Re: Superfetation or severe IUGR??
From: Charlie Chambers (cchamber@alumni.rice.edu)
Sat Feb 24 16:25:23 2001
on 2/24/01 1:37 PM, M. Kelly Shanahan, MD at mks@sierra.net wrote:
> You tell me what you think:
>
> 41 yo G1 (LMP 8/10 EDC 5/17) with essential hypertension has an abnormal
> triple screen (risks of TS 21 >1:10). Pt referred for genetic
> counseling under California's system and gets scanned -- by that 17 week
> scan the MFM redates her with an EDC of 6/14 and tells her we were off
> on her dates.
>
> That's well and good EXCEPT, she had first trimester spotting and had a
> TVUS 9/22 showing a 6 wk 3 day fetus with a heartbeat, another scan 2
> wks later showing an 8 wk 3 day fetus and a third scan at 15.3 weeks
> where measurements equaled 14.5 weeks. I call the MFM, who hadn't
> reviewed the records sent with the patient and he aggrees there probably
> really is a problem. Pt refuses genetic testing as she would not
> terminate under any circumstances.
>
> Pt continues to be significantly S<D and has serial US showing about a
> 4-5 week discrepancy with her dates and early US.
>
> Sent for a second MFM consult with a different MFM (MFM#1 just does
> genetic counseling). This MFM scans her, gets an EDC of 6/20 and says
> there is no IUGR, just erroneous dates. He does review all hte data and
> can't explain how we saw a 6 week fetus on 9/22, which is a couple of
> days before the estimated date of conception according to his scan.
> "Maybe she lost the first one and just got pregnant again" is his
> explantation".
>
> I know superfetation occurs in horses, but humans? And even if this is
> superfetation, how can you explain seeing a fetus at 6 wks, 8 wk and 15
> wks, then it completely disappearing only to be replaced by a second
> baby, never seen before that is 4 weeks younger??
>
> Kelly
> Kelly Shanahan, MD, FACOG
> S. Lake Tahoe, CA
>
I think you have every reason to be concerned. If this kid is aneuploid then
the scenario you have described would explain the discrepancy in size. Refer
to the old maxim of common things happen commonly, i.e. more likely that a
41 year old mom would have aneuploid fetus that is symmetrically small than
the alternative scenario.
--
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Charlie Chambers "All good things...come
Hood River, OR by grace, and grace comes
by art, and art does not
cchamber@alumni.rice.edu come easy."
Norman Maclean
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