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Pregnant, Consumed alcohol and started bleeding. Does this affected the growth of embryo?

DOCTOR OF THE MONTH - May 2013
May 2013
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Practicing since : 2006
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Patient believes she is 9 weeks pregnant based on regular 28 day cycle, knowledge of conception date and positive pregnancy test at 5 or 6 weeks pregnant. The Doctor dates the pregnancy according to ultrasound. The ultrasound shows an embryo with a crown rump length that indicates 6 weeks and a heartbeat of 111. The ultrasound is three weeks off from LMP. At 4 weeks, patient did have some bleeding (brown with tissue-like discharge, then a flow with some clotting and bright red blood for one day and three days of brown blood) but did not see the doctor until she was 9 weeks pregnant based on Last normal missed period. Patient had consumed alcohol while pregnant on 7 different occasions. In week 4, 2 and 1/2 glasses of wine with dinner; in week 7, 2-3 drinks one night, 4 drinks another night and 2 another night; in week 8, patient had 1 and 1/2 glasses of wine on two different occasions.
According to ultrasound drinking occurred in weeks 4 and 5. Is it likely the alcohol consumption affected the growth of embryo? Does the heartbeat indicate more than likely patient is 6 weeks along or could heartbeat just be slow for 9 weeks? This is patient's 4th pregnancy. All other children are healthy and have always measured spot on with ultrasound and LMP. If patient is really 9 weeks pregnant, then she was also exposed to a jacuzzi for approximately 45 minutes. Should patient consider terminating pregnancy? Is risk of insults affecting baby high or low?
Posted Sun, 17 Feb 2013 in Women's Health
 
 
Answered by Dr. Sree Gouri SR 1 hour later
Hi,
Thanks for the query.

The possibilities are:
-Delay in ovulation.
Generally the ovulation will occur on around 14 to 16 days (around the end of 2nd week) of the menstrual cycle.
But hormonal fluctuation due to many causes can affect the ovulation.
So if the ovulation delayed due to that and occurred around 4th week, then the bleeding she had seen could be post-ovulatory bleeding and the gestational age should be around 6 to 7 weeks as showed by the ultrasound.
Because usually the ultrasound will calculate the gestational age as 2 weeks+ to the conception date assuming that ovulation or conception will occur 2 weeks after last menstrual period generally.
The heart beat of around 111 can be normally seen in 6th to 7th week of gestation.
Pregnancy test can come positive after 2 weeks of ovulation.

-Growth retardation due to alcohol consumption.
But usually alcohol may not affect the growth of the baby in very early weeks of pregnancy.

Jacuzzi can lead to temporary effects like over heating, dehydration, fainting etc., but studies are lacking regarding its long term effects on pregnancy. Possibly it may not have any long term effect.

So what she can do is:
As at present the fetus is healthy, she can continue with regular antenatal checkups and ultrasound examinations.
If future ultrasounds shows normal and regular growth she can continue
Or if the growth lag increases or growth stops she can terminate the pregnancy.

Hope I have answered your query. I will be available to answer your follow up queries. If you are satisfied with all my answer, please rate the answer after closing the discussion.
Take care.

Above answer was peer-reviewed by
 
Follow-up: Pregnant, Consumed alcohol and started bleeding. Does this affected the growth of embryo? 4 hours later
In response to stunted growth due to alcohol consumption, what weeks are considered very early in pregnancy?
Is it likely that the abnormal bleeding could have been from implantation bleeding or possibly loss of twin?
 
 
Answered by Dr. Sree Gouri SR 9 hours later
Hi,

-Usually 4 to 5 weeks are considered very early weeks in related to alcohol consumption in pregnancy.
For more details: WWW.WWWW.WW
-According to the history there is some what less possibility for implantation bleeding.
Because:
Usually ovulation and conception will occur around one week before implantation and the ultrasound calculate the gestational age as two weeks plus to ovulation date.
Then the gestational age according to ultrasound should come as around 8 weeks.

Regarding twins:
If that was twin pregnancy then the remaining fetus should be of 9 weeks gestation according to the last menstrual period.
So this is also having less possibility.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.

Above answer was peer-reviewed by
 
Follow-up: Pregnant, Consumed alcohol and started bleeding. Does this affected the growth of embryo? 5 hours later
So alcohol can slow down the growth of embryo between weeks 6 and 8?
Also, if the heartbeat is 111 at 9 weeks and growth of embryo is 6 weeks, could that mean a threatened abortion?
 
 
Answered by Dr. Sree Gouri SR 1 hour later
Hi,

Sometimes alcohol consumption may lead to intrauterine growth retardation, but drinking in one or two occasions may not lead to 3 weeks disparity. But chronic alcoholism can lead to IUGR.
Threatened abortion usually presents with symptoms like abdominal cramps with or without bleeding.
If the bleeding at 4 weeks was because of threatened abortion and then the bleeding stopped and pregnancy continued, usually the gestational age should correspond to lmp.
But excessive blood loss can sometimes that lead to IUGR.
If you continue the pregnancy possibly the fetus can pickup growth and pregnancy may successfully completed.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
Follow-up: Pregnant, Consumed alcohol and started bleeding. Does this affected the growth of embryo? 23 hours later
If dr. and patient are sure the embryo is measuring three weeks small for gestational age, and subsequent ultrasounds show steady growth; for example, an ultrasound four weeks later shows four weeks of growth, should patient continue pregnancy? Growth is occurring but fetus is still really 3 weeks behind in Gestational Age.
Also, ultrasound shows no defects.
If growth is initially affected by an insult such as teratogen or infection, will growth continue to lag?
 
 
Answered by Dr. Sree Gouri SR 3 hours later
Hi,

If doctor is also believing that fetus is having IUGR, then better to rule out the possibility of symmetrical IUGR.
If the parameters of the fetus are below the 10th percentile of the expected parameters at that gestational age, then there is possibility of symmetrical IUGR.
In that case better to terminate the pregnancy.
If the parameters are above 10th percentile, as there are no defects and baby is having regular growth pregnancy can be continued.
You can discuss this with your doctor and can follow her advice.
If blood loss, infection etc affects only the progress or growth, the baby can recover.
But if the structure or development of particular organ is affected that is irreversible, this is usually seen with teratogens.
Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
Follow-up: Pregnant, Consumed alcohol and started bleeding. Does this affected the growth of embryo? 14 days later
Patient gets a positive pregnancy test result at 5 And 1/2 weeks from last normal period. She goes in for first ultrasound at 9 weeks based on LMP--heartbeat is 111 and embryo measures 6.1 weeks. Patient returns 15 days later and heartbeat is 166 and embryo is measuring 7 weeks 6 days. Patient returns again 15 days later and embryo measures 10 weeks 6 days with a strong heartbeat. Does the discrepency between LMP and the first ultrasound concern you as a dr? Patient has regular 28 day cycles and typically ovulates on day 14. Patient is healthy and is 41 years old. She has three other children and none were small for gestational age. What would be protocol for this patient? Is it possible that there was growth retardation before the first ultrasound and then the baby grew normally after that?
How could you rule out growth retardation if that may be the case?
 
 
Answered by Dr. Sree Gouri SR 10 hours later
Hi,
-Yes, we should be concerned if we consider the first ultrasound and lmp, but as now growth is regular the pregnancy may be continued with regular checkups.
-The preferred protocol is let her continue with regular antenatal checkups and ultrasound examinations to monitor the future growth of the fetus.
-Yes, it is possible that baby is growing normally after initial little lag in growth.
-As I told previously if the fetal parameters are above the 10th percentile of the required range to that gestational age and fetus is growing regularly without any anomalies no need to worry.
Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.

Above answer was peer-reviewed by
 
Follow-up: Pregnant, Consumed alcohol and started bleeding. Does this affected the growth of embryo? 11 hours later
If embryo measures 6 weeks at 9 week check up, what is percentile?
 
 
Answered by Dr. Sree Gouri SR 16 hours later
Hi,
The percentile of parameters like fetal weight, crown-lump length etc to be taken to compare.
But it is difficult to calculate in the early gestational age.
According to your lmp the fetus should be of 13 weeks gestation with 22gms of average weight now. And the 10th percentile of the weight is around 18.8gms.
So, if the baby is above this that can be considered normal.
There percentiles can be better compared after 16 weeks as baby will grow some extent by that time.
For more details: WWW.WWWW.WW Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
Follow-up: Pregnant, Consumed alcohol and started bleeding. Does this affected the growth of embryo? 48 hours later
What could be the causes of brownish tissue-like bleeding? Does it typically mean a miscarriage?
 
 
Answered by Dr. Sree Gouri SR 23 hours later
Hi,
Bleeding may not always indicate miscarriage.
In early pregnancy some amount of spotting can be seen because of the causes like,
-Some women may have bleeding on expected day of periods even in pregnancy.
-Increased blood supply to local organs can cause spotting even on mild friction.
-Growing gestational sac sometimes can damage blood vessels, as uterine cavity may not be completely obliterated in early pregnancy spotting can be seen.
So if you are not having symptoms like pain abdomen and spotting subsides no need to worry. But if your spotting increases or pain arises consult your doctor immediately to rule out the possibility of the miscarriage.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
 
Follow-up: Pregnant, Consumed alcohol and started bleeding. Does this affected the growth of embryo? 16 minutes later
So in order to diagnose symmetrical iugr, it's crucial to be accurate with gestational age? From previous emails, the doctor will need to follow the growth for certain amount of time (up to week 16?) to see if baby starts to catch up to true gestational age, but if it doesn't catch up and continues to grow at steady rate and is below 10% for gestational age, best to terminate pregnancy?
 
 
Answered by Dr. Sree Gouri SR 15 minutes later
Hi,
Thanks for the query.
Yes, the gestational age and regular and normal growth of the fetus to that gestational age are crucial in diagnosing symmetrical IUGR.
As you are saying that the woman is very accurate about her dates, better to follow the pregnancy for few more weeks (preferably 4 more weeks) with regular antenatal checkups.
And if the baby's parameters are found to be less than the 10th percentile of the expected gestational age, better to terminate after taking your doctor's opinion.
Take care.
Above answer was peer-reviewed by
 
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