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Re: Yolk Sac sizeFrom: Dr.Andrea Corda (acord@tin.it)Sat Jan 23 08:28:51 1999
At Tue, 19 Jan 1999, Bill King wrote: > >I personally have not seen a pregnancy in which the yolk sac was 7 mm. or larger before 8 weeks gestation that has progressed past the first trimester. I have been measuring yolk sac size for about 4 years. We usually tell the patient that we would like to re-scan them in 2 weeks. We hint that sometimes it is a sign that things are not quite right. We caution that we are just going to take another look in two weeks to be on the safe side to see if things are progressing normally.This seems to help prepare the patient. Have the Chromosome abnormalities that you have found been confirmed only by testing the abortive fetus, or have you seen these pregnancies progress? We do not do 1st trimester scans on all patients. Maybe if we did, I would see this more frequently. Also, I have seen the yolk sac when it has a crumpled, or calcified appearance. Would anyone care to discuss this? These pregnancies don't seem to do very well either. > Ruth A. King RT, RDMS
-- Since your experience is exactly the same I have,why not put all these data together following simple rules (i.e. check the growth rate of the yolk sac compared to the embryo starting from 2 mm CRL ,check the EHR comparing it to Terry Du Bose's data and rules) making up a simple protocol?Having the opportunity to kariotype them (if they might progress,or also using fresh abortive material as I did)may help us discover some interesting facts about early pregnancies.To answer your second question,yes,I saw some of these pregnancies progress:all showed a thickened nuchal fold and an amnio was then performed.I remember a Klinefelter who started the series,then a trisomy 21 ,a Turner,a trisomy 22 (she was actually born and the kariotype performed on the neonate),a 4p deletion,and others.I started checking sistematically yolk sac diameter after hearing a lecture from Ed Lyons on this topic in Las Vegas in 1993.I did notice already that funny yolk sacs were more or less linked to altered pregnancy outcomes but what to look for ? Size?Shape?Echogenicity?I started with three suspects and focused finally on size.Of course,I would like to discuss this topic as well,but I think it has more to do with other illnesses than chromosome abnormality.So,if we first clarify the role an enlarged yolk sac has in signalling a possible (a very likely? A sure?) chromosomal anomaly (and it wouldn't be impossible ,even in a short time,thanks to the web and our conjoined efforts),we will be on the right track to discover all the other precious signals that this disregarded structure of the embryonic life has to tell. Regards, A.Corda
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