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Re: any clues?From: Jose C. Ferreira (zec@inx.net)Thu Jul 10 20:32:48 1997
> >Dr. Amarnath Bhide/Rajendra Deshpande wrote: > >> > >> A 22 yr old G1 registered for AN care at 16 weeks. 19 weeks scan was > >> normal. No risk factors. A visit at 23 weeks, I was unable to document FHS > >> on stethoscope/doppler. No symptoms. An urgent USG documented severe > >> oligoamnios and IUFD. > > > >I usually evaluate these patients with a fetal autopsy and karyotype > >(sounds impossible in your situation with a macerated fetus), > >antiphospholipid antibodies, a hysterosalpingogram (HSG) to rule out > >uterine anomalies, and perhaps a hemoglobin A1C. Since the 19 week scan > >was "normal" it sounds unlikely that a condition such as Potter's > >Syndrome was the culprit, although another anomaly, including a > >chromosomal problem, could have caused this. Good luck. I really hate > >when tragedies like this happen. > > I agree with Ashley's assessment. My money (little that there is after > managed care) is on fetal autopsy/karyotype findings being the culprit. > > -- > Harvey Unfortunately, doing all that research, plus placental pathology (it's very important to have someone with experience and knowledge in this field; unfortunately there are not many) and viral and bacteriologic studies in the mother and the fetus (placenta or amniotic fluid by amniocentesis before delivery), one is able to find a cause in only about 40 to 50% of cases. Our ignorance about the causes of fetal death is so big .....! P.S.-I wouldn't do the histerosalpingogram. Jose Ferreira zec@inx.net Ob.-Gyn. Department, Garcia de Orta Hospital, Portugal Genetics Fellow, Montefiore Medical Center (AECOM), New York
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