Q: My 24 years old wife had her last menstrual period one and a half month back. She had a bit of spotting two weeks back on the day when her periods were due. There was no spotting after that. Later after a week, we went to a doctor, who asked for a transvaginal ultrasound (TVS). The test reported a very small yolk sack and a fetal pole, but no cardiac activity. The doctor repeated the TVS and gave the same feedback. The doctor has now told us that if a TVS done for the third time also reports of no cardiac activity, my wife will have to undergo diltion and curettage (D&C). The situation is really shocking for both of us. My wife is on complete bed rest. Please tell us what went wrong with her pregnancy?

A:She has had a miscarriage. She will first need to accept it and come to terms with the reality and then have cleaning up of the uterus, which can be done with medicines like misoprostol or miphepristone or a combination of the two. After the miscarriage is managed, if she gets depressed, she will need treatment and support for that as well. After a gap of six months, she can try again for pregnancy but only after she gets tested for the cause of the miscarriage. It may be an infection, blood group mismatch, sexually transmitted disease, uterine defect, fetal defects, blood sugar, thyroid problem or antibodies formation. Once these are taken care of, pregnancy can be planned again with good success rates of over 85 per cent, using support with progesterone drugs and injections of HCG. In many (25-30 per cent) no cause of the miscarriage may be found.