Re: Pregnancy Loss
From: art fougner, md (evsono@pipeline.com)
Fri Jan 19 09:13:19 2001
not a good idea to provide patient identifiers in a public forum.
art
At Thu, 18 Jan 2001, DR. AMITABHA LAHIRI wrote:
>
>Sending you the case history one of my patient, Mrs. Jayati Mukherjee.
>
>JAYATI MUKHERJEE
>
>w/o MR. DR. AMLAN MUKHERJEE
>
>ADDRESS :. 17/A, A.D.Pal Road, Uttarpara, Pin:712258 CONTACT NOS.:
>6638235
>
>DOB : 23.03.1971 DOB OF PARTNER : 38.01.1969 RELIGION: Hindu
>
>OCCUPATION : Housewife PARTNER’S OCCUPATION: Doctor
>
>DATE OF MARRIAGE : 08.03.1995 DATE OF FIRST VISIT : 27.06.2000
>
>MENSTRUAL HISTORY :
>
>Menarche (4 ) Age-13 years LMP- 05.01.2001 Cycle- Regular
>
>Period length- 3-5days Cycle length- 24-28days Period problems- Nil
>
>IMB (8 ) PCB (8 )
>
>OBSTETRIC HISTORY :
>
>Total = 2 Term = 1
>
>Para = 1 + 1 + 0 + 0 Preterm = 1 Ectopic = 0 Live birth = 0
>
>Miscarriage = 0 Still birth = 2 Termination = 0 Living = 0
>
>Molar = 0 Perinatal death = 0
>
>Problems in pregnancy- First pregnancy – Chickenpox in the last
>trimester
>
>Second pregnancy - IUGR 20 weeks onward with PIH
>
>Details of pregnancies- First: Male 36 Weeks IUFD
>
> Second: Female 32 Weeks IUFD 850GMS
>
>Any genetic disorder- Not known
>
>No. & dt. / year of previous live births- 8
>
>No. of previous children still living- 0
>
>No. & dt. / year of previous still births 31.01.1998 ( P1) &
>13.02.2000 ( P2 )
>
>No. & dt. / year of previous abortions- 0
>
>Date of last delivery- 13.02.2000
>
>Labour & delivery- Vaginal 4 Forceps Breech Vac. ext. Caesarean
>section
>
>Analgesia- Was labour induced- 4
>
>Any disease or congenital malformation- 8
>
>Perinatal death :
>
>Type of death- Late foetal
>
>Was autopsy performed- No
>
>Age at death- 38 weeks ( P1) & 32 weeks (P2)
>
>Cause of death : P1 = Probably due to high temperature (103º F)
>following chicken pox
>
> P2 = Not known – associated PIH & gross SFD
>
>PAST HISTORY :
>
>Medical - Viral hepatitis at 16 years age - hospitalised for 3months
>
>Surgical – 8
>
>PREVIOUS THERAPY : Nothing suggestive
>
>DRUGS ADMINISTERED DURING PREVIOUS PREGNANCIES : Methyldopa & Nifidipine
>
>DRUG ALLERGY : 8
>
>IMMUNISATION HISTORY: T.T.last received in 1999 Rubella vaccine on
>28.06.2000 Hepatitis B vaccine 8
>
>FAMILY HISTORY : Hypertension
>
>PERSONAL HISTORY : Contraceptive practices before pregnancy- barrier,
>Smoking, Alcohol, Tobacco use.
>
>EXAMINATION :
>
>GC- Fair Height- 1.69m Weight- 69Kg BMI- 24.15 Pulse- 76/ min BP- 122/78
>mmHg
>
>Obesity- Nil Thyroid- Not enlarged Breast- Normal development
>Galactorrhoea- Nil Abnormal hairs-Nil
>
>Secondary sexual character- Present
>
>Per abdomen- NAD Per vagina-
>
>INVESTIGATIONS :
>
>Name of the test
> Date
> Result
>
>Hb
> 08.02.2000
> 11.6 gm %
>
>Blood Gr. & Rh
> A Positive
>
>BT
>
>CT
>
>Platelet Count
> 08.02.2000
>
>08.02.2000
>
>08.02.2000
>
>17.08.2000
> 1 min 50 sec
>
>5 min 10 sec
>
>125 × 10°/L
>
>275 × 10°/L
>
>Activated PTT
> 17.08.2000
> 32 sec (Control = 29 sec)
>
>VDRL
> 17.08.2000
> Negative
>
>ANF
> 23.08.2000
> Negative
>
>Anti Cardiolipin Antibody IgM
>
>IgG
> 19.05.2000
>
>19.05.2000
> 5.77 U/ml
>
>10.10 U/ml (10-19 Low Positive)
>
>T4
> 07.01.2000
>
>13.04.2000
> 13.0 mcg/dl
>
>9.4 ug/100ml
>
>TSH
> 07.01.2000
>
>13.04.2000
>
>17.08.2000
> 0.28 micro IU/ml
>
>2.37 micro IU/ml
>
>3.03 micro IU/ml
>
>PRL
> 13.04.2000
> 1.6 ng/ml
>
>Anti-Toxoplasma IgM
>
>IgG
> 16.03.2000
>
>16.03.2000
> 0.14 Index ( < 0.50 : Negative )
>
>7.0 IU/ml ( < 8.0 : Negative )
>
>Anti-Rubella IgM
>
>IGG
> 16.03.2000
>
>18.05.2000
>
>16.03.2000
>
>18.05.2000
> 0.52 Index ( < 0.80 : Negative )
>
>0.68 Index
>
>367 Index ( > 50.0 : Positive )
>
>396 Index
>
>Anti-Cytomegalovirus IgM
>
>IGG
> 16.03.2000
>
>18.05.2000
>
>16.03.2000
>
>18.05.2000
>
>20.09.2000
> 0.63 Index ( < 0.7 : Negative )
>
>0.73 Index ( 0.70 - <0.90 : Equivocal)
>
>400 U/ml ( > 40.0 : Positive )
>
>> 400 U/ml
>
>> 400 EU/ml
>
>Anti-Herpes IGM
>
>IGG
> 16.03.2000
>
>16.03.2000
> 1.13 Index ( 0.85 – 1.15 : Dubious )
>
>0.79 Index ( < 0.85 : Negative )
>
>2hr PP Plasma Glucose
> 22.11.1999
>
>13.01.2000
> 86 mg/dL
>
>89 mg/dL
>
>USS Pelvis
>
>HSG
>
>Laparoscopy
>
>Hysteroscopy
>
>HVS For C/S
>
>Cervical Smear (PAP)
>
>Karyotyping
>
>Semen Analysis
> Density
>Motility
>Progression
>Abnormality
>Please clarify the followings :-
>
>Can I suggest the couple to go for a third pegnancy just at this moment?
>Can you suggest any preconceptional therapy or precaution for the
>couple?
>Is there any role of Ganciclovir given before conception?
>If Anti-CMV IgM titre goes high during her antenatal period, can I start
>parenteral Ganciclovir?
>What precautions or treatment shall I undertake if she becomes pregnant?
>Can you suggest any further investigations in this case?
>Actually I think that the TORCH may not be the reason for the previous
>two latefoetal death. What is your opinion?
>
>Earnestly looking for your reply and valuable suggestions .
>
>DR. AMITABHA LAHIRI MD (Gyn.&Obs.)
>Address: Shovona Mansion, Flat - H, Second Floor
> 16, Kabi Nabin Sen Road, Kolkata - 700 028, INDIA
>Tel: (033) 559 1393, 529 1763
>e-mail: dralahiri@satyam.net.in
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
