Thanks to Prudence, M.D. for GrandRounds 4.10!

3 Comments:

• At Thu Nov 29, 06:12:00 AM 2007,  Anonymous said…

  Doctor,
  
  I have written in the past about 2 miscarriages I had this year...and now I'm having my 3rd..single mutation C677T MTFHR. My LMP was 10/12 and I was tested positive for HCG around 11/7 and my doctor prescribed 40mg of lovenox and I was taking Advanced natalcare prenatal vitamin. On 11/21 did an US and did not see anything in sac. Doctor said to not be concerned yet since I could have my dates wrong...but i know I conceived on 10/25 using fertility monitor. on 11/21 started 200 mg of prometrium. 11/28 did another ultrasound and still no embryo, just empty sac...do you have any advice you can give me for a future successful pregnancy? who should I see next as a specialist? anymore tests I need to get done? My doctor did bloodwork and found no issues except the MTFHR mutation which he said may not even be a cause...
  I have had 2 D&C in March and July of this year...my doctor wants to see me again to confirm loss on 12/6...should i have another D&C? I find it mentally helps me get over it faster than waiting for it to happen naturally, but have concerns what a 3rd D&C will affect the uterus and future pregnancies...Please help...I'm so desperate to find hope and a cause.

   

• At Sun Dec 02, 08:25:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Nov 29: I am so sorry again for your losses. I am also sorry that I have no way to easily find your earlier correspondence with me or my responses. That's one disadvantage of the way this blog is set up.
  
  I will be honest with you, it is highly unlikely the single MTHFR C677T polymorphiosm is causing your miscarriages this early, although I don't disagree with the attempt at 'empiric therapy' either. Probably would have started the prometrium in mid-luteal phase after ovulation rather than at '4 weeks' into the pregnancy.
  
  Refresh my memory if you can on what other tests have been done and then I will be in a better position to tell you what could be done. Are you seeing any sort of specialist at this point? As far as the D&C goes, I have mixed emotions. It is a natural response to just want to get this over and move on, but I sometimes wonder if there might not be some advantage to future pregnancies from an 'immunologic response' standpoint until waiting until your body begins to reject the current pregnancy and you start bleeding. You are at very low risk for complications at this point and might consider that. Repeated D&Cs can cause damage to the cervix at its internal opening and that could increase your risk for cervical incompetence when you finally do successfully get through first trimester. Thanks again for reading and feel free to get back to me with your answers to my questions. Dr T

   

• At Wed Dec 05, 07:13:00 PM 2007,  Anonymous said…

  Hi Doctor. Thank you so much for writing back. 12/5 when to see doctor. empty sac, dr. confirmed blighted ovum. we are going to wait 1 month for miscarriage to occur naturally instead of having D&C. The following are tests that have been performed by my doctor thus far. And no, I have not seen any specialist...Same result for myself.
  
  Not sure if I'm listing this properly< here goes:
  
  2 - Thyroid Cascade Profile
  TSH, Glucose Serum, Prolactin, FSH, Estradiol, Lupus Anticoagulant Reflex, LH, FSH, Thrombotic Risk Profile, Comp
  
  3 - Single mutation C677T
  
  4 - HSV, IgM, Toxoplasma gondii
  
  5 - CMV Ab, IgG 10.5H (high??)
  CMV Ab, IgM <0.9
  
  Rubella Antibodies, IgG 152
  Toxoplasma gondii Ab, IgG,Qn <6.5
  
  HSV I/II IgG 41.2H (not good?)
  
  HSV I IgG, type spec 4.2H (not good?)
  
  HSV II, IgG, Type spec <0.9
  
  sorry..not sure if I'm correctly providing you info.
  
  Medical History:
  
  1 - Saw specialist regarding double vision --never got any confirmed causes...had an MRI of brain, to check for pituitary gland issues...doctor thought there was white spots may indicate MS...but had spinal tap and found nothing
  
  2 - Always had a lot of vaginal discharge...doctors used to give me a lot of antibiotics because they would see a lot of white blood cells indicating infection..but nothing concrete...this doctor thinks is gardinerella vaginosis?? saw a specialist a few years ago and he said is it was desquamative inflammatory vaginitis..prescribed cleocin? never cleared...have used clindesse during 2nd miscarriate ended pregnancy...current doctor do not think vaginal infection like gardinerella? affect miscarriage...
  
  3 - past doctors have said my prolactin levels were high (24-25)..but other doctors said that's not really high...
  
  I have seen so many doctors in the past with my double vision issue, vaginal discharges, and currently repeated miscarriages...and nothing conclusive....so frustrating and scared...
  
  I just sometimes wonder if all of this is interrelated....also..never had regular periods...45 days sometimes...but since I because pregnant 1/07 of this year, I have been regular every 28 days...
  
  I really appreciate your thoughts. I sometimes wonder whether I should just for additional specialist and doctors and just let nature do its thing...but I hate to think that there is something specifically wrong and I'm not doing anything to help me keep my baby!

   

Post a Comment

<< Home