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.
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.
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
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.
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
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.
1. Intra-uterine small gestation of average gestational size of 5 weeks 1 day at POA of 7 weeks & 1 day with faintly delineated
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.
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
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.