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PREGNANCY LOSS - NEEDS CLINICAL HELP From: DR. AMITABHA LAHIRI (dralahiri@satyam.net.in) Wed Jan 31 12:56:52 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Lunelle/contraception coverage" Previous message: Marilyn Ringst: "Re: OC costs" Sending you the case history one of my patient, Mrs. X. DOB : 00.03.1971 DOB OF PARTNER : 00.01.1969 RELIGION: Hindu OCCUPATION : CONFIDENTIAL PARTNER’S OCCUPATION: CONFIDENTIAL DATE OF MARRIAGE : 00.03.1995 DATE OF FIRST VISIT : 00.06.2000 MENSTRUAL HISTORY : Menarche (4 ) Age-13 years LMP- 00.01.2001 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 PLEASE REPLY AT dralahiri@satyam.net.in Next message: art fougner, md: "Re: Lunelle/contraception coverage" Previous message: Marilyn Ringst: "Re: OC costs"

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