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14 weeks pregnant, having minor bleeding, watery discharge. Can low amniotic fluid be reversed, abortion avoided ?

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This is an urgent query is regarding my wife's condition. She is 14 weeks + pregnant. Its her first pregnancy and with no previous history of miscarriages/abortions. However she has been complaining of minor bleeding and vaginal watery discharge since last 4-5 days. The problem started just a week ago, when she had small amounts of blood discharge in addition to her regular thich white discharge. Then, the thick white discharge gave way to watery and very fluid discharge in the last 3-4 days with occassional red/brown coloration. We immediately sought gyneic expert's help and she suggested us to get her admitted. Post admission there have been 2 rounds of ultrasound examinations in the last 2 days. The first scan came out normal as per the radiologist (yesterday), which showed normal placenta position + fetal heartbeat. However yesterday night, the watery discharge and bleeding continued intermittently and the doc advised another ultrasound today morning. This time, the radiologist gave a report that amniotic fluid volume is critically low and some suspended particles showed up in the fluid, indicating infection. In parallel as mentioned, her blood and urine tests have revealed high TLC and CRP counts, and she is on anti-biotics.

The Gyneic has warned us of a threatened miscarriage in light of this low fluid volume. My wife has been put on observation for next 12 hours, on complete bed rest with foot up position. The doc has mentioned that they would be able to take a decision on continuing the pregnancy based on Ultrasound conducted tomorrow. Worst case scenario - if fluid levels do not improve and bleeding/discharge persisits tonight, then they would advise us for an abortion.

We are very much concerned with this development and would seek your expert opinion in handling this crisis.

Need answers to the following queries to help us take a decision :

1. Can the low amniotic fluid be reversed and replenished by any means of treatment - Medication etc ; some friends have recommended L-Arginine ; however my doc has not advised it, mentioning that since US report does not show any fetal anamoly - and XXXXXXX organs of fetus are fine, then no need for L-Arginine; But we need a confirmation that if giving a controlled dose of L-Arginine or any other similar medication can improve chance of amniotic fluid volume replenishment. As per our current gynec, she suspects membrane rupture which has led to leakage of amniotic fluid and she does not believe that there is any medication that can help stop leakage and increase fluid volume.

2. In case fluid volume is still low tomorrow based on Ultrasound, is it confirmed and recommended that we go for an abortion or is there any other available treatment/therapy which can prevent termination of pregnancy.
3. She is also having viral infection as mentioned. Could reversing the infection through antibiotics have a better impact on the pregnancy ? I mean, if the viral infection is controlled, can the membrane damage/bleeding etc be arrested. If yes, then is it recommened to override the doctors recommendation of going for an abortion and continue with the antibiotic treatment. (Urine/Blood and vaginal culture reports are expected in next 2 days).
4. In worst case scenario, if we have to go for abortion - can it be postponed till the time, my wife's viral infection has improved? Currently she appears very weak physically and our concern is the risks of abortion. What are potential risks for her? and would having an abortion at this stage have any impact on future planned pregnancies? What should be a recommeded plan for abortion - options/time etc?
5. Currently she is admitted in XXXXXXX Hospital, Gurgaon. In case we need to shift her to a different hospital under a different gyneacologist, (incase it is recommended to continue the pregnancy and this doctor differs), then would travel/transportation/shifting cause a risk for miscarriage?
6. Finally, can you recommed a better Gynaecologist in Delhi/Gurgaon/NCR whom we can consult for this issue, in case your recommendation is to continue the pregnancy.

This is an urgent query and we would really appreciate any help and advice in this regard.

Thanks and Regards,

Posted Wed, 23 May 2012 in Pregnancy
Answered by Dr. Rhea Chanda 4 hours later
To answer your queries,
1.I agree with your gyanec on the first point.If there is a membrane leak,that is leading to the loss of amniotic fluid,there is not much that you can do at this point.Medical therapy doesnt help much in increasing the fluid volume at this early stage in the pregnancy.
2.If the fluid volume decreases significantly then termination is advisable,as that may happen anyway even if no intervention is done from your side.
3.Sometimes it has been seen that any leak plugs itself spontaneously after antibiotics and bed rest,however,that may be in cases where the leak in minor and ultrasound reports dont show any loss of fluid.However,if there is XXXXXXX leak,then chances of arresting the fluid loss is minimal.In such cases,continuing the pregnancy isnt recommended.The viral infection has to be treated simultaneously.
4.Waiting till your wife's general condition improves isnt necessary since that has no direct impact on the abortion.There shouldnt be any long term risks in future pregnancies provided there is no other co morbid condition.
5.Shifting to another hospital is possible provided her general condition allows it.Obviously by ambulance.

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