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Re: Error Condition Re: RE: Superfetation or severe IUGR??From: Braun, R. Daniel (rbraun@iupui.edu)Sun Feb 25 12:18:50 2001
Wow, the screening software is good,but it still misses some of the bad ones. Dan -----Original Message----- From: ob-gyn-l@obgyn.net To: rbraun@iupui.edu Cc: ob-gyn-l-request@obgyn.net Sent: 2/25/2001 2:04 PM Subject: Error Condition Re: RE: Superfetation or severe IUGR?? We are sorry, but this system sensed the following request which may have been inadvertedly sent to this list: GET A COUPLE OF NEW MFM'S. FIRST ONE ISN'T THOROUGH AND SECOND ONE DOESN'T If your posting was intentional, please accept our apologies and resend your mail message, making sure you do not include anything that may look like a request in the first line of the body of the actual message. If this was indeed a request please resend it to listproc@medispecialty.com Your entire message is copied below. ------------------------------------------------------------------------ ------- ------------------------------------------------------------------------ Get a couple of new MFM's. First one isn't thorough and second one ------------------------------------------------------------------------ doesn't have a clue. Sounds like a very severee IUGR, c/w trisomy. -----Original Message----- From: mks@sierra.net To: Multiple recipients of list OB-GYN-L Sent: 2/24/2001 4:37 PM Subject: Superfetation or severe IUGR?? 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
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