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Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help?

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Hi, I missed my period and am late by 14 days. I took two separate home tests and both came in positive. However, USG did not reveal the sac yet. But the report revealed a left haemorrhagic corpus leuteum cyst measuring 3.8x3.7x3.4 cm. Doctor prescribed the following medicines to me:
1. MecoNeuron-HR - My question is, I read on internet, simple Folvite is better than this medicine. Is it correct? Should I have this medicine?
2. Sustem 200
3. Duphaston 10 MG

I am attaching the prescription, scans and other reports.

Please suggest if I am on right medication.

One more question, is the cyst harmful? Can it impact pregnancy? My doctor advised rest for the next 2 weeks. Can I resume my regular work (12 hours a day) after that or need to take light for the pregnancy?

Thanks,
XXXXX
Posted Sun, 20 Oct 2013 in Early Pregnancy Signs and Symptoms
 
 
Answered by Dr. Shanti Vennam 8 hours later
Brief Answer:
The cyst is not harmful for pregnancy.

Detailed Answer:
Hi Ms. XXXXX,

Thanks for writing to us.

I have gone through the attached reports. If you have regular 28-30 day cycles, you should be about 6-7 weeks pregnant now. This means during the sonogram, the gestation sac should be clearly visible along with the fetal pole and also heart beat if resolution is good. As your sonogram shows no gestation sac, a repeat scan should be able to decide the fate of the pregnancy. Sometimes, an early sac can fail to get detected on ultrasound and gets revealed later. You can get serial serum beta-hCG titres and doubling values on alternate days indicate good prognosis for the pregnancy.

The cyst is of no problem; in fact, it is the corpus luteum that is seen as cyst. Corpus luteum helps in maintaining the pregnancy by secreting the necessary hormones. It can be followed during the course of pregnancy intervening only when necessary. It usually resolves spontaneously.

Your doctor has prescribed the hormone progesterone with the hope that any necessary hormone may be supplied. Usually vaginal tablets would suffice but it is your consultant's discretion. You are right that methylcobalamine is of limited use. Folic acid preparations are available in various forms but the 5-MHF form is the ideal as the available folate is good. You may discuss with your doctor if you wish to change the prescription.

Please take rest, avoid intercourse, take healthy diet and plenty of liquids. Avoid stress as any form of anxiety is not good for pregnancy. I would suggest abstaining from work until the safety of your pregnancy is established as you need to work for long hours.

Hope your query has been answered. Please feel free to contact for further clarifications. I will be happy to help.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
Follow-up: Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help? 3 hours later
Hello, thank you so much for your reply. I got my BHCG report and it is around 5600. Thyroid report has come to be normal. My doctor is suggesting to repeat BHCG after 48 hours to confirm. But, I am getting worried as to why nothing is seen in the scan. Is there something to worry or it is too early to show up in the scan?
 
 
Answered by Dr. Shanti Vennam 50 minutes later
Brief Answer:
It is good to repeat sonogram as well as beta-hCG

Detailed Answer:
Hi,

Thanks for writing back.

Your serum beta-hCG values are good. As your doctor said, it is the doubling titres after 48 hours that give an indication of the progress of the pregnancy. Simultaneously, a repeat trans-vaginal sonogram with an experienced sonologist after a couple of days may reveal the gestation sac.

As I mentioned earlier, the sac may not be visualized in very early pregnancy of 4 weeks or so, but should be noticeable by 6 weeks. It so happens many-a-time that owing to poor resolution and the inexperience of the sonologist the sac may fail to get noticed. Please do not worry as anxiety has adverse effects on pregnancy. You can definitely get things clarified.

Hope your query is clarified. Please get back if you need more clarifications. I will be ready to help.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
Follow-up: Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help? 1 hour later
Thank you again. Is it okay if I do regular house hold work like cooking which needs standing for an hour in the first few weeks till the pregnancy is confirmed?
 
 
Answered by Dr. Shanti Vennam 7 minutes later
Brief Answer:
Better to avoid any form of stress.

Detailed Answer:
Hi,

Thanks for writing again.

In my opinion, any form of stress that puts undue pressure on the pelvic organs should be avoided in such a situation. Bed rest should be absolute until everything seems fine with your pregnancy. I ask my patients to stay in bed until the viability of pregnancy is successfully established.

Hope your doubt is clarified. Please contact for more queries. I will be ready to help.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
Follow-up: Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help? 28 minutes later
Thank You again. When you mentioned about 5-MHF form of folate, I did not understand. Is Folvite good or MecuNeuron?
 
 
Answered by Dr. Shanti Vennam 27 minutes later
Brief Answer:
Folvite is better.

Detailed Answer:
Hi,

Thanks for writing again.

Methylcobalamine supplementation is not an absolute necessity. It is given when neurological defects are anticipated. The requirements are usually met with diet alone. Folic acid would suffice.

5-MTHF means the altered form of folic acid better for absorption and available as such. It is 5-methyltetrahydrofolate, a natural active form of folic acid used at the cellular level. The usual folic acid needs to be metabolized in the body to be useful and the necessary enzyme is low in concentration; as a result, whenever excess folic acid is given in the diet, most of it enters the circulation as such. High folic acid in the circulation has harmful effects like cancer. Hence, it is better to take folic acid as folate.

Hope your query is clarified. Please contact for further queries. I will be available to help.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
Follow-up: Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help? 45 hours later
Hello, Thanks again for your reply. I got another BHCG test fone on 26th, i.e., 48 hours from the first test and now the score is 0000. I am attaching both the reports for your review. It is normal for the HCG to increase so rapidly? I have not yet gone for another scan. Please suggest.
 
 
Answered by Dr. Shanti Vennam 2 hours later
Brief Answer:
Sudden rise is not normal, needs observation.

Detailed Answer:
Hi,

Thanks for your query.

Though there is a sudden spurt in the rise of serum beta-hCG levels in 48 hours, the levels are yet within the permissible limits for this stage of pregnancy. There is a condition called molar pregnancy associated with very high hCG levels and usually manifests at 10 weeks of pregnancy. This should be kept in mind and careful observation done. In the majority with such a spurt, sonograms show normal progress of pregnancy and no untoward incident. So, I would ask you to wait for your repeat sonogram to get things sorted out.

Hope your query is clarified. Please contact for more information. I will be available to help.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
Follow-up: Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help? 2 days later
Hello Madam, looks like the place where I took the blood tests messed up the reports. I undertook another test on 27th September and my HCG count is 7720. I have again taken another test today, report has not yet come. But my doctor has suggested to start with Pubergen 2000 injections twice a week till 12th week. I read online reviews and saw it is not required to be administered during pregnancy but before it, while trying.
I am confused. I am already taking Duphaston and Susten. Too many hormones might lead to problems.

Please suggest.
 
 
Answered by Dr. Shanti Vennam 2 hours later
Brief Answer:
HCG injections are given to prevent an abortion

Detailed Answer:
Hi Ms. XXXXX,

Thanks for your query.

It is good to see your normal beta-hCG report. Please follow it up and also with repeat sonograms until you find a good sac and viable pregnancy.

Pubergen contains the pregnancy hormone HCG. It is usually given in the treatment of infertility as you said. Yet, it is sometimes given during pregnancy when the benefits outweigh the risks as in habitual abortion to see that the pregnancy progresses well without any hormonal defect. Extensive studies did not show specific relation to congenital anomalies when it is used alone.

I think your doctor might have prescribed the drug in the hope of seeing a good gestational sac soon with a viable pregnancy. Susten and Duphaston contain progesterone. Please discuss with your doctor about the strategy and you can wait for the repeat serum hCG report to see if you need the injection.

Hope I have answered your query. You can contact for more information. I will be ready to help.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
Follow-up: Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help? 2 hours later
Hello Madam,

Thanks for your reply. I just got my report from yesterday's test and the HCG count if 14,645. Thus, it has increased by 89% in the 48 hours.

Do you think I need that injection? Also, as per the calculation, I should be in 4th week tomorrow. This might be too early for a scan.

Do you suggest we should wait for the scan to start with the injection?

Also, if you can help me with some good referral inn Hyderabad, it will be very helpful. As I am not originally from Hyderabad, I am not aware of dependable places.

Please suggest.
 
 
Answered by Dr. Shanti Vennam 11 minutes later
Brief Answer:
It would be better to wait for the sonogram.

Detailed Answer:
Hi Ms. XXXXXX,

Thanks for writing to us.

I think it would be better to wait for the sonogram also before you go for the injection. It is good that your hCG values are progressing. Four weeks would be early for a sonogram to identify the gestation sac.

You can see Dr. XXXXXXX XXXXXXX of XXXXXXX nursing home in Punjagutta. She is well experienced.

Hope your query is answered. Please contact for anymore information. I will be available to help.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
Follow-up: Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help? 6 minutes later
Thank you very much. Your opinion is very helpful.
 
 
Answered by Dr. Shanti Vennam 3 hours later
Brief Answer:
You are always welcome.

Detailed Answer:
Hi,

You are always welcome to contact anytime. It was very nice contacting you.

Wish you good health.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
Follow-up: Missed period. Home test positive. USG revelaed no sac. Prescribed Sustem. Report showed haemorrhagic corpus leuteum cyst. Help? 51 minutes later
Thank you Madam. I was reading somewhere online that it is better to take either Duphaston or Susten at one time and not both of them together. Is it harmful for the baby or mother? Also, are these hormones which are either injected or given as medicines harm the baby or mother or have any side effects?
 
 
Answered by Dr. Shanti Vennam 1 hour later
Brief Answer:
No evidence of anomalies in studies.

Detailed Answer:
Hi Ms. XXXXX,

Thanks for your query.

Duphaston and Susten are safe in pregnancy as there are no studies suggestive of any harmful effects on the baby. Though Duphaston is not advised in some countries, it is used in the first trimester in India.

I feel the amount of progesterone intake during the first trimester of pregnancy should be based on the actual deficiency detected. Use of one form should usually suffice.

Susten, preferably in the vaginal route is very effective. Please discuss with your doctor for further plan.

As of now, no harmful effects on the fetus have been evidenced in any of the studies.

The effects on the mother include symptoms like bloating, breast heaviness, fluid retention, nausea, dizziness etc. which are the usual ones seen with progesterone. However, one should be cautious about the more rare and serious ones like thromboembolic manifestations, liver disorders and breast lumps.

Please do not stress much and take the help of a good gynecologist. Rest and relaxation are very good for pregnancy.

Hope I have clarified your query. Please get back if you have any more doubts. I will be available to help.

regards,
Shanti.V.
Above answer was peer-reviewed by
 
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