Re: Threatened abortion--some questions
From: art fougner, md (evsono@pipeline.com)
Mon Jul 9 09:29:27 2001
i look forward to the inevitable enthusiastic report on the use of eye
of newt in the setting of threatend miscarriage. voodoo and witchcraft
are alive and well.
art
At Mon, 9 Jul 2001, Griffiths Malcolm wrote:
>
>Yes this is overenthusiastic management with no evidence base. The only
>issue of doubt is regarding the Triple test after the "normal" nucchal scan.
>Both tests are screening tests and there is no evidence to allow one to
>combine risks from two tests to give a third risk. Nevertheless one does
>come across individuals who rather than accept the first negative screening
>test continue to have further screening tests as if seeking a positive
>result. If that were so, one needs to bear in mind that threatened
>miscarriage can affect AFP and BhCG levels and therefore skew the triple
>test. Not to mention giving hCG injections!!!
>
>-----Original Message-----
>From: dr_naseemahmad@yahoo.com [mailto:dr_naseemahmad@yahoo.com]
>Sent: 06 July 2001 21:07
>To: Multiple recipients of list OB-GYN-L
>Subject: Threatened abortion--some questions
>
>Some questions regarding a case of threatened abortion have been posted
>by amember to RCOG forum. These are interesting questions and I hope
>the original writer will not object if I ask the Obgyn listers of their
>opinions.Following is the actual text as it appeared in the forum.
>
>"A patient has recently come to me with history of spotting thrice in
>the present pregnancy. She has had one
>normal pregnancy in the past. She has been treated at another centre
>with bed rest, hcg injections till 14
>weeks and has had an USG everytime she had spotting.Based on the latest
>USG she has been advised
>Aspirin 60 mg daily. The reportis as given:
>1) Single live intra-uterine foetus is seen.
>2) Foetal movements and cardiac activity is seen.
>3) FHR 146 bpm.
>4) CRL 4.64 cm corresponding to 11 weeks 4 days gestational age.
>5) Nuchal lucency is 0.23 mm.
>6) A healthy yolk sac is een.
>7) Placental reaction is anterior.
>8) A small crescentric collection of fluid is seen anteriorly 1.23x0.3
>cm in size.
>9) The OS is closed.
>10) Right uterine artery shows slightly increased impedance to flow
>resistive index 0.79.
>11) Left uterine artery shows normal spectral waveform with resistivee
>index of 0.63.
>She was also advised IMMUNOPHENOTYPING and a triple screen test.The CD56
>value was 14% (Normal
>3-12). Based on this she has been advised DOWNREGULATION WITH PATERNAL
>LEUCOCYTES. The triple
>screen has yet not been done. My questions are:
>1. Is a triple screen test required in the presence of a normal nuchal
>translucency?
>2. Is Aspirin required? And that too based on a slightly high resistive
>index in the right uterine artery?
>3. Is there any role of the so called 'Immunotherapy' in cases of
>threatened abortion. I thought it had a
>theoretical role in cases of Recurrent Miscarriage and is not in use
>clinically.
>4. Has this been a case of over-enthusiastic management?
>I will be grateful if someone can share their views with me. "
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
