identified till the time of scan. I am on human chronic gonadotrophin (HCG) 5000 twice a week, micronised progesterone 200 bd, folic acid and aspirin 0.75mg. What do you think the problem may be?

A:The information you have sent is incomplete to make a firm diagnosis or suggest a course of treatment. You will have to specify what the BOH (bad obstetric history) is and the exact nature of pregnancy losses or complication(s) you have had in the past. You will also have to tell me why progesterone and Inj HCG was given? Is it an IVF pregnancy? In the meantime, either your pregnancy dates are incorrect meaning thereby that you have long cycles or there was a delayed ovulation this pregnancy or this fetus is not ok. Anembryonic pregnancy or the fetus was not formed at all we will know if we repeat the ultrasound after one week. Nothing can and should be done about the fibroid at this stage. Please repeat the scan in one week and inform me about it. There is no proven benefit of Progesterone pessaries or Injection HCG (in evidence based medicine trials it has not been shown to improve pregnancy). If the baby is formed normally and it is only a delayed conception the fetus, it will remain ok. Alternately, if the baby has not been formed at all no amount of hormones or progesterones & Inj HCG will help. please write in detail if you have more questions especially of your past history. Meanwhile till the pregnancy outcome is known for sure disregard the fibroid.