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Second difficult pregnancyFrom: Jim Wang (jimwangmd@yahoo.com)Sat Oct 21 11:20:37 2006
Dear physician colleagues: My wife's first pregnancy a year and a half ago was terminated at 22 weeks after the baby was diagnosed with tetralogy of Fallot and other anatomical abnormalities. Chromosome analysis of both my wife and myself were normal. Aborted fetal tissue was contaminated/infected and therefore no analysis results were obtained. The current pregnancy: LMP was 8/20/06. She has been having spotting of brown and dark red blood since the beginning. We first saw OB doctor on 9/27 regarding the bleeding. US was performed and showed no sac in the uterus. Serial BHCG were ordered, and we were referred to see a perinatalogist on 10/11. The perinatalogist performed TA and TV US on 10/11 which showed 1 partially collapsed sac 1x0.3cm and another sac 1x1cm, however, no fetal pole and no FMB (?fetal maternal bloodflow) were detected in either sacs. Serial BHCG were again ordered. US repeated by the perinatalogist on 10/17 showed both sacs slightly larger, however, no fetal pole nor FMB were detectable. Repeat chromosome analysis on parents are normal again. The brown spotting continues periodically throughout the day. The following were the serial BHCG results: 9/27 BHCG = 2,700 9/30 BHCG = 6,080 10/03 BHCG = 12,189 10/11 BHCG = 30,000 10/17 BHCG = 45,343 10/20 BHCG = 45,403 We were given the diagnosis of missed AB and told that there is no chance of viable pregnancy and advised D&C, Cytotec or waiting for the body terminate and expell the pregnancy tissue. My wife would not want to wait if there is indeed no chance for a normal baby and would choose Cytotec. I believe waiting is useless. However, my wife found- from patient internet discussion websites- similar cases where initial "emty sac" on US imagings were later found at 10 weeks to have fetal presence. Now she is hesitant about intervention. 1. Is there any reason to wait further? If so, how much longer? 2. Any advise regarding prenatal studies or intervention prior to trying 3rd preganancy? Would IVF give better outcome than natural conception? Appreciate any input greatly. Regards, Jim Wang, MD A non-OB/GYN physician
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