Q: I conceived naturally after 4.5 years of marriage. When I went for an ultrasound to confirm my pregnancy, it was good as fetus had heartbeat. The doctor advised me to start Loprin (to thin blood), Cyclogest (to ensure safety) & folic acid. But after a few days, I had a light spot and nothing later. After 2 days I got a scan again and the doctor said that the fetus has stopped growing & the cardiac activity has stopped. My doctor is now asking me to wait for normal bleeding otherwise he will induce labour and do DNC next weekend, which is 25 days after the death of the fetus. They are concerned that because of Loprin the blood will be thin, therefore to avoid too much bleeding, they are not going for an immediate step. How safe is it to wait?

A:In normal women with normal pregnancy, no medication is clinically indicated except folic acid and if anaemic an iron preparation. Neither aspirin nor progesterone (Cyclogest) is needed. The use of Cyclogest is only indicated if there is documented, proven deficiency of progesterone or in cases of recurrent miscarriages or infertility due to inadequate luteal phase. In fact, many experts now recommend that progesterone should not be used at all during early pregnancy. Rare instances of foetal death have been reported in pregnant women prescribed the drug for unapproved indications. The problem with progesterone is that it can prevent spontaneous, natural evacuation of a dead foetus. This is exactly the problem in your case. It is further complicated by your consuming aspirin. In the hands of a competent, experienced gynaecologist, D&C should not produce excessive bleeding. In any case, it is very easy to do tests such as bleeding time, prothrombin time, coagulation time, platelet count to see if the blood is indeed very thin or not as of now. Evacuation should be done quickly to avoid complications.