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Re: Miscarriage and Antiphospholipid SyndromeFrom: Kelly Shanahan, MD (anonymous@obgyn.net)Sun, 22 Mar 1998 14:27:18 -0600 (CST)
At Tue, 17 Mar 1998, Kirsten wrote: > >I am 33 years old and have experienced two first-term miscarriages in >the past year - May 1997(7 weeks, second pregnancy) and December 1997(5 >weeks, third pregnancy). My first pregnancy 3 1/2 years ago was >medically uneventful and wonderful - a healthy, full-term 7 pound boy. >Thankfully, I am very healthy - the only medical situation is an >elevated ANA blood level. All tests for autoimmune problems over the >past 3 years are negative. I am considered in the 15% of women with an >elevated ANA. > >I had two separate sets of tests for antiphospholipid syndrome (APS) >following my 2nd miscarriage as a result of my elevated ANA. The first >tests (Jan. '98) were by a hematologist (specializing in APS), who >found an IGM anticardiolipin antibody (6) and concluded I had APS. It >was recommended that I use low-dose baby aspirin and heparin during my >next pregnancy. An OBGYN who also specializes in APS received these >results, said I "didn't fit the profile for APS," and requested >additional blood work (March '98). My blood was negative (no IGM >antibody found) and it was concluded by this doctor that I don't have >APS. > >Now, a search for direction on where to head next - a third tie-breaking >APS test??, trying for a fourth pregnancy without using aspirin/heparin >(now we are nervous about a possible second or third-term miscarriage >after being told we have APS)??, trying for a fourth pregnancy using >experimental aspirin (or heparin) just in case?? Any advice or comments >you have are sincerely appreciated. > >-- >Thank you for your time, Kirsten Kirsten I am a regular ob-gyn, not a reproductive endocrinologist, but I know a fair amount about APS andI have pretty strong feelings on this issue; I, like you, have had 2 early miscarriages and have a "borderline" ACA IgA. I also have a patient with a "borderline" anticardiolipin and 2 prior miscarriages -- she is now 29.5 weeks pregnant ans has been on baby ASA since before conception and was on heparin from positive pregnancy test until 28 weeks. Is the heparin and the aspirin the reason she is doing well this time and that I will have the extreme honor of delivering her first child in May? I don't know for sure, but I can tell you she and I both think it's the key. I know for me, I would do absolutely anything to improve my chances of carrying a baby to term. The risks of aspirin are zero and the risk of heparin is small (increased chance of osteoporosis). The question you need to ask yourself is "if I don't do this and I miscarry again, will I feel guilty?" I know for me, that if I do everything I possibly can, yet miscarry anyway, I will feel a teeny bit less bad. I am trying to conceive again, and my RE has me begin heparin from ovualtion on -- sticking myself with a needle twice a day is a small price to pay for the chance to have a baby (although, I must admit, doing it for 2 weeks without even knowing if I'm pregnant is a little tough). I wish you the very best of luck in acheiving your dream of having another child. This is going ot be a tough time for you, so I encourage you to find a doctor who is understanding and willing to work with you.
-- Kelly Shanahan, MD, FACOG S. Lake Tahoe, CA
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