|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Recurrent 2nd Trimester LossFrom: hribot@obdoc.is.netMon Apr 8 16:30:29 1996
To the more obstetric/maternal-fetal among us: I would appreciate any thoughts regarding the following patient of mine. She is now a para 0020 (if you go by fetal weight < 500g) or para 0200 (if you go by gestational age > 20 weeks) and I feel powerless. Her first pregnancy she presented at age 20, 13/40 (dates) and was 9/40 by size and vag U/S. Negative medical hx, BP 120/70, prenatal labs wnl (HIV, HBsAg, RPR, etc.) and an asymptomatic cystitis (E. coli >20K <50K [R] to Ampicillin, Staph. aureus >100K [R] to tetracycline, rx'd with macrodantin. At 15/40 visit gave hx of spotting 2d prior. FHTs + At 17/40 visit BP 138/80 Triple screen wnl, FHTs + At 21/40 visit BP 166/90 sitting, repeat 118/84, FHTs +. Gave hx of MVA 1 week prior, didn't seek attention, no hx of abdominal trauma. Returns 8 days later "not feeling right" and no FHTs heard, IUFD confirmed by sonogram. BP 130/100 sitting. Induced with laminaria followed by PGE2, required D+E for retained placenta. Path showed female with significant postmortem autolysis, skin slippage, no gross anomalies. Placenta showed 'mild acute chorioamnionitis' without significant infarction. Her 2nd pregnancy she presents 19 months later, 13/40 by dates, 19/40 by size and U/S. Initial exam benign except for trichomoniasis, rx'd with Flagyl. Triple screen comes back AFP 4.29 MoM (148.3 IU/ml). Finally has Level II U/S 13 days later. Scan anatomically wnl, adequate fluid. Amniocentesis done, clear straw fluid, 46, XY with AF AFP 1.02 MoM (5.97 KIU/ml). (Seven days prior had spotted x 2d, exam: cervix closed, no blood in vault.) Three days after amnio, checked for 'cramping,' Cx closed/thick, frothy d/c with Trich, FHTs +, no blood in vault. At 23/40 visit, BP 132/80, no proteinuria, FHTs +, stated 'no movement, U/S wnl. At 25/40 visit, BP 120/80, no movement, no FHTs, U/S confirms IUFD, skin slippage/edema seen, adequate AF. Induced with Lams/PGE2, easy delivery of fetus/placenta in intact sac with wine colored AF. Labs obtained that day (all neg): ANA, Lupus anticoagulant, anticardiolipin antibodies. Path: Fetus - no gross anomalies, postmortem autolysis, 348gms. Placenta - "maternal floor infarction" with significant fibrin deposition along 'maternal floor.' Also focal marginal infarction. No amnionitis. As you can all imagine, "distraught" is a gross understatement as far as the pt and her family are concerned. The only prophylaxis I could think of was to have her take ASA 80mg qd, and to come in immediately when < 1 week late to confirm pregnancy and start subcu heparin 5000 tid or thereabouts. Any thoughts on etiology and prognosis or further testing? Should she be screened for Protein C or S deficiency? Any help would be welcome. Sorry for the T. Jones sized post - just kidding Terry! Hugo Hugo D. Ribot Jr., M.D. FACOG An exurban Atlanta Ob/Gyn in a two MD, two CNM practice 958-A Joe Frank Harris Parkway, Suite 102 Cartersville, GA 30120 (770) 386-4824 Voice 386-4220 Fax 975-6041 alphanumeric pager hribot@obdoc.is.net
|
|
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 05:18:04 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.