Hello doctor, I have past history of two miscarriages at 18 weeks. Hysteroscopy and laparoscopy confirmed cervical incompetence and my polypoidal endometrium was removed. I conceived again with follicle test procedure during which CG 10000 was injected into my blood, but unfortunately, I had to undergo DNC at 8 weeks because of no sign of fetal pole (no yolk sac and heartbeat). My TSH value at that time was 7.44. Now I am on medication for PCOD and TSH. After my lupus test I will be going for pregnancy again. My doctor suggested me not to do travelling, stich and complete bed rest this time. Is it necessary for complete bed rest for nine months? My employer would not be convenient with my complete unavailablility. Can you help me to make rest less stringent? Could you advise how could I attend office at least one day a week? How can I make it not necessary to spend entire 24 hours in bed? This allowing me to work from home.
Hello. The fact that you had two miscarriages at 18th weeks of gestation which were spontaneous and that leech wilkinson canula went inside uterus during hysterosalpingography procedure attempted prior hysteroscopy confirms cervical incompetence here (attachment removed to protect patient identity). The third pregnancy being anembryonic pregnancy does not really qualify you for a lupus test for thrombophilia but nevertheless it is better if we rule that out as well. Regarding your next pregnancy, I would say MacDonald's cervical stitch would definitely be mandatory at 11th week of gestation to avoid another spontaneous miscarriage, but complete bed rest is not required. You may do your daily household work but have to take care of avoiding lifting anything more than 3 kgs or avoiding any form of increased intra-abdominal pressure which can cause inadvertent pressure over uterus.   Going to office should be avoided till at least third trimester and you can easily opt for work from home. The aim is to avoid any form of inconvenience or jerks which can cause an unfavourable outcome. As long as the cervical stitch shall remain you would not deliver vaginally, but chances of preterm labor which are common in such cases would have to be countered with tocolytics, ideally in third trimester.