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What Does The Following Trans-vaginal Ultrasound Report Indicate?
Question: We got IVF done because of 55% DNA fragmentation of Male sperm.
My wife got pregnant after IVF embryo transfer on 7th July 2014, but the scan on 14th August 2014 indicated a missed abortion, with just a 10 mm gestational sac, no yolk sac . My wife had a D&C on 16th Aug 2014.
She had period like clot discharge on 28th Aug, which the gyne said most probably was some left over placenta of D&C and gave Trapic mf for 3 times a day for 3 days. after which bleeding stopped completely.
While waiting for a regular period , she had period like mild cramps from 29th Sept - 5th Oct , with minor pinkish discharge clot on 4th Oct. Following which Doctor suggested trans-vaginal ultrasound on 7th October 2014.
to our XXXXXXX she is pregnant! with :
6.9 mm gestational sac
1.2 mm yolk sac
no fetal activity or fetal pole.
Impression:
Gestation of 5-6 weeks Bilateral polycystic ovaries with haemorrhagic corpus luteum cyst seen in left ovary ( Vol 30.3cc). Two Layered endometrium thickness measured 1.15 cm .
We are really concerned as the doctor had asked us to wait minimum 3 months , but on seeing the scan she is not commenting anything but just asking for a repeat scan after 2 weeks.
our questions are as follows:
1. Are the reports ok / good / bad?
2. What was the Cramping from 29th sept - 5th Oct and pinkish discharge on 4th Oct?
3. What precautions should we take? she is taking susten 200 , twice a day since yesterday and has been on MCBM-69 since July.
4. When would you suggest the followup scan?
5. any other Suggesion you have?
My wife got pregnant after IVF embryo transfer on 7th July 2014, but the scan on 14th August 2014 indicated a missed abortion, with just a 10 mm gestational sac, no yolk sac . My wife had a D&C on 16th Aug 2014.
She had period like clot discharge on 28th Aug, which the gyne said most probably was some left over placenta of D&C and gave Trapic mf for 3 times a day for 3 days. after which bleeding stopped completely.
While waiting for a regular period , she had period like mild cramps from 29th Sept - 5th Oct , with minor pinkish discharge clot on 4th Oct. Following which Doctor suggested trans-vaginal ultrasound on 7th October 2014.
to our XXXXXXX she is pregnant! with :
6.9 mm gestational sac
1.2 mm yolk sac
no fetal activity or fetal pole.
Impression:
Gestation of 5-6 weeks Bilateral polycystic ovaries with haemorrhagic corpus luteum cyst seen in left ovary ( Vol 30.3cc). Two Layered endometrium thickness measured 1.15 cm .
We are really concerned as the doctor had asked us to wait minimum 3 months , but on seeing the scan she is not commenting anything but just asking for a repeat scan after 2 weeks.
our questions are as follows:
1. Are the reports ok / good / bad?
2. What was the Cramping from 29th sept - 5th Oct and pinkish discharge on 4th Oct?
3. What precautions should we take? she is taking susten 200 , twice a day since yesterday and has been on MCBM-69 since July.
4. When would you suggest the followup scan?
5. any other Suggesion you have?
Brief Answer:
its a missed abortion and failed D& C..explained
Detailed Answer:
hello ,
thanks for contacting health care magic
After going through your history , it appears that the D& C done on 16th august was a failed D&C and the products were not removed leaving the sac intact. As it is a blind procedure and also in early weeks of gestation , failure rate of such procedure is high. Your gynae should have opted for medical methods of termination .
nevertheless now that the sac is still insitu , with no fetal pole at all , the condition remains the same...its missed abortion.
The embryo should have showed fetal pole and cardiac activity now.which is seen by 5-6 weeks ideally.
now that once d& c is done , it should not be repeated within 3 months as it would increase the chances of intra uterine adhesions, hence your gynae is skeptical and followed an observational approach to wait for fetal pole to establish ( considering size of sac corresponds to 6 weeks).
she wants to wait for another two weeks to establish the diagnosis.
in my opinion, as its a IVF pregnancy where embryo was fertilised putside and then introduced in the uterine cavity , if fetal pole has not been established by now , then it would not form now.
you can wait for 2 weeks, repeat a scan , reconfirm the diagnosis and then opt for medical termination of pregnancy with mifepristone and misoprostol under supervision. in the meantime , the uterus would also get some adequate rest to withstand the medical procedure.
the bleeding from 29th sept to 5th oct was an attempt by the uterus to abort the failed pregnancy.
In my opinion , there is no harm taking SUSTEN, for progesterone support but its futile for a missed abortion.
regards,
Dr.Sameer Kumar
its a missed abortion and failed D& C..explained
Detailed Answer:
hello ,
thanks for contacting health care magic
After going through your history , it appears that the D& C done on 16th august was a failed D&C and the products were not removed leaving the sac intact. As it is a blind procedure and also in early weeks of gestation , failure rate of such procedure is high. Your gynae should have opted for medical methods of termination .
nevertheless now that the sac is still insitu , with no fetal pole at all , the condition remains the same...its missed abortion.
The embryo should have showed fetal pole and cardiac activity now.which is seen by 5-6 weeks ideally.
now that once d& c is done , it should not be repeated within 3 months as it would increase the chances of intra uterine adhesions, hence your gynae is skeptical and followed an observational approach to wait for fetal pole to establish ( considering size of sac corresponds to 6 weeks).
she wants to wait for another two weeks to establish the diagnosis.
in my opinion, as its a IVF pregnancy where embryo was fertilised putside and then introduced in the uterine cavity , if fetal pole has not been established by now , then it would not form now.
you can wait for 2 weeks, repeat a scan , reconfirm the diagnosis and then opt for medical termination of pregnancy with mifepristone and misoprostol under supervision. in the meantime , the uterus would also get some adequate rest to withstand the medical procedure.
the bleeding from 29th sept to 5th oct was an attempt by the uterus to abort the failed pregnancy.
In my opinion , there is no harm taking SUSTEN, for progesterone support but its futile for a missed abortion.
regards,
Dr.Sameer Kumar
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your Answer.
But I have a few questions:
her first scan for the first IVF pregnancy on 1st August showed 6.1 mm gestational sac , with no yolk sac , but on august 14th , it showed 10 mm gestational sac , with a faint line of yolk sac. Also her B-HCG was 9 on 28th August, but yesterday he Home pregnancy test showed a lite but prominent pink line indicating pregnancy.
So my question is :
if its a failed D&C , what explains the shrinking of gestational sac from 10 mm to 6.9 mm and apearance of 2 mm yolk sac?
second, She had cramps , not bleeding from 29th Sept to 5th Oct, but bleeding with pinkish discharge was only on Oct 4th. Before this she had period like bleeding with clots on 28th August. So, would the gestational sac have sustained past this heavy clot like bleeding?
Third, We were thinking whether getting a B-HCG done rite now would help confirming if its a failed D&C or a second pregnancy. what is your opinion?
But I have a few questions:
her first scan for the first IVF pregnancy on 1st August showed 6.1 mm gestational sac , with no yolk sac , but on august 14th , it showed 10 mm gestational sac , with a faint line of yolk sac. Also her B-HCG was 9 on 28th August, but yesterday he Home pregnancy test showed a lite but prominent pink line indicating pregnancy.
So my question is :
if its a failed D&C , what explains the shrinking of gestational sac from 10 mm to 6.9 mm and apearance of 2 mm yolk sac?
second, She had cramps , not bleeding from 29th Sept to 5th Oct, but bleeding with pinkish discharge was only on Oct 4th. Before this she had period like bleeding with clots on 28th August. So, would the gestational sac have sustained past this heavy clot like bleeding?
Third, We were thinking whether getting a B-HCG done rite now would help confirming if its a failed D&C or a second pregnancy. what is your opinion?
Brief Answer:
This may be second gestational sac....explained
Detailed Answer:
Hello , thanks for the follow up.
I totally agree with you.
Firstly during IVF procedure they generally introduce 3-4 embryos into the uterine cavity at one time.
so one should have seen atleast 2 or 3 embryos during the first ultrasound , which raises a doubt whether the other sacs were searched for or not.
Secondly the bleeding on 29th aug with clots is probably a warning bleed for the sac which was measured earlier and detected to be missed abortion( the one seen for the first time).
now during the D& C , likely that the smaller sac/sacs may not have been curetted out, and this one may be the missed gestational sac during the first ultrasound which has grown to 6.1mm now and measures 6 weeks.
So I think it would be wise to wait for another 2 weeks and follow up with an ultrasound just to see if fetal pole forms and cardiac activity appears.
tou may continue susten for progestational support if we go by this assumption that this may be another developing embryo.
In the next ultrasound you may request the sonographer to look for more than one sacs which may be a possibility. I believe you would have been made aware at the time of IVF as to how many embryos were transfered into the uterus, that would also give us an idea and the element of XXXXXXX can be understood hence.
So safest is to wait for 2 weeks and repeat an ultrasound.
Regards,
Dr.Sameer Kumar
This may be second gestational sac....explained
Detailed Answer:
Hello , thanks for the follow up.
I totally agree with you.
Firstly during IVF procedure they generally introduce 3-4 embryos into the uterine cavity at one time.
so one should have seen atleast 2 or 3 embryos during the first ultrasound , which raises a doubt whether the other sacs were searched for or not.
Secondly the bleeding on 29th aug with clots is probably a warning bleed for the sac which was measured earlier and detected to be missed abortion( the one seen for the first time).
now during the D& C , likely that the smaller sac/sacs may not have been curetted out, and this one may be the missed gestational sac during the first ultrasound which has grown to 6.1mm now and measures 6 weeks.
So I think it would be wise to wait for another 2 weeks and follow up with an ultrasound just to see if fetal pole forms and cardiac activity appears.
tou may continue susten for progestational support if we go by this assumption that this may be another developing embryo.
In the next ultrasound you may request the sonographer to look for more than one sacs which may be a possibility. I believe you would have been made aware at the time of IVF as to how many embryos were transfered into the uterus, that would also give us an idea and the element of XXXXXXX can be understood hence.
So safest is to wait for 2 weeks and repeat an ultrasound.
Regards,
Dr.Sameer Kumar
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hello doctor , we got her Routine blood test done ,
few things came out of range :
IRON 40 ug/dl ( normal range : 60 - 180)
TIBC 407 ug/dl (range 215 - 535)
transferin saturation 9.8% ( range 13 - 45)
ferrtin 12.7 ng/ml ( range 10 - 291)
hemoglobin : 11.9 g/dl ( normal range 12 - 15)
testosterone : 142.5 ng/dl ( but she is in 1st trimester)
HsCRP : 7.42 mg/L
( However other cardiac indicators like cholestorl Lipoprotein A were normal.)
vitamin D: 24.5 ng / ml ( normal 30 - 100)
vitamin B-12 : 218 pg/ml ( normal 211 - 911)
Any advise of she should start on Iron tablets, vitamin b12 ( although she is already having MCBM 69 since 3 months) and Vitamin D ?
few things came out of range :
IRON 40 ug/dl ( normal range : 60 - 180)
TIBC 407 ug/dl (range 215 - 535)
transferin saturation 9.8% ( range 13 - 45)
ferrtin 12.7 ng/ml ( range 10 - 291)
hemoglobin : 11.9 g/dl ( normal range 12 - 15)
testosterone : 142.5 ng/dl ( but she is in 1st trimester)
HsCRP : 7.42 mg/L
( However other cardiac indicators like cholestorl Lipoprotein A were normal.)
vitamin D: 24.5 ng / ml ( normal 30 - 100)
vitamin B-12 : 218 pg/ml ( normal 211 - 911)
Any advise of she should start on Iron tablets, vitamin b12 ( although she is already having MCBM 69 since 3 months) and Vitamin D ?
Brief Answer:
follow up reports ..seen and explained
Detailed Answer:
hello ,
thanks for follow up.
the reports are all borderline and not grossly out of range.
iron tablets and calcium +vit d3 tablets would be anyways started after 12 weeks of gestation , so there is no requirement of starting it now.
She should be on just tab folic acid, dupastan till 12 weeks .
firstly, we are still awaiting the ultrasound report which is due in next 10 days for confirmation of a viable pregnancy.
rest all medications can be instituted under a set protocol. dont rush up onto anything , go step by step.
regards,
Dr.Sameer Kumar
follow up reports ..seen and explained
Detailed Answer:
hello ,
thanks for follow up.
the reports are all borderline and not grossly out of range.
iron tablets and calcium +vit d3 tablets would be anyways started after 12 weeks of gestation , so there is no requirement of starting it now.
She should be on just tab folic acid, dupastan till 12 weeks .
firstly, we are still awaiting the ultrasound report which is due in next 10 days for confirmation of a viable pregnancy.
rest all medications can be instituted under a set protocol. dont rush up onto anything , go step by step.
regards,
Dr.Sameer Kumar
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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