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Is an internal ultrasound safe?

Q: I am 26 years old and suffering from polycystic ovaries. I also underwent treatment for ovulation. Now I am pregnant and the doctor has asked me to get an internal ultrasound which showed that the fetus is 4.7 weeks. The doctor also told me that it is an early pregnancy. I am taking tab. Susten 200mg. My LMP was 01.03.04. I had a missed abortion last year which was because the fetus was not growing. I have two doubts: Is it safe if we do an internal ultrasound or can it be harmful for my baby? Why am I prescribed tab. Susten? I feel very weak and being a working woman, take less rest. Could you give me some suggestion?

A:Congratulations on being pregnant. You seem to be believing that polycystic disease (PCOS) is a major disease. Actually it affects as many as 20% or more of all women in this world so it is not really a disease or a disorder but just a variant of normal. Either way whatever problem you may have had conceiving is over now that you are pregnant. Did you conceive last year by treatment or on your own? Anyway the point is that you are pregnant now and you do not have to worry at all. This pregnancy should continue normally and no special ‘treatment’ or ‘precautions’. It is true that in PCOS and with clomiphene use the chance of aborting these conceptions is marginally higher. This is partly because of multiple pregnancies associated with clomiphene use and partly because of some hormonal imbalance we do not understand fully yet. Progesterone use as tablets, injections or vaginal tablets, (progesterone is susten and similar drugs) have not shown to improve the chances of carrying a pregnancy through. Once you have had an abortion and if you have been diagnosed as PCOS you have a slightly higher risk of aborting this pregnancy. But this risk is only marginally more. Meaning thereby that an average women of your age who gets pregnant has about 22-24 % of aborting and about 76% chance of carrying. The chance of aborting may be 27% or so in your case. This means you have one or two percent more chance of aborting. This is not clinically relevant at this stage. You do not need any special investigations or treatments. All you need is an ultrasound at 11-13 weeks to confirm a live pregnancy. If the pregnancy lasts 13 weeks it will last 9 months in as many as 97% of the times. Internal ultrasounds done properly are safe and you need not worry on that account. You should avoid unnecessary ultrasound examinations internal or external but those which are required should be done and minimal number of scans for minimal duration each is what is prescribed currently. Why you are taking the medicine susten? Well you will have to ask the prescribing physician that but my guess is that these are prescribed by the logic that something must be given as no treatment is not an option for most Indian patients and doctors. When there is a choice between bad treatment and no treatment no treatment should be preferred. Pregnancy is a classical example where no interference with nature is the best policy. Normal babies are born depending on whether the conception was normal or not and not on the basis of how many hormones have been given to the pregnant women. Early abortions occur because the fetus conceived is abnormal and not because there is a ‘lack of treatment and precautions’. You are feeling weak as there are a lot of hormonal changes in the body in early pregnancy. Please see a physician to see you do not have a disease or anaemia. If you do not have all these then it is just easy fatigue which is common in early pregnancy. Just take extra amount fluids and avoid extremes of temperatures like heat and humidity. Avoid unnecessary exertion but rest is not required. Rest is not only useless but is harmful in early pregnancy. Please continue to work and do as much physical activity as your body allows. Please treat your pregnancy as a normal one until you have proof that it is not normal. Do not wait for complications to develop. All you need at this stage is folic acid and stop all unproven and potentially harmful treatments like hormones. Please read 'Care of a Healthy Pregnant Woman' at www.rcog.org.uk.

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