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What Do My Lab Test Reports Indicate?
Question: my wife had a miscarriage last year March 15th..miscarriage might be due to low heat rate of baby 118 bpm..recently my wife has been conceived... I am attaching the reports through mail as health care magic app attachment is not working.. my doctor said everything was normal... she asked to continue folic acid tablets and additionally she has given calcimax tablets..please check the reports once more.. if every thing is normal... we want a healthy baby.. please confirm whether any extra care to be taken..
Brief Answer:
Some more information and reports needed
Detailed Answer:
Dear XXXXXXX
Unfortunately, the reports you have sent has not reached us. So I can opine on the condition by your history (and of course my experience).
Your wife had lost her previous baby due to low foetal heart sound count; or rather after low Foetal Heart sound. I would have appreciated and preferred to know:
What was the duration of pregnancy when this mishap took place?
Was ultrasonography performed on her?
Was the growth of the baby congruent with the age of gestation?
Did she have any underlying disease or disorder?
Does she have Diabetes in her family?
If you give me this information, probably it will help me arriving at the cause of the previous loss of pregnancy. May be after getting this information, I may ask for some more. If ultrasonography was done, please upload the reports and the images.
Now, during current pregnancy, your doctor has opined that everything is normal. This is a good news. How old is the pregnancy at this stage? What all investigations she has undergone? Please upload the reports and the images for my review to have a clear picture.
Folic acid and Calcium are good supplementation in the pregnancy. If she has crossed 12 weeks of gestation, you may add iron tablets to her daily medication.
I can empathize your apprehension from your queries; however, I need more relevant information and reports for giving you appropriate advice. Please supply them to me.
I am eagerly awaiting for the requested information and the reports.
Dr. Nishikant
Some more information and reports needed
Detailed Answer:
Dear XXXXXXX
Unfortunately, the reports you have sent has not reached us. So I can opine on the condition by your history (and of course my experience).
Your wife had lost her previous baby due to low foetal heart sound count; or rather after low Foetal Heart sound. I would have appreciated and preferred to know:
What was the duration of pregnancy when this mishap took place?
Was ultrasonography performed on her?
Was the growth of the baby congruent with the age of gestation?
Did she have any underlying disease or disorder?
Does she have Diabetes in her family?
If you give me this information, probably it will help me arriving at the cause of the previous loss of pregnancy. May be after getting this information, I may ask for some more. If ultrasonography was done, please upload the reports and the images.
Now, during current pregnancy, your doctor has opined that everything is normal. This is a good news. How old is the pregnancy at this stage? What all investigations she has undergone? Please upload the reports and the images for my review to have a clear picture.
Folic acid and Calcium are good supplementation in the pregnancy. If she has crossed 12 weeks of gestation, you may add iron tablets to her daily medication.
I can empathize your apprehension from your queries; however, I need more relevant information and reports for giving you appropriate advice. Please supply them to me.
I am eagerly awaiting for the requested information and the reports.
Dr. Nishikant
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
hi sir.. I hope current reports have been come as attachments... currently her pregnancy is 8 week old approximately.. her last lmp Dec 20 the 2015...now heart beat is 128 bpm...lmp and scan has 1 week gap now.. doctor said due to my wife's 40 days period...for past 4 months..
coming to previous mishap.. we came to know approximately at 10 the week of pregnancy..yes ultrasonic was performed.. growth of baby was 2 weeks 2 days leading from gestational age... she don't b have any disorder... no diabetics in her family..
coming to previous mishap.. we came to know approximately at 10 the week of pregnancy..yes ultrasonic was performed.. growth of baby was 2 weeks 2 days leading from gestational age... she don't b have any disorder... no diabetics in her family..
Brief Answer:
Regular Monitoring by Ultrasonography needed
Detailed Answer:
Dear XXXXXXX
Thank you for uploading the reports. You had sent these reports by email to me through HCM; which I received after I answered you query.
Prima facae, I do not see any abnormal findings in those reports.
I am still unclear about whether she lost her previous baby in uterus and hence the pregnancy was terminated or pregnancy was terminated due to some abnormality in the baby or pregnancy got terminated spontaneously. Will you please provide me with the exact chronological events? These chronology of the events do matter in clinching the diagnosis. Do you have any reports of the last pregnancy? If so please upload them. Since this was a first trimester abortion, I would have appreciated the chromosomal/genetic study on the foetal tissue last time after wastage of pregnancy. Was she tested for TORCH?
Mrs. XXXXXXX Raji had her last menstrual period on 20/12/2015. Hence, on 16/02/2016 she has to be about 8 weeks and 2 days pregnant. Ultrasonography scan shows her pregnancy 6 weeks and 2 days. Thus there is a lag of about 2 weeks. As your doctor has very rightly pointed out that since she has menses of 40 days cycle, the lag is there. I shall explain you this with exact figures.
She had menses on 20/12/2015. So her next expected menses would be on 29/01/2016 (considering her periodicity of 40 days). The egg is released 14 days prior to next expected menses. This calculates her egg release and thus the probable date of conception to be 15 January 2016 (you can confirm this remembering the history of your marital relations, if you can). And hence the size of the baby would be that of 3 weeks and 5 days on 10/02/2016. Now since we calculate the gestational age from last menstrual period date (LMP), which is about 2 weeks before day of egg release, this would be 5 weeks and 5 days. Some variation in the early stage of pregnancy in calculating the age of the baby is permissible.
Now referring to the current reports of Mrs. XXXXXXX Raji, I find them within normal limits. In order to support growth of the foetal and chorionic cells, Folic acid is a very important medicine. In addition, you may request the doctor to put her on some natural progesterone preparation which helps to stabilize the pregnancy.
Frequent, may be weekly monitoring by ultrasonography and comparing the results with the previous scans plays an important role. If the scans do not warn, there is no necessity of any invasive tests on the foetal tissues; however if the subsequent scans show that the risk factor probability is substantial, she may have to undergo some invasive procedures like amniocentesis (tapping the fluid around the baby for laboratory testing of foetal cells in it) or Chorion villus biopsy (taking few cells from the developing placenta). Since these tests are not without risk to the pregnancy, they are performed only if indicated by the probability of the abnormality in the baby by ultrasonography.
Since her last mishap was at 10 weeks gestational period, I would say, these coming 6 weeks are critical for her pregnancy. Take appropriate care by avoiding stress to her body and mind. Particularly heavy weight lifting, travelling on two-wheelers, etc. should be avoided.
Usually early pregnancy losses are chromosomal abnormalities. So once she crosses 14 weeks of pregnancy, that factor for loss of pregnancy can be eliminated.
I would advise you consult a Foetal Medicine Consultant ASAP for any specialized management. His/her advise will be very crucial for her.
I would appreciate if you keep on uploading her subsequent ultrasonography reports and images for my review. Though not related to previous mishap, I would like her blood group - ABO and Rh checked.
I would be keen to have look at all the past, present and future reports of Mrs. XXXXXXX Raji. For any more information, please feel free and at ease to ask me, XXXXXXX
Dr. Nishikant Shrotri
Regular Monitoring by Ultrasonography needed
Detailed Answer:
Dear XXXXXXX
Thank you for uploading the reports. You had sent these reports by email to me through HCM; which I received after I answered you query.
Prima facae, I do not see any abnormal findings in those reports.
I am still unclear about whether she lost her previous baby in uterus and hence the pregnancy was terminated or pregnancy was terminated due to some abnormality in the baby or pregnancy got terminated spontaneously. Will you please provide me with the exact chronological events? These chronology of the events do matter in clinching the diagnosis. Do you have any reports of the last pregnancy? If so please upload them. Since this was a first trimester abortion, I would have appreciated the chromosomal/genetic study on the foetal tissue last time after wastage of pregnancy. Was she tested for TORCH?
Mrs. XXXXXXX Raji had her last menstrual period on 20/12/2015. Hence, on 16/02/2016 she has to be about 8 weeks and 2 days pregnant. Ultrasonography scan shows her pregnancy 6 weeks and 2 days. Thus there is a lag of about 2 weeks. As your doctor has very rightly pointed out that since she has menses of 40 days cycle, the lag is there. I shall explain you this with exact figures.
She had menses on 20/12/2015. So her next expected menses would be on 29/01/2016 (considering her periodicity of 40 days). The egg is released 14 days prior to next expected menses. This calculates her egg release and thus the probable date of conception to be 15 January 2016 (you can confirm this remembering the history of your marital relations, if you can). And hence the size of the baby would be that of 3 weeks and 5 days on 10/02/2016. Now since we calculate the gestational age from last menstrual period date (LMP), which is about 2 weeks before day of egg release, this would be 5 weeks and 5 days. Some variation in the early stage of pregnancy in calculating the age of the baby is permissible.
Now referring to the current reports of Mrs. XXXXXXX Raji, I find them within normal limits. In order to support growth of the foetal and chorionic cells, Folic acid is a very important medicine. In addition, you may request the doctor to put her on some natural progesterone preparation which helps to stabilize the pregnancy.
Frequent, may be weekly monitoring by ultrasonography and comparing the results with the previous scans plays an important role. If the scans do not warn, there is no necessity of any invasive tests on the foetal tissues; however if the subsequent scans show that the risk factor probability is substantial, she may have to undergo some invasive procedures like amniocentesis (tapping the fluid around the baby for laboratory testing of foetal cells in it) or Chorion villus biopsy (taking few cells from the developing placenta). Since these tests are not without risk to the pregnancy, they are performed only if indicated by the probability of the abnormality in the baby by ultrasonography.
Since her last mishap was at 10 weeks gestational period, I would say, these coming 6 weeks are critical for her pregnancy. Take appropriate care by avoiding stress to her body and mind. Particularly heavy weight lifting, travelling on two-wheelers, etc. should be avoided.
Usually early pregnancy losses are chromosomal abnormalities. So once she crosses 14 weeks of pregnancy, that factor for loss of pregnancy can be eliminated.
I would advise you consult a Foetal Medicine Consultant ASAP for any specialized management. His/her advise will be very crucial for her.
I would appreciate if you keep on uploading her subsequent ultrasonography reports and images for my review. Though not related to previous mishap, I would like her blood group - ABO and Rh checked.
I would be keen to have look at all the past, present and future reports of Mrs. XXXXXXX Raji. For any more information, please feel free and at ease to ask me, XXXXXXX
Dr. Nishikant Shrotri
Above answer was peer-reviewed by :
Dr. Deepak
Hi doctor..
Thank u for ur detailed answer. In this mail I will be attaching reports previous pregnency which ended into a miscarriage...we came to know about it when a blood clot came out when she went to wash room..please refer the reports by the date.
In current pregnency, I am taking extra care. She is completely taking rest. No lifting..no travelling at all.
As u rightly said that usg is required every week to track the growth. My problem is my doctor did not recommend it. Is it OK to take scan on our own. Is there any harm in taking usg in first trimester. If no harm...then we will be taking scan on 25th or 26th of this month. I hope u will guide us to tell if any problem.
And one more thing doctor,we have taken current scan on 10th February 2016. So the difference between LMP age and gestational age is only one week one day. In previous pregnency it was consistently 3 weeks gap approox.
Thank a ton sir for ur guidance. I will be a happy person if every thing goes well.
Brief Answer:
It was a missed abortion last time.
Detailed Answer:
Dear XXXXXXX
It was indeed nice of you to upload the reports of previous pregnancy of Mrs. XXXXXXX Raji. You are indeed a caring husband and I compliment Mrs. XXXXXXX for that. I have gone through the reports thoroughly and would like to discuss about the reports of previous pregnancy before I discuss about the current pregnancy.
From the scan of 29 December 2014, foetal heart activity is not noticed. It is only in the report of 14 January 2015 foetal heart activity has been mentioned. This cannot explained. It could be some error. In no other reports foetal heart is recorded. Since on 29 December also it was absent, and the gestational sac margins were recorded as irregular on 2 February, 2015, the report of 14 January appears to be ambiguous. I will ignore that report. Since December 2014 end the baby was non-viable. The miscarriage has not happened due to slow heart of the baby. It probably had become non-viable before 29 December 2014. Since she did not undergo abortion spontaneously, she landed into what we called as missed abortion. This wastage of pregnancy is most probably due to chromosomal abnormality. The lag in foetal growth you were observing was because of no embryonic growth due to embryonic death.
The current pregnancy seems to be well growing till the date of latest report you have uploaded. I sincerely feel that weekly or fortnightly scan would help us to monitor the progress of the baby and any indicators of abnormality in the baby, if present.
Yes, you can directly approach the ultrasonologist for scan for monitoring the growth of the baby. However, there is a hitch in this. As per PCPNDT Act in our country, the sonologist has to have reference letter before performing any USG scan on any pregnant lady. However, self reference is permitted in this act. So the sonologist will have to write a self reference letter and then he/she can do Mrs. Guru's scan.
As I suggested you in my previous message, a period up to 14 weeks of gestation is very critical and you have to take utmost care with fingers crossed. I had also suggested to have an expert opinion of a Foetal Medicine Consultant. Please do not take this advice lightly.
Meanwhile, get her haemogramme, blood grouping (ABO & Rh), urine examination done. Continue with Folic Acid religiously. Have you suggested your Obstetrician about Progesterone therapy?
I would be expecting to see her next scan report soon. Meanwhile if you need any more information, I am always available for you, XXXXXXX If you find my advice useful, you may please post your favourable review with 5 stars rating for me.
Dr. Nishikant Shrotri
It was a missed abortion last time.
Detailed Answer:
Dear XXXXXXX
It was indeed nice of you to upload the reports of previous pregnancy of Mrs. XXXXXXX Raji. You are indeed a caring husband and I compliment Mrs. XXXXXXX for that. I have gone through the reports thoroughly and would like to discuss about the reports of previous pregnancy before I discuss about the current pregnancy.
From the scan of 29 December 2014, foetal heart activity is not noticed. It is only in the report of 14 January 2015 foetal heart activity has been mentioned. This cannot explained. It could be some error. In no other reports foetal heart is recorded. Since on 29 December also it was absent, and the gestational sac margins were recorded as irregular on 2 February, 2015, the report of 14 January appears to be ambiguous. I will ignore that report. Since December 2014 end the baby was non-viable. The miscarriage has not happened due to slow heart of the baby. It probably had become non-viable before 29 December 2014. Since she did not undergo abortion spontaneously, she landed into what we called as missed abortion. This wastage of pregnancy is most probably due to chromosomal abnormality. The lag in foetal growth you were observing was because of no embryonic growth due to embryonic death.
The current pregnancy seems to be well growing till the date of latest report you have uploaded. I sincerely feel that weekly or fortnightly scan would help us to monitor the progress of the baby and any indicators of abnormality in the baby, if present.
Yes, you can directly approach the ultrasonologist for scan for monitoring the growth of the baby. However, there is a hitch in this. As per PCPNDT Act in our country, the sonologist has to have reference letter before performing any USG scan on any pregnant lady. However, self reference is permitted in this act. So the sonologist will have to write a self reference letter and then he/she can do Mrs. Guru's scan.
As I suggested you in my previous message, a period up to 14 weeks of gestation is very critical and you have to take utmost care with fingers crossed. I had also suggested to have an expert opinion of a Foetal Medicine Consultant. Please do not take this advice lightly.
Meanwhile, get her haemogramme, blood grouping (ABO & Rh), urine examination done. Continue with Folic Acid religiously. Have you suggested your Obstetrician about Progesterone therapy?
I would be expecting to see her next scan report soon. Meanwhile if you need any more information, I am always available for you, XXXXXXX If you find my advice useful, you may please post your favourable review with 5 stars rating for me.
Dr. Nishikant Shrotri
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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