Is bed rest vital during pregnancy after two miscarriages?

Question

Hello doctor,

I have a past history of two miscarriages at 18 weeks. Hysteroscopy and laparoscopy confirmed cervical incompetence and my polypoidal endometrium was removed.

I conceived again with a follicle test procedure during which CG 10000 was injected into my blood, but unfortunately, I had to undergo DNC at eight 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 that I not travel and take complete bed rest this time.

Is it necessary for complete bed rest for nine months?
My employer would not be convenient with my complete unavailability. Can you help me make the rest less stringent? Could you advise how I could attend the office at least one day a week?
How can I make it not necessary to spend the entire 24 hours in bed? This allows me to work from home.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

The fact that you had two miscarriages at 18th weeks of gestation, which were spontaneous, and that the leech Wilkinson canula went inside the uterus during the hysterosalpingography procedure attempted prior to hysteroscopy confirms cervical incompetence here (attachment removed to protect patient identity).

The third pregnancy, being an 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 a McDonald's cervical stitch would definitely be mandatory at the 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 six pounds or avoiding any form of increased intra-abdominal pressure, which can cause inadvertent pressure over the uterus.

Going to the office should be avoided till at least the third trimester, and you can easily opt for work from home.

The aim is to avoid any form of inconvenience or jerks that can cause an unfavorable outcome. As long as the cervical stitch remains, you would not deliver vaginally, but the chances of preterm labor, which are common in such cases, would have to be countered with tocolytics, ideally in the third trimester.

I hope this helps.

Take care.