Fetal Heartbeat Concerns: Ultrasound Findings & Potential Implications

Question
QUESTION: my sister in law had a transviginal u/s on 21 may 2009 and her LMP is 26 march 2009... so a/c to her LMP 8th week was started on 21 may but the gestational age of fetalpole found out is six weeks and size is 5.2 mm having no heart beat....she already had an abortion last year on 28 june 2008 on 10th week with the same prob that baby had no heart flicker... now today she had been having pains kind of the labour pains since last night so doctor again did an u/s in which it was found that baby sac is at a very lower position of pelvis still without heart beat so doctor and she was also feeling pressure as something had to come out so doctor has asked her to stop medicines of progestrone named Duphastone and a pessary naming Cyclogest.... kindly tell me are there any chances for her to continue with her pregnancy?

ANSWER: Dear Nida,

I answered your previous question and had no idea that you had posted another one with more details.

The doctor has stopped the oral progesterone and has advised the vaginal pessary only to see that her body produces more progesterone naturally faster as absorption in the vaginal lining is fast. At this stage its too early to speculate since first her cramps should subside. Usually cyclogest pessary is recommended during the first trimester where there is a threatened abortion like a chance of she aborting. this abortion happens when the body progesterone levels go down signalling the uterine wall to shed the endometrium. If she is stable by tomorrow I think a repeat U/S will give us a clear picture of how she is fareing. Kudo's to her doctor who administered her these pessaries as an emergency procedure. My prayers are always there - Insha Allah - dont worry she will be allright.

with prayers & best wishes,
lady doc

---------- FOLLOW-UP ----------

QUESTION: dear doc...thanx a lot 4 ur precious time...doctor she is having pains on and off especially whenever she walks a little or stand for a little while she starts having pains... and as it is sunday today so her doc is not available here... now she is confused what to do whether to continue with pessary or not? plz plz guide us.... may Allah Tabarak Taala bless u n ur famili Aameen

Answer
Dear nida,

She has to continue using the vaginal pessary till her doctor examines and gives a clean chit.This is as i said is to prevent abortion.I advice total bedrest and unnecessary strain while getting up ana sitting down.

With regards,
Lady doc