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Re: OB: Mid trimester loss- a different perspective From: Garry E. Siegel, M.D. (garrys@mindspring.com) Mon Nov 7 18:14:36 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Natalie Melanson, RM: "Impaired Glucose Tolerance vs Gestational Diabetes - treatment?" Previous message: Dean Huffman .: "Shake-up envisioned in health insurance [in Massachusetts]" In reply to: JD Stewart,MD: "Re: OB: Mid trimester loss- a different perspective" My plan was to get chromosomes--done and go from there. My threshold to do thrombophilia testing and Anti-phospholipid testing is low, and I would do it later after results and discussion. Garry At Mon, 7 Nov 2005, JD Stewart,MD wrote: > >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: >> >>34 YO P1001 at 14.5 weeks presents for routine visit, no problems, and >>has no FHTs. Scan shows a 12.5 week (CRL) missed Ab, and her dates and >>viability had been established by a 9 week scan. >> >>Her history is negative and she is to undergo a D and C. >> >>Would you send chromosomes? >>Depending of that answer, and depending on the result, would you >>evaluate more fully, i.e. anti-phopholipid testing, thromophilia >>testing, etc.? >> >>Garry >> >>-- >>Garry E. Siegel, M.D. >>Private Practice >>Roswell, GA >> >-- >JD. Stewart, MD >MFM up too late all night, every night > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Natalie Melanson, RM: "Impaired Glucose Tolerance vs Gestational Diabetes - treatment?" Previous message: Dean Huffman .: "Shake-up envisioned in health insurance [in Massachusetts]" In reply to: JD Stewart,MD: "Re: OB: Mid trimester loss- a different perspective"

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