[Meet2013]

Hi All,

Required your valuable suggestion for the concurrent miscarriage of my wife, i am sharing the case details with reports
She is under observation of a experienced doctor but still i want to check if any test or any diagnosis is missed.


1st Miscarriage:-

May 2008
Report of TVS given below,
1. Uterus is bulky in size.
2. Endometrial cavity shows a gestation sac.
3. GSD measures 1.82 cm - 6 weeks 1 day.(LMP gestation age is 9 weeks)
4. No fatal pole is seen.
5. Cervical Canal is normal.
6. Both Ovaries are normal in size and shape. Parenchyma of both ovaries are within normal limits.

No cardiac pulsation noted.

IMPRESSION:-
Features are favor of Anembryonic Pregnancy

Dr suggested to surgical evacuation of missed abortion. After the evacuation another USG has been done and results are
given below,

1.Urinary Bladder:- Urinary bladder is well distended with normal wall thickness.No intramural lesion is noted.
2.Uterus:- Uterus is normal in size,shape and outline.It is anteverted. Myometrium echogenicity is normal. No obvious
focal lesions are noted in the myometrium.
3. Endometrial stripe is normal and measures approx 4mm.
4. Uterus measures 8.5 X 4.9 X 3.2 cm
5. Ovaries :- Both ovaries are normal in size and echogenicity. No focal lesion is noted in the ovaries.
Right ovary measures 2.7 X 1.7cms. and left ovary measures 2.9 X 2.0cms.
6. No free fluid is seen in cul-de-sac.

IMPRESSION:- Normal USG of lower abdomen.

Dr suggested to avoid trying for next 2-3month and advised to perform TORCHS IgG + IgM Infection test.

In TORCHS Test Rubella IgG value observed 0.48 IU/mL so Dr has suggested to take RVAC vaccination after next period and
advised to avoid pregnancy for next 3 period /2.5 months.

After completing three month we have tried for pregnancy and at that time she was having Folinex D(daily one) from
Day one of period.


2nd Miscarriage:-
February 2013
In January she missed period and preg test card was positive, So had a discussion with Dr and he asked to take Folinex D and
Microgest 200mg. Advised to perform USG after one month (LMP 12/12/12)

USG Report as on 31.01.2013:-
1. A small intra-uterine gestational sac noted with faintly delineated embryonic pole. No demonstrable evidence of cardiac
pulsation noted.
2. Trophoblastic reaction is uniform,global with regular outline.
3. No peri-gestational fluid noted.
4. Cervix looks healthy and endo-cervical canal appears collapsed.
It measures 34mm X 26mm internal OS is closed and normal.
5. Amniotic Fluid appear less.
6. A postero-right fundic sub serous fibroid (35mm X 26mm X 35mm) noted.
7. Adnexa : No obvious mass lesion could be detected.
8. Ovaries are appear normal.
9. Pouch of Douglas is clear.

Gestation : (POA : 7 weeks 1 day, LMP 12/12/2012)
Biometry : Corresponds to an average gestational maturity of 5 weeks and 1 days
GSD = 16mm : 5 wks 1 day

Yolk sacs faintly delineated.
IMPRESSION:-
1. Intra-uterine small gestation of average gestational size of 5 weeks 1 day at POA of 7 weeks & 1 day with faintly delineated
embryonic pole.
2. No retro-placemental pathology. Cervix : within sonographic limit

Dr. Suggested to continue medicine as prescribed before and perform one more TVS after 2 weeks.

TVS Report as on 16/02/2013:-
1. Single ,still embryo noted at changing lie.
2. Placenta (maturity :- grade - I ) is localized anteriorly/posteriorly at upper segment of uterus,well off the closed
iternal OS. No retro -placental collection noted.
3. Cervix looks healthy and endo-cervical canal appears collapsed. It measures 28mm X 21mm.
4. Amniotic fluid is adequate.
5. No Uterine SOL or anomaly is detected.
6. Andexa : No obvious mass lesion could be detected.
7. Obaries are appears normal.
8. Pouch of Douglas is clear.

Foetus :- (POA : 9 weeks 3 days, LMP: 12/12/2012)
Biometry :- Corresponds to an average gestatioal maturity of 7 wks & 3 days.
CRL = 12mm :: 7 weeks 3 days
GS = 24mm :: 6 weeks 4 days

No Cardiac pulsation noted.

IMPRESSION:-
Embryonic demise : Missed abortion.


Dr suggested to perform Surgical Evacuation as early as possible to avoid infection and it has been done today (18/02/2013)

Dr taken sample for HPE and POC for Chromosome Analysis. We will receive the reports after 3 days and i will share the same
after that.

I just want to have a secondary advise on this case...Is all treatment are ok or we can do something more to identify the
concurrent miscarriage. All her other reports are normal ( suger/HIV/bilirubin/hemoglobin/HBsAg/Thyroid/Hepatitis C Virus)
Till the time we are in dark and yet to know root cause of concurrent miscarriage.

[Snuffster]

I would trust your doctor and/or obs/gyno.

I experienced 4 miscarriages in a just over 1 year period, with each pregnancy only having 1 month break inbetween them. It took until the 3rd miscarriage for my private Obs to order DH and I to have several tests to rule out chromosomal abnormalities and other factors. It turned out that I had a clotting disorder and was on asprin for the duration of my pregnancy.

With the amount of time in between the two miscarriages, it is doubtful that the doctor would be going into this amount of testing as yet.

I am so sorry for your losses. It is truly heartbreaking, and I hope that your doctor is able to help you fulfill your dream of a family.

This post has been edited by Snuffster: 18/02/2013, 08:53 PM

[KRT]

I am sorry for your experience of miscarriage.

I agree with Snuffster. I'm surprised that your doctor is willing to order a chromosomal analysis on the products of concept after only two losses, but it is the most appropriate next test. The other tests for recurrent miscarriage usually involve looking at clotting disorders.

Unfortunately, in most cases the cause of miscarriage is unknown. In my case, even with a history of problems associated with clotting and recurrent miscarriage, my miscarriage was deemed to most likely be bad luck. Even if the cause had been put down to clotting problems, there are very few treatments, and those have their own side effects.

In cases of chromosomal problems, with the exception of IVF with PGD (only suitable for some chromosomal disorders), there is not much to be done either.

A pregnancy in 2008 followed by one in 2013 is a fairly signficant gap. I would ask my doctor in that situation about other fertility problems, unless of course you had other successful pregnancies in that time.

[Meet2013]

Thanks Snuffster & KRT