-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Second difficult pregnancy From: Andrew Folley (agfolley@hotmail.com) Mon Oct 23 12:54:21 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: dmecnm@aol.com: "Re: Cleveland Clinic Pelvic Floor Distress Inventory Questionaire" Previous message: DoctorJoe@aol.com: "Re: TX doctor wins 2.5M peer review suit" In reply to: Jim Wang: "Second difficult pregnancy" Based on the information given one cannot conclude that this pregnancy is going to be nonviable. I am particulary interested in the US on 10/11 and 10/17. On 10/10 you have a 10mm by 10mm gestationsal sac which would give one an EGA of 40 days or about 5 weeks and 5 days. Based on the LMP of 8/20 the patient should be about 7weeks EGA. The next ultrsound is 6 days later. In a normal developming pregnacy, over the course of 14 days one should expect to go from a gestational sac to seeing a yolk sac, to seeing a fetal pole (day 44) to seeing a fetal heart beat day 46 (6 weeks 4 days from LMP or 4 weeks 4 days from conception. Most likely the perinatologist is correct. However, it would be nice to have 2 ultrasounds 2 weeks apart that do not show this nomrla progression before embarking down path of termination. Having a sac on 10/11 and 6 days later not seeing a fetal pole is not necessarily diagnositic of missed abortiion or blighted ovum. However, one should expect to see at least a 4-5mm yolk sac at the ultrasound on 10/17. (By the time one sees a 10mm gestationsal sac we should be able to see the 4mm yolk sac. By the time the gestational sac is 20mm (day 50) we should see a fetal pole) You do not want to have a doctor who drags out needless hope for a patinet when it is obvious that there is no chance for a pregnancy. At the same time we do not want to be too quick to "right off" a potentiallynormal pregnancy. there is little risk , emotional or physical to rechecking a final trans vaginal ultrasound 7-8 days after the 10/17 ultrasound (ie this week). If there is no fetal pole then absolutely this is non viable and cytotec or out patient D&C or letting natrue take its course would be appropriate. agf >From: jimwangmd@yahoo.com (Jim Wang) >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: Second difficult pregnancy >Date: Sat, 21 Oct 2006 11:22:22 -0500 > >Dear physician colleagues: > >My wife's first pregnancy a year and a half ago was terminated at 22 >weeks after the baby was diagnosed with tetralogy of Fallot and other >anatomical abnormalities. Chromosome analysis of both my wife and >myself were normal. Aborted fetal tissue was contaminated/infected and >therefore no analysis results were obtained. > >The current pregnancy: LMP was 8/20/06. She has been having spotting of >brown and dark red blood since the beginning. We first saw OB doctor on >9/27 regarding the bleeding. US was performed and showed no sac in the >uterus. Serial BHCG were ordered, and we were referred to see a >perinatalogist on 10/11. The perinatalogist performed TA and TV US on >10/11 which showed 1 partially collapsed sac 1x0.3cm and another sac >1x1cm, however, no fetal pole and no FMB (?fetal maternal bloodflow) >were detected in either sacs. Serial BHCG were again ordered. US >repeated by the perinatalogist on 10/17 showed both sacs slightly >larger, however, no fetal pole nor FMB were detectable. Repeat >chromosome analysis on parents are normal again. The brown spotting >continues periodically throughout the day. The following were the >serial BHCG results: > >9/27 BHCG = 2,700 >9/30 BHCG = 6,080 >10/03 BHCG = 12,189 >10/11 BHCG = 30,000 >10/17 BHCG = 45,343 >10/20 BHCG = 45,403 > >We were given the diagnosis of missed AB and told that there is no >chance of viable pregnancy and advised D&C, Cytotec or waiting for the >body terminate and >expell the pregnancy tissue. My wife would not want to wait if there is >indeed no chance for a normal baby and would choose Cytotec. I believe >waiting is useless. However, my wife found- from patient internet >discussion websites- similar cases where initial "emty sac" on US >imagings were later found at 10 weeks to have fetal presence. Now she >is hesitant about intervention. > >1. Is there any reason to wait further? If so, how much longer? >2. Any advise regarding prenatal studies or intervention prior to >trying 3rd preganancy? Would IVF give better outcome than natural >conception? > >Appreciate any input greatly. > >Regards, >Jim Wang, MD >A non-OB/GYN physician > Next message: dmecnm@aol.com: "Re: Cleveland Clinic Pelvic Floor Distress Inventory Questionaire" Previous message: DoctorJoe@aol.com: "Re: TX doctor wins 2.5M peer review suit" In reply to: Jim Wang: "Second difficult pregnancy"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:05:05 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.