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Dr. Andrew Rynne

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Exp 50 years

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Frequent miscarriages. Always fetal growth lags 1-2 weeks, heartbeat bradical. Prescribed injection, full bedrest. Suggestions?

Frequent miscarriage is my problem,after the 1st miscarriage i have got a baby(now he is 2nd half). then occurred the 2nd and 3rd miscarriage. my TSH , PROLACTIN ,BETA-2 glycoprotein I-IgM, lupus anticoagulant ,Anti cardiolipin Ab IgM values are normal. but microsomal antibody titre declined from 93 to 68 ( 60 is normal) meanwhile thyroglobulin Ab titre rised from 20 to 119 ( 60 is nrml) with in 3 month. all my miscarriage happens at 5-7 weeks). Before the last miscrge i have taken folic acid and thyronorm 25 as precaution. on the day of miscarriage my BLOOD HCG is 499 only. always the fetal growth will lag 1-2 weeks. The heart beat was also bradical. Please help me to find out the problem doctor. For my success pregnancy doctor have given me an injection and full bed rest. for the next 2 i haven t took both, does these factor help me for a success one.
Wed, 9 Oct 2013
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OBGYN 's  Response
Hello
Thanks for your query.
Most of the causes of recurrent abortions have been ruled out in your case.
i can still think of the following investigations which should be done further -
1. Chromosomal analysis of the products of conception.
2. Karyotype of the couple
3. Oral glucose tolerance test
4. Structural anomalies of the uterus and cervix to be ruled out.
5. Complete semen analysis to rule out semen abnormalities
6. Thrombotic disorders testing - Protein C, Protein S, factor v leiden mutation
Yes, the injections and bedrest would help you.
take care.
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doctor1 MD

Good Morning Doctor, My wife have three miscarriage. we are upset now. I am sending you all details of all pregnancy. Please help me and advice me. Detail are given below:- Name -           Madhumita Das Age-               29 Husband Name-     Sanjeev Kumar Age-               38 Marriage-           03-06-2009 First Pregnancy (LMP 19.02.2010) Positive pregnancy test on 24.03.2010 by home test kit. First gynecologist visit on 02.04.2010 (42th day from LMP) Gynecologist Name- Sakuntala Kumar Doctor examine vaginally with TVS. Suspect about late period (answer –no). She prescribed medicine- Folinext- one daily Lupigest 200mg- one daily. Spotting on 04.04.2010 evening( 44th day from LMP. i.e 2 day after medicine start). Call doctor, she advice insert lupigest vaginally, take rest and consult in morning. I consult doctor next day. She examines with TVS and prescribed medicine- Folinext- one daily Lupigest 200mg(vaginally) -twice daily. Duphastone(10mg)- -twice daily. Ecosprine-one daily. Advice TVS after one week for viability. First Ultrasound (vaginally) done by radiologist on 13.04.2010 (53th day from LMP) Show single intrauterine gestational sac with fetal pole and yolk sac. CRL is 0.44 cm-----6 week 1 day ( 1 week 3day less corresponding from LMP) Cardiac activity present. Impression;- Single viable Intrauterine pregnancy. Doctor advised repeat ultrasound after 2 week. (Continue previous medicine). Second Ultrasound (vaginally) done by radiologist on 02.05.2010 (72th day from LMP) CRL is 0.52 cm-----6 week 2 day ( 3 week less corresponding from LMP). No cardiac activity is seen. Same day D&C (02.05.2010) by gynecologist . Second Pregnancy (LMP 03.06.2010 i.e one month after first abortion) Unplanned Positive pregnancy test on 07.07.2010 by home test kit. First gynecologist visit on 07.07.2010 (34th day from LMP) Doctor examine vaginally with TVS. She prescribed medicine- Folinext- one daily Lupigest 200mg- one daily. (vaginally) Second gynecologist visit on 24.07.2010 (51th day from LMP) She refer TVS scan for viability. First Ultrasound (vaginally) done by radiologist on 25.07.2010 (54th day from LMP) Uterus is anteverted and bulky in size. Show single gestational sac. No fetal pole and yolk sac seen yet. Sac is 12.6 mm corresponding with mean gest age of 5 week 2 day( 2 week less corresponding from LMP). Impression;- Single Intrauterine gestational sac. Doctor advised repeat ultrasound after 3 week for cardiac activity. Second Ultrasound (vaginally done by radiologist on 14.08.2010 (74th day from LMP) No fetal pole and yolk sac seen yet. Second pinion from Dr. Nirmala Agrawal (Sant Parmanand Hospital, Delhi) on 16.08.2010. She advised ultrasound. TVS Report- Non viable intrauterine pregnancy. Suction evacuation done under GA on 17.08.2010. POC sent for HPE, LJ C/S report, RT TB (PCR) All test result Normal. Planning stop for 1year and 6 month. Third Pregnancy (Planning from July-2012, Medication start from April-2012). Gynecologist Name- Dr. Deepi Maithani First visit (06.04.2012) Medicine prescribed:- 1 .Fol G1- once daily 2.Ovacare- once daily 3. Ebecid- once daily 4. Ecozyme – once daily for Husband Test suggested:- 1.THS Profile:- T3,Free; FT3 - 2.88 pg/mL (1.71 – 3.71) T4,Free; FT4 - 1.10 Ng/dL (0.70 – 1.48) TSH Ultrasensitive- 2.430 uIU / mL (0.350 – 4.940) 2. Torch Profile: Toxoplasma, IgG      0.30 IU/mL ( Toxoplasma, IgM      0.05 Index ( Rubella, IgG      132.20 IU/mL (0.00 – 4.99) Rubella, IgM      0.30 Index (Cytomegalovirus, IgG 235.70 IU/mL (0.00 – 5.99) Cytomegalovirus, IgM      0.19 Index ( Herpes Simplex Virus 1+2, IgG 0.30 Index (0.10 – 0.80) Herpes Simplex Virus 1+2, IgM 0.12 Index (0.10 – 0.80) 3. Lupus Anticoagulant- APTT Patient value -          35.40 SEC (28.60 - 41.10) Control value-          35.20 SEC PTT-LA          45.20 SEC (41.40 - 43.40) DRVVT          No Lupus-like Anticoagulant present      Menstrual Cycle – 28.04.2012 ( period last for 1 and ½ day) Second visit (04.05.2010) Medicine prescribed:- 1 .B Long-F- once daily 2.Syp.Amycordial- twice daily Menstrual Cycle – 26.05.2012 ( period last for 4 day) Planning start after next cycle Doctor advice for consultation on 3 day of period Menstrual Cycle – 24.06.2012 ( period last for 4 day) Third visit (26.06.2010) Medicine prescribed:- 1 .Folgel Plus- once daily 2.Ovacare- once daily 3.Syp.Amycordial- twice daily 4.Ecosprin – once daily 5.PPZ Gel- After dinner No period at time. We hope pregnancy. All pregnancy symptom present. Spotting like period on 23.07.2010 ( i.e 30th day from LMP). Next day consultation with doctor . Doctor advice urine pregnancy test after 2 day. Pregnancy test negative and repeat pregnancy test after 7 day negative. Fourth visit (01.08.2010) Doctor advice continue planning with medicine 1 .Folgel Plus- once daily 2.Ovacare- once daily 3.Syp.Amycordial- twice daily 4.Cifzer – once daily 5.PPZ Gel- After dinner Pregnancy test Positive (27.08.2012) Fifth visit on 27.08.2010 (35th day from LMP) 1 .Folgel Plus- once daily 2.Duphastone(10mg) - twice daily 3.Ecosprin – once daily Advice:- USG after 7 day to confirm exact age of gestation. First Ultrasound (Pelvis) done by radiologist on 04.09.2010 (43th day from LMP) Uterus appears normal in size anteverted. No focal lesion seen. Endometrial lining is well seen,is central and appears thickens (13mm) Decidual reaction (Suggest repeat USG after 2 week) Sixth visit on 04.09.2012 (43th day from LMP) 1 .Folgel Plus- once daily 2.Duphastone(10mg) - twice daily 3.Ecosprin – once daily 4.Argipreg Sachet- 1X 7 day Advice:- USG after 15day. Second Ultrasound (Pelvis) done by radiologist on 19.09.20102 (58th day from LMP) Single live fetus in intrauterine gestation sac is seen. Fetal cardiac activity is well seen. CRL is 6mm-----6 week 3 day ( 1 week 6 day less corresponding from LMP) Same as first pregnancy Seventh visit on 19.09.2012 (58th day from LMP) 1 .Folgel Plus- once daily 2.Duphastone(10mg) - thrice daily 3.Ecosprin – once daily 4.Injection Lupigest (5000 IU) Test Suggested:- CBC,ESR VDRL,HIV I&II, HBS, RBS,TSH, Rubella IgM. All test reports are normal except: Glucose Fasting     103.00 mg/dL          (70 -100 ) ESR                34               (0 – 20) 8th visit on 04.10.2012 (73th day from LMP) Complain about burning sensation in palm and heal from conception. Also fever between 99-100 but no fever like feeling. 1 .Folgel Plus- once daily 2.Duphastone(10mg) - thrice daily 3.Ecosprin – once daily 4.Injection Lupigest (5000 IU)- After 2 week of first injection 5. Syr. Neeri Brownish discharge on 08.10.2012. informed doctor. She advice take 3tab- Duphaston immidiatly and Limcy. Discharge stop. Again brownish discharge start from 15.10.2012 and it become darker day by day. We consult doctor. She advice Ultrasound. Ultrasound on 17.10.2012(87th day from LMP). Fetal cardiac activity is not seen. CRL is 10 mm-----7 week 1day ( 5 week 2 day less corresponding from LMP) Impression:- Missed Abortion i.e fetal growth stop after inj. Lupigest (5000) start. Its my opinion. Medical abortion done on 17.10.2012.

doctor1 MD

Hi this is arif, We went to the Dr. for pregnancy testing 1 month back and she prescribed us dupastan 10mg and ascard after checking the ultrasound at 5.4 weeks which shows intrauterine gs sac with normal yolk sac with no fetal pole. Radiologist suggest to rescan after 2 weeks, after 2 weeks we rescanned and the result showed single intrauterine gs with crl of 15.8mm and cardiac flicker noted. our doctor prescribed Duphaston 10mg and cylogest suppostories 400mg and revisit after one month, we revisited one month later and she ordered the Nuchal scan, in that scan Radiologist said she find irregular gs sac with small yolk sac crl of 17mm with no cardiac activity. our doctor then ordered bhcg which came back 3300 only. what should we do. my wife does not have any symptoms of miscarriage or bleeding or pain. doctors said its missed abortion. what should i do

doctor1 MD

History : My sister (Age 32) under gone three repeated miscarriages • First miscarriage happened in 2nd month • Second miscarriage happened in 4th month • Third miscarriage happened in 4th month After third miscarriage we undergone some of the tests suggested by the doctor and below are the details Date : 28 July 2010 Tests undergone first time after three miscarriages Lupus Anticoagulant 1 (Screen) 53 sec (Normal 28-45) Lupus Anticoagulant 2 (confirm) 58 sec (Normal 28-40) Ratio (LA1/LA2) 0.91 ( 1.3 Normal) A.P.T.T TEST 38 sec (result) (Normal 30-40 sec) CONTROL 24 sec (result) (Normal 30-40 sec) ANTI CORDIOLIPIN ANTIBODIES CARDIOLIPIN ANTIBODY – lgM 9.67 PL-lgM-U/mL ( 10 : Negative) CARDIOLIPIN ANTIBODY – lgG 28.0 PL-lgG-U/mL ( 10 : Negative, 10-20 LOW POSITIVE 20-40 MODERATE POSITIVE) CARDIOLIPIN ANTIBODY – lgA 13.27 PL-lgA-U/mL ( 10 : Negative 10-20 LOW POSITIVE) PROLACTIN (PRL) 11.67 ng/ml (Result) (Normal Range ; Females Non-Pregnant: 2.8 – 29.2) Thyroid Stimulating Hormone ( TSH ) 1.06 ulU/mL (Result) (Normal Range 0.34-5.60 ulU/mL) FSH 6.17 mIU/mL (Result) (Normal Range (Normal Range Femal Follicular phase 2.5-10.2) Date : 28 September 2010 After 2 months medication repeated below tests Lupus Anticoagulant 1 (Screen) 32 sec (Normal 28-45) Lupus Anticoagulant 2 (confirm) 36 sec (Normal 28-40) Ratio (LA1/LA2) 0.88 ( 1.3 Normal) A.P.T.T TEST 27 sec (result) (Normal 30-40 sec) CONTROL 24 sec (result) (Normal 30-40 sec) ANTI CORDIOLIPIN ANTIBODIES CARDIOLIPIN ANTIBODY – lgM 8.71 PL-lgM-U/mL ( 10 : Negative) CARDIOLIPIN ANTIBODY – lgG 10.9 PL-lgG-U/mL ( 10 : Negative, 10-20 LOW POSITIVE ) CARDIOLIPIN ANTIBODY – lgA 7.26 PL-lgA-U/mL ( 10 : Negative) Date : 10 January 2011 Found that my sister is affected with TB undergone 6 months course for TB Date : 17 May 2011 Suggested Laproscopic surgery for better findings, after laproscopic surgery below is the discharge summary Recurrent Pregnancy loss for evaluation Operative Hysteroscopy & Laparoscopy done on 17 May 2011 At Hysteroscopy: • Both ostia visualized normally placed • Uterine cavity normal At Laparoscopy: • Uterus normal size • Both tubes normal. Dye test positive both sides. • Small fimbrial cyst present on test tube, excised. • Both overies polycystic, ovarian drilling done • POD free, No E/O adhesions or endometriosis Biopsy result Nature of Specimen: Endometrial Curettings for HPE Microscopic Examination: Sections revealed endometrial tissue with predominantly blood clots and few glands in proliferative pattern. No evidence of neoplasia or granulomas Impression: Proliferative pattern What I want to say: After three miscarriages my sister undergone above tests and some test results were not in normal range, after two months medication those readings came to normal range. And upon our request for any tests Dr. went for Laproscopic surgery and said that she has done ovarian drilling and uterus condition is good and biopsy says that TB which attacked my sister doesn’t have any effect on her uterus. And Dr also says that we need to go Ecosprin and Loprin (not sure of the correct names) injections continously till 9th month once after conceived What I want to ask: There was no specifc finding from Dr that this was the reason for 3 repeated miscarriages, to the best of my knowledge except karotyping we have completed all tests. I am seeking your suggestion in case we are missing any other tests and will be there any side affects of taking daily injections for 9months and any other suggestions/advice are invited. Our whole intension is not to have another miscarriage. Thanks in Advance

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