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Pregnant. Took sustain, hcg injection and started spotting. Suspected for mixed abortion. What's wrong?

Mar 2013
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Practicing since : 1998
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my wife is 9.4 weeks pregnant now. at 7.6 weeks gyncolgist scanned and said that cardiac activity is there,crl-10.9mm. and prescribed some drugs sustain200mg, duphston, hcg injection weekly, maintain inj weekly, mhr. she took those medication on time. but from 7.6 weeks onwards there is some spotting, she had intimated as such. but now she scanned today again and said that there is no heart beat and mixed abortion. and suggested MTP. previuosly she had undergone one MTP,due to the reson of no cardiac activity. and then immediate after that she was pregnant, before coming a first period. that pregnancy is present one only. please me your opinions and what is mixed abortion. what is the chances future fertility.
Posted Wed, 13 Feb 2013 in Abortion and Stillbirth
Answered by Dr. Aarti Abraham 2 hours later
Thanks for writing to us.

Missed abortion refers to the clinical situation in which an intrauterine pregnancy is present but no longer developing normally. This means that either the embryo failed to develop ( anembryonic pregnancy ), or , as happened in your case, the embryo ( fetus - baby ) undergoes intra uterine death before 20 weeks of pregnancy.

As she has a previous missed abortion also, she should undergo complete evaluation for recurrent abortions.

The commonest cause is genetic ( chromosomal ) defects in the fetus, accounting for 60 % of causes. You should definitely send the products of conception that come out after the MTP for a chromosomal ( genetic ) testing and biopsy of the placental tissue. Also, you both should undergo a couple karyotype.

ANother cause is uterine abnormalities in size and shape. These are diagnosed by ultrasound and hysteroscopy / hysterosalpingogram.

Infections like toxoplasmosis, rubella, cytomegalovirus, herpes etc cause such abortions, and your wife should be thoroughly tested for these.

Hormonal imbalances causing inadequate progesterone support to the growing embryo causes abortion, but the drugs which you mentioned in this pregnancy should have taken care of that.

Maternal diseases like uncontrolled diabetes, hypertension, thyroid disorder etc, increased maternal BMI, increased maternal age, or smoking, alcohol, intake of teratogenic drugs, radiation etc is one cause.

Recurrent pregnancy loss is associated with several autoimmune diseases. One such disease is antiphospholipid antibody syndrome (APS). For this, specific and detailed laboratory testing is required.

Disorders of coagulation such as Protein C, Protein S deficiency and Factor V Leiden mutation also contribute to fetal demise.

Recurrence rate after two missed abortions can be as high as 35 %.

Please go for detailed chromosomal analysis of the fetus, detailed couple counselling and investigations with a Genetic Counsellor, and keep atleast 3 months spacing before planning the next pregnancy.

Make sure your wife takes adequate pre pregnancy folic acid supplementation.

Take care and feel free to ask for further clarifications.
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Follow-up: Pregnant. Took sustain, hcg injection and started spotting. Suspected for mixed abortion. What's wrong? 18 hours later
thank you very much for your explaination.
today early morning itself MTP was done. i didn't seen your reply. so that i didn't asked for the genetic ( chromosomal ) defects in the fetus. even the doc also didn't said. but she advised me that there may be a some chromosomal abnormalites or auto immune syndrome. so that she advised us to diaognise regarding these two. but my doubt is the results of couple karyotype is how helpful rather than doing the genetic ( chromosomal ) defects in the fetus. And what will be the cost of these tests approximately. kindly provide the information.
Answered by Dr. Aarti Abraham 3 hours later
Hello again,
Balanced chromosome translocations, in which sections of chromosomes change their geographical position on the chromosomal map without any loss or gain of important genetic material, are an important cause of recurrent miscarriages because they are common; one in 500 people carries a balanced translocation. When one member of a couple carries a balanced chromosome translocation, the risk of having a miscarriage is approximately doubled. In 3-5% of couples with recurrent miscarriage, one partner has a balanced translocation.
Hence, peripheral blood karyotype of both partners is a must.
The analysis of the products of conception is even more important, since it specifically identifies other genetic defects also.
These tests are costly, and cost varies on the centre where you are based, plus which laboratory you choose to get these done. Am sure your treating doctor would guide you better on the cost issue.
Take care.
Above answer was peer-reviewed by
Follow-up: Pregnant. Took sustain, hcg injection and started spotting. Suspected for mixed abortion. What's wrong? 48 hours later
Thank you very much doc iam understood the thing very well with your detailed explaination.
Tomarrow iam planning to go to my native place it's of almost 700 KM by train is it safe to travel. iam also interested to leave her at my home because she may get some rest there and some mental relaxation by seeing all our relatives, so that she will not be tense. Now she have very low bleeding with little lower abdominal pain. and the medication she's taking is meftal spas 2doses per day, Beplex forte 1 dose, DOXT-s(doxycycline hyclate) 2doses per day. now she's looking better. Please suggest me can i plan to travel to my home city.

Answered by Dr. Aarti Abraham 2 hours later
Hi again,
After MTP , one requires a follow up visit to the gynecologist, to confirm that the procedure is complete.
In case, you are planning to travel before that, its best to consult the doctor who performed the MTP, and take clearance from her, since she would know the intra operative complications, and then ask her if it would be okay to have the follow up check up at your native place.
Take care.
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