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Re: OB: Mid trimester loss- a different perspectiveFrom: JD Stewart,MD (jdstewartmfmob@sbcglobal.net)Mon Nov 7 11:30:16 2005
Next pregnancy she will be 35yrs plus, worried about aneuploidy, fertility rates falling, and she will already assuming the worst and calling about aspirin,Folic acid, CVS -early amnio and a wreck. I would try specimen chromosomes, counseling we may not get cells to grow with a 2wk old IUFD; screen for ANA/ f/u if positive; check for thrombophilias - genetic tests for MTHFR, Factor V Leyden, =/- Factor II and unlikely ATIII without a clot history in the family. Protein S/C/homocystein will be unreliable in this setting. This approach will identify problems we can do something about in early pregnancy, and I think a discussion of the costs versus the possible benefits should be presented to the patient, and let her ultimately decide. I have a problem with deciding not to offer this without fully discussing it with the patient. My $.02. JDS
At Sun, 6 Nov 2005, Garry E. Siegel, M.D. wrote:
>
-- JD. Stewart, MD MFM up too late all night, every night
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