Re: Superfetation or severe IUGR??
From: art fougner, md (evsono@pipeline.com)
Sat Feb 24 16:42:59 2001
Kelly -
this seems like trouble - have seen 6 wk sono's be radically off on the
date but at 8.5 wks the sonar should be within +/- 5 days. be afraid be
very afraid. has anyone done dopplers?
art
At Sat, 24 Feb 2001, M. Kelly Shanahan, MD 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
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
