Quintuplet Story: A Physician's Perspective - 4
Monday, February 09, 2009
Kenneth F. Trofatter, Jr., MD, PhD
Initially magnesium sulfate was given to try to break her labor and then indomethacin was added but she continued to contract. At that point, a second dose of corticosteroids was given and I received a call at home to end my vacation early. By the time I arrived, Joy was having considerably more discomfort with her contractions. The cervix was noted to be stretched around the cerclage and the presenting baby’s head was well-applied to the cervix. As promised, I looked her in the eye and said, “It is time” and she nodded knowingly and agreed.
A “CODE 5” was called and the five NICU teams arrived within a short period of time from all over the city. At about 4:00 AM (4:11-4:13 AM to be exact) on April 7, 2007, Abram, Adal, Ian, Noelani, and Nadia were delivered to Joy and Andres Gonzalez at 28 weeks gestation by cesarean section in Greenville, South Carolina. The response and the entire “operation” went as smoothly as was planned and could have been hoped for and, fortunately, Joy had a relatively uncomplicated post-operative course.
The babies could not have been born into a stronger or more nurturing family. As difficult and dangerous as the pregnancy was for Joy, the time since the delivery (now almost two years) has proven how important the power of faith, love, and friendship can be to overcoming all obstacles. The first-born, Abram, had problems following delivery that led to a series of medical complications and hospitalizations that have stressed the family's resources, financially, and I am sure, personally, and may well continue to do so, but there has not been one instance during that time when we were visited by Joy, Andres, and all the children that there were not smiles on their faces, optimism in their voices, and enough love in their hearts to brighten all of our spirits.
Into each of our lives come events leading to memories that we carry with us until we’re gone. That has been especially true for me in medicine. There are many patients who, unbeknownst to themselves, sometimes gave to me more than I gave to them, and I will never forget those folks. Their memories are as clear to me now as the day they happened. They are the foundation of my approach to the practice of medicine, guiding my deductive and intuitive senses, and my inspiration to awaken early every day to a new set of challenges. They have made me a better physician and a better person. Such is the case with the Gonzalez family, and I am so grateful that they have let me be a part of their lives.
Dr T
Labels: quintuplets; multiple gestations
40 Comments:
At Mon Feb 09, 05:41:00 PM 2009,
Anonymous said…
Dr. T
I am 38 years old and just had my second miscarriage-- both in the second trimester. This miscarriage was at 18 weeks and I had the miscarriage at home. The fetus looked normal except that there was a lot of bleeding in the head and neck and his nose was flat. There were small rideges on the sides of the baby's nose, but no bone in the middle. Is this normal for an 18 week fetus or is this a sign that he may have had Downs Syndrome? Would his nose be flat because of deterioration in the woumb between demise and the miscarriage? Thank you for your help.
At Tue Feb 10, 06:47:00 AM 2009,
Kelly said…
This story has been an amazing one, and I'm very happy to see there were none of the horrible moments of which I was expecting.
I am a high-risk pregnancy - at 28 weeks, our daughter Riley just stopped kicking one day and went to be with the Lord. Since then, I have had a miscarriage at 12 weeks, and a blighted ovum at 7 weeks.
My ob/gyn and MFM doctors have thoughts that I may have APS, so with the 3rd pregnancy, I began daily injections of Lovenox - to no avail, but we didn't know until I began spotting and then the ultrasound showed a sac but no baby.
We are nearing 7 weeks this Thursday, and one initial blood test has shown my pregnancy hormone and progesterone level to be very elevated, so we're ecstatic. We go for our first ultrasound on Friday and are eager to see that little blip of a heartbeat. The injections don't thrill me, but I'd go through just about anything to keep this baby.
I write this to let you know that both of my doctors are absolutely WONDERFUL. The most caring and sensitive men, for which I am grateful. While you say that your patients have given you more than you have given them, rest assured that just being there and bending over backwards, and CARING - and showing that care without reservation means so much more than you know. We've come across some unthinking people - a doctor who, after he assisted delivering Riley, when we weren't sure what took her (and we're still not sure, but one possibility was it being the cord), said, "Yeah, she basically hog-tied and strangled herself" because it was around her legs as well. He said this TO OUR FACES the morning after she was delivered, while we still had her in our room with us, aching to be able to take our baby home, but knowing we had to leave what was once the busiest baby in my stomach and moved no more.
So THANK YOU for being such a wonderful, giving, caring and in a professional way a very loving person. We can't make it properly without you.
At Sun Mar 01, 05:24:00 AM 2009,
Anonymous said…
Dear Dr T
I really admire your expertise and energy. I am reading your materials for sometime. I owe you a change in my technique of cervical cerclage. BUT you seem to stop at Quintuplet. Have ran out of your so much admired energy? my regards from Egypt.
Hesham A.F.AMIN,MRCOG
Known as Dr H
At Sun Mar 01, 05:25:00 AM 2009,
Anonymous said…
Dear Dr T
I really admire your expertise and energy. I am reading your materials for sometime. I owe you a change in my technique of cervical cerclage. BUT you seem to stop at Quintuplet. Have ran out of your so much admired energy? my regards from Egypt.
Hesham A.F.AMIN,MRCOG
Known as Dr H
At Wed Mar 04, 01:14:00 PM 2009,
ANSLEY said…
Dr. Trofatter,
I have seen some of your previous postings on cystic hygromas. I am 20wks pregnant. At 12wks our baby girl was diagnosed with a cystic hygroma and were told the outcome was not good. At 16wks we had and amnio. The results were negative. Needless to say, my husband and I were ecstatic. Even in the 16wk ultrasound the hygroma had not grown.
However, we went in today and the Dr. told us that the hygroma had doubled in size and there was even swelling in her neck, scalp, back, and chest.We have been on this agonizing roller coaster for weeks now... what should we expect? What do we do now?
At Wed Mar 18, 11:06:00 AM 2009,
Anonymous said…
Hello DR. I have a couple of questions
My wife is Rh negative, We got pregnant, got a family dr. went in for a check up( they took a urine sample, told her she was pregnant, and told her that a misscarage is very likly ??? only because this was her first pregnancy ?? and was sent home -- ??
it was not till a week later she started spotting a little bit and we went in again and was told everyhing was fine but we went for an ultrasound on feb 10, was told everything looked good baby was 8 weeks heart beat 168 and we went home happy.
we than had another scedualed app. where we told the dr. there was still some bleeding,
the doctor performed a pap smere and told my wife her cervix was very sensitive and when she even just tutched it it would bleed ( should she have done a pap smere to a perfictly healthy women while 9 weeks preg .1; even if she wasn't rh negative ???)
so for the next couple off days my wife was then bleeding red blood and brown then red than brown wich the doctor said was completly normal ???
so finally on feb 25 she went for blood work
march 10 we went back for an appointmrnt there was still alot off bleeding dr said everything was fine ( at this point we were no told anything about the blood tests or that my wife was o negitive blood type ??? )
We forced the dr to make another ultrasound for us
march 11 ultrasound comes up no heart beat they could see everything there just was no heart beat and thy couldn,t see the sack they said it was 10 weeks size
we went back to the dr . where they refered us to a pregnancy loss center had an apointment then made for march 16 on a monday
on sunday my wife how is still bleeding starts to have cramps and kinda dissmised it hence they told us she would feel moderate cramping, but it continued to get worse and worse until i took her to emergancy where the pain got to be to umbarable and she was almost passing out. they finaly did blood work and gave her some morphine wich didnt really seem to work she was in tremendus pain almost needed to be strapped down
then she lost alot off blood and the pain went down to barable levels we were told she had the miscarage and was told she was rare o negative blood type and was given a shot of rhogan and was told it was 100 % that there were to be no trouble to are next pregnancy.
and today we went back for an ultrasound to make sure it was all gone and to see if there will still be a d&c neede
my questions are would my wifes meical history have said she was o negative?
should she have gotten her blood taken right away ?
should the doctor have preformed a pap smere
should the doctor have told us that she was o negative ?? is that one off the reasons its important to have blood work done
when my wife started to bleed the spotting at around 6-7 weeks
should she have gotten the rhogan shot then
and what are the chances off the blood mixing and her developing antibodies and becoming rh sensitive before we got the shot a month and some after the first sign off bleeding
we will make an apointment to see if she is rh sensitive but for the meantime any insight on my questions would be greatly appreciated
my e mail is jmemaxholdings@hotmail.com
thank you so much jamie
At Wed Mar 25, 06:41:00 AM 2009,
Anonymous said…
Dear Dr Trofatter
My apologies for the length of this message I just want to give you as much info as possible! I’ve read your posts on CMV infections and mid trimester pregnancy loss with interest over the last few months. I would be so grateful if you would take the time to read my history and offer your opinion. My doctor here in the UK seems unfamiliar with CMV infections and unable to offer me any advice. My history is as follows:
I had a successful and uneventful pregnancy in July 2005 that resulted in the birth of a healthy little girl. It was a ventouse delivery after a 24 hour labour.
My second pregnancy resulted in an early miscarriage that was discovered at a routine scan. By my dates I was approximately 9 weeks pregnant but the baby measured 6 weeks 3 days with no heartbeat and I had a lot of blood in my uterus. I had a ‘natural’ miscarriage 5 days later with a lot of bleeding that left me weak for some weeks afterwards.
I became pregnant again in May 2008. I had a routine scan a 11 weeks that showed no problems. I first felt the that baby move at about 15 weeks. These random and sporadic movement continued for a couple of weeks. I last felt definite movement on 16th September 2008 at 17 weeks to the day. I then notice a lack of movement, but pushed my concerns to the back of my mind as I assumed it was still early days to be feeling movement strongly or with any frequency. I had my next routine scan at what should have been 20 weeks 6 days on 13th October 2008 and was told that my baby had died. She was measuring 16 weeks. A amniocentisis was performed. The amniotic fluid was brown and the doctor who performed it suggested the death wasn’t recent and that the head was macerated. I was not examined internally. I was given a tablet to soften my cervix and went into labour the next day before they had chance to induce me. I had pain for a few minutes, no worse that bad menstrual cramps, then my waters broke. I went to the hospital and delivered very easily 45 minutes later on 14 October.
I had bloods taken on 13 October which took many weeks to come back. The only thing they showed was the presence of both IGM and IGG CMV antibodies. Titers weren’t performed. The baby was sent for autopsy, the results of which came back in January 2009. These showed nothing, including no chromosomal or genetic problems or inflammation consistent with infection. Tests on me for Antiphospholipid antibodies or lupus anticoagullant came back high but within normal boundaries. A repeat CMV screen in December 2008 and again in January 2009 showed ‘weakly positive for CMV IGM with high avidity IGG’. My doctor doesn’t seem to know much about CMV infection and after initially saying a CMV infection was a likely culprit now seems unsure.
My questions are:
- Given the absence of titers, I assume it is impossible to tell whether I have had a primary or recurrent CMV infection?
- Given the presence of IGM CMV antibodies, is it likely that I’ve had a recent CMV infection or could this be a remote infection?
- Am I right in thinking that CMV infection in early pregnancy can lead to a mid term loss?
- Would the autopsy show signs of a CMV infection given the macerated state of the baby and the gestational age? I doubt that the person conducting it would have been aware of the possible CMV connection.
- Given that I definitely felt movement up to 17 weeks gestation but the baby only measured 16 weeks, could it be that she had IUGR or is a slight discrepancy like this common?
- In the absence of any other answer, do you think it likely or possible that CMV caused my baby to die?
- I’m now 8 weeks pregnant and terrified that I will suffer another loss. Have you any feelings on what my chances might be of having a successful pregnancy this time round?
I know that you have experienced problems with receiving messages but will continue to check your posts in the hope that this message gets through to you. Thank you for your time and devotion to this site in spite of your busy schedule. Your information has been a real help to me when I’ve had nowhere else to turn.
Many thanks in anticipation.
Louise
At Wed Apr 01, 11:29:00 PM 2009,
Anonymous said…
Dear Dr. Trofatter,
What a wonderful tribute...I am a former patient of yours and a former fellow collegue from DUMC. You delivered my son, Jerrod...remember? 1986--Duke South--You were wonderful. I miss you. I wish you were still around here in NC. I still keep in touch with Kathy Gustafson and her husband...I work at Wake Med Cary Womens Pavilion. Keep up the good work! Whenever you are up this way, stop by the Women's Pavilion.
Best Regards,
Marla Lindley
At Thu Apr 09, 06:00:00 AM 2009,
angela said…
Dear Dr Kennet,
I'm a girl from China,28 years old.I found your blog when I search"low level progesterone at early pregnancy".I'm pregnant and begun to bleeding a little for about 8 days.My last menstrual time was 22th Feb which was 47 days before.
Last Friday I went to hospital got a blood test with HCG 1298mIU/ml and progesteron 14.4mg/ml.The ulstrasonic found a 0.3*0.3*0.3cm dark part in uterus. This wedsday,which is 4 days later found HCG3807mg/ml and progesteron13.8mg/ml. The ulstrasonic found a 0.6*0.4*0.3cm dark part in uterus.The doctor here gave me progesteron pills to higher the progesteron level.
Now I'm not bleeding except a little brown secretion.I want to know should I have to countinue the pills which I have had 1 days.The pill's name is Dupbaston,Dydrogesterone Tablets.Each tablet contains 10 mg dydrogesteron.I had 4 pills for the first time and then 1 pill for each 8 hours.
Thank you very much.Would you please copy your answer to my Email:sunnyzhna@yahoo.com.cn.
With best Regards.
Angela Zhang
At Mon Apr 13, 03:52:00 PM 2009,
Anonymous said…
Dear Dr. T,
As I can see First Trimester Screening topic is closed few months ago :-(
Please if You can check my Down syndrome screening results and tell me do I need to go on amnio?
Here is my results:
Age:27,5
Ethnic:Caucasian
Weight 61kg.
Fetuses: 1.
Smoking:no
Gestational age by CRL: 11w 4d
fbhCG 82,6 ng/ml 1,79 MoM
PAPP-A 1,78 mlU/ml 0,86 MoM
CRL: 50mm
Nuchal translucency 1,4mm 1,04MoM
Biochem. risk + NT 1:5076
Double test 1:1368 below cut off
Age risk 1:1208
Trisomy 18 + NT <1:10000 below cut off
Hope this is enough.
Im little confused and don't know who to trust,my doctor told me that it will be good for me to go on amnio....I need Your opinion Dr. T.
Thanks in advance for You time.
Best Regards from Novi Sad (Serbia,EUROPE)
Jelena M.
At Wed Apr 15, 09:15:00 PM 2009,
Angela said…
Hello I was pregnant at 5 months with twins and the babies were both fine. I have SLE but when I was admitted to the hospital something went wrong and one of my waters broke. The Dr said I had to induce the labor and both fetuses wont survive. I noticed that you mentioned prednisone can cause this. I was on 30-40 mg and then they had me on the IV form. I was also taking 60 mg of Lovenox....Can this have been the cause of me loosing my babies? My Dr. never told me that prednisone had these side affects. I hope to hear a response from you asap please contact me via email at ana_angela86@yahoo.com
At Fri Apr 24, 08:53:00 PM 2009,
Anonymous said…
Dear Dr. Trofatter,
I am 41 years old, and my husband and I have no children. A year and a half ago were pregnant and at 7 weeks my Dr. sent me for ultrasound, they said maybe to early come back in two weeks, also Dr. wasn't happy with hcg levels, went back for 2nd ultrasound, they found a sac with no baby so had a D&C.
Now I am pregnant finally again, seeing a different Dr. as we had moved. My new Dr. said on the first visit he did not want to send me for an ultrasound till 12 weeks as he thinks they can cause early miscarrage considering my age, having two ultrasounds in first 12weeks. 1st day of my last period was the 27th Feb 09, my first hcg blood test on 2nd March was 4,000 (5weeks), 4 days later on the 6th March (5.5weeks), my hcg test was 11,000. A week later 14th March (6.5weeks)hcg was 21,500 which Dr. wasn't happy with but my progesterone was 46 which Dr. said was a healthy fetus, Dr. said do test week later, 22nd March (7.6weeks) hcg level 27,000, Dr. not happy but they hadn't done a progesterone, don't ask me why, I wasn't happy they hadn't done progesterone, Dr. doesn't want me to go for ultrasound, he wants to do one more week of bloods, so I now have another hcg/progesterone test to do on the 29th March and to back to see Dr. on the 1st May 09. Do you have any answers and thoughts on this. Dr. has said not to stress, (which isn't that easy), don't lift anything heavy. Can you offer any advise. Thank you, Sherry & John
At Mon May 04, 01:47:00 PM 2009,
Anonymous said…
Hi, Dr. T,
I know I am not posting someting that relates to this topic; however, after reading a lot of your other topics and the different comments, I am really hoping you can help me.
My name is Sara. My husband and I are 36 and in fairly good health. Yet, we have had 4 recurrent pregnancy losses. The first in 12/07 was at 20 weeks gestation but all others were at 6 to 8 weeks gestation. We are so fertile that we can literally get pregnant within 1 cycle but I can't seem to hold on to a pregnancy.
I reviewed the extensive testing our RE did on both of us and besides me having a high thyroid peroxidase level due to the Hashimotos, everything else came out just fine. (I am hyperthyroid currently and take Synthroid.) Hysteroscopy was fine too. After the 3rd loss, the RE thought that I wasn't developing a good egg and had us to a low-dose of Clomid. Also, I did baby aspirin and progesterone suppositories from the 2 week wait until it was over.
Now, the RE is saying he will try empiric therapy with Lovenox. Is this the best course to take when it's still a shot in the dark? All of my initial lab work says that I am negative for these problems...but each test had a disclosure attached saying a particular test could be negative but that there still could be a problem as not every gene was tested for blood clotting problems.
Also, the 2nd and 4th pregnancies were both chemical pregnancies. Both times I was also sick with a simple viral infection that resolved but after a short time came back 10 times worse. I can't help wondering if there is there is any link between my body's immune responses and my pregnancy losses.
At Tue May 05, 10:58:00 AM 2009,
Seth and Megan said…
Dr Trofatter -
I found your blog through google and have read a lot of comments/answers about low HCG Though that was from last summer, I was hoping you could help me out.
I am 26. Found out I was pregnant last Monday (4/27), second pregnancy. I had my HCG levels taken on 4/27, 4/29, and 5/1 which were: 106, 143, 162. And then on 5/4 which found out this morning was 184. I understand this will most likely end in a miscarriage. However, with your experience do have you had a case look like mine and end with good results?
Would this m/c have anything to do with my previous experience? my first pregnancy - positive HPT on my 28th cycle day. experienced aches/cramps, Doc ordered HCG tests. 4 wk 4days along HCG was 2060, next day had a transvaginal U/S - saw nothing in the uterus, some thickening. But confirmed mass just outside my right ovary - suspected Ectopic. Got more HCG levels taken after u/s, next day found out it was 3600. Had another U/S, still nothing in uterus - treated me with methotrexate for the ectopic pregnancy.
3 weeks later began bleeding, did another transvaginal u/s to find an interuterine gest sac/yolk sac. No fetal pole. two days later, had another so the doc could see it for himself. Determined I was miscarrying it, I requested a DnC. Two days later, had another U/S to see how much tissue was left in there and they said I just had a little more to pass on my own and shouldn't get a DnC. But then continued to bleed for 5 more weeks.
I didn't ovulate for the next 3 cycles, which were about 50-60 days long. Finally got on the medicine to induce my period, and then clomid to induce ovulation. Worked well, ovulated for first time since the whole ordeal last August during my cycle in February. Next cycle, ovulated and got pregnant. LMP March 18th - Lh surge detected on 4/6. Took progesterone suppositories for 10 days after Lh surge. no period after 8 days of finished suppositories, but was not getting positive HPT's either. Talked to doc 4/27, told me to take another HPT and It came out positive. but levels, as first state, have not been increasing well. I am currently doing more vaginal progesterone suppositories.
- Do you think my pregnancies linked in anyway?
- Will the progesterone suppositories prolong my miscarriage from starting? I haven't had any bleeding yet.
Also, to note - I had a transvag u/s last week, showed no corpus luteum. No thickening of tissue (too early I'm sure) - small mass on my left ovary - cyst they assume, possibly another ectopic.
HCG levels are so low, they're not concerned about ectopic again.
Any help/advice/opinions you have about my traumatic pregnancy experiences is very appreciated!! Thank you for your attention and time! mohartley@gmail.com
At Tue May 05, 04:09:00 PM 2009,
Polly Gamwich said…
What an interesting perspective ... I will say that it's surprising that their first born was presented the health issues - I would have thought it would be a smaller/later baby ... but maybe I'm wrong in my assumption that the largest baby comes out first.
Again, great story.
At Tue May 05, 05:51:00 PM 2009,
Anonymous said…
Where can we find statistics for the mortality rate at specific gestational ages?
I am trying to decide if it is best to have a cordocentesis at 35 weeks to assess fetal anemia, or deliver then. I am Rhesus isoimmunized and have undergone serial Dopplers. The latest showed a jump from 1.07 MOM at 30 weeks to 1.27 MOM at 32 weeks. I want to have more children (that is, I want to avoid mixing our blood and increasing the antibody levels) and do not want to risk the 3-5% fetal death rate from cordocentesis. Thank you for your thoughts.
At Fri May 08, 12:46:00 PM 2009,
TXan said…
I love reading your posts, so hopefully your schedule has lightened up and you will continue again soon. 3 months is a long time!
At Fri May 15, 01:02:00 PM 2009,
TXan said…
I've enjoyed reading your posts over these last couple of years, especially since we've had trouble ttc, and finally after infertility treatments are now expecting a baby due later this year. Hopefully you will post more articles soon! I've missed new content over these last 3 months...
At Tue May 19, 11:27:00 AM 2009,
Anonymous said…
Dr T. - I have been following your blog since almost it's beginning and have really missed your educational and most helpful posts of late! I hope all is okay with you. I keep checking for you to return. I just wanted to leave a post to let you know you are missed and it is a loss to all of us who have been helped by you. I am thankful that all your past posts are still there to help the many others who need it.
Thank you for all the knowledge, time, effort and love that you put into your blog here for so long. I do hope so much you will return!
You are missed!
A faithful reader in WA
At Wed May 20, 03:02:00 PM 2009,
Kimberly said…
this has nothing to do with the story but i have a question about myself im 17 years old and i've had two miscarriages the second one was just recent but the doctors never told me what could be the cost. my o.b recommended birth control but im really trying to have a baby. what are some things i can do to prevent further miscarriages??
At Sun May 31, 06:53:00 AM 2009,
Anonymous said…
In december i had a mis carriage at 5 wks. I am now pregnant again, with identical twins. Monoamnionic... with a thin membrane seperating them. I am 13 wks pregnant, and last week we had our first ultra screen. At that appt. they found that baby B had very elevated nucal fluid behind its neck...more than double what it should be .68
baby A, was in a tough postion to measure, but seemed to be normal. at our next sono a few days later they found cystic hygroma also on baby B's neck. so we did the cvs test and are waiting the fish results tomorrow. If chromosomally they are ok, I still have to worry about the cysts goin away by wk 18-20. And for TTTS. (Twin to twin transfusion syndrome) its looks as though baby B has more space than baby A, although they both measure in size only a small difference. I am devasted and nervous that something is terribly wrong, and praying that we have a chance. but the more i read the more i see how complicated this situation is...even if there are no chromosome abnormalities. I am trying to be hopeful... but feeling very down and out... Do my babies stand a chance??
At Thu Jun 04, 04:11:00 PM 2009,
Anonymous said…
Dr. T,
I am 39 years old and a little over 4 weeks into my first pregnancy, which was achieved via IUI. My RE's nurses have me very concerned about the viability of the pregnancy based on 3 HCG level tests, but research I've done indicates that they might not be so bad. I have an ultrasound scheduled for next Wednesday, but would love to get your thoughts:
14dpiui - 131
18dpiui - 471
20dpiui - 869
They're not doubling every 48 hours but they are rising, and I believe are doubling every 53 hours. What are the odds of a successful pregnancy in your opinion?
At Sat Jun 06, 03:22:00 PM 2009,
Anonymous said…
Dear Dr Troffater,
I have just had a 12week ultrasound and our fetus has a 9.5mm thick NT, mild tachycardial (180-190bpm) and a two vessel cord. CVS showed no chromosomal abnormailties for trisomy 21 (Downs), 18 (Edwards), and no monosomy X (Turner's). The HCG(2.39):PAPA(0.49) ratio was high 4.5. All other aspects of the fetus were normal. Femur length normal, nasal bone present. We have no remarkable family history of congenital abnormalities but my husband has mild tachycardia, a tiny red angioma-like spot on his right arm. His brother was born with an artrial septal defect that resolved and has large area on his right chest and neck area. His grandfather at age 80 was found to have an atrial septal defect. We already have two lovely sons aged 4.5yrs, and 18months who had completely normal neonatal ultrasounds and were born healthy. We are considering termination but what are the chances this fetus could be born totally normal? If not born normal what are the most likely abnormalities it might have. Thank you in advance for your feedback. Kindest regards, Elisabeth. (Sydney, Australia)
At Sat Jun 06, 04:02:00 PM 2009,
Anonymous said…
Dear Dr Trofatter,
I recently posted a question based on our fetus's 12 week scan. I failed to mention I am 38yrs old, my husband is 40yrs. My email is e.smith@garvan.org.au
Kind Regards,
Elisabeth Smith
Sydney, Australia
At Mon Jun 08, 08:24:00 AM 2009,
louise said…
What advice for pregnancy care would you give to us. We were diagnosed with IC due to a previous twin IVF loss and am now pregnant again with twins at 8 weeks. What sort of stitch would be used and what sort of tests woud you advise. Can a twin pregnancy force a stitch to fail? Would you say that even with all the new tests and stitch that PTB is still likely?
At Mon Jun 08, 08:26:00 AM 2009,
louise said…
we are pregnant again using IVF with twins. We lost twins last year at 21 and 22 weeks due to an IC. This time are are going to a leading hospital and think that we will be offered a stitch and fibronectin testing plus swabs. What course of management would you suggest we look out for this time and do you think with the righ management that we could prevent PTB
At Mon Jun 08, 06:22:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Louise June 8: I have had great success with cerclage in twins although you will find that the scientific literature is controversial in that regard. If you have read my posts on cervical incompetence and cerclage, you will see the technique I usually use laid out in detail. In most cases a well-placed 'McDonald cerclage' at 13-14 weeks is adequate unless you have an unusually small amount of cervix within the vagina with which to work. I recommend that you have first trimester screening for aneuploidy before having that done. Once the cerclage is placed, I usually perform serial transvaginal ultrasounds starting at about 18 weeks to evaluate the cervical status. Good luck with your pregnancy and let me know if I can offer any other suggestions.
Dr T
At Mon Jun 08, 06:24:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Dr H March 1:
Thank you for the kind comments. As of today, I am BACK.
Dr T
At Mon Jun 08, 06:28:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Marla April 1:
Of course I remember you and thank you for the kind words. Say hello to Kathy G for me the next time you see her or talk with her. Good to hear from you again and my how time flies!
Regards,
Dr T
At Mon Jun 08, 06:34:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Jamie March 18:
It is a routine to check blood type and to perform an antibody screen and Pap smear in early pregnancy. Despite what your wife went through, there is a very good chance that she did not become sensitized. However, enough time has passed that your doctor could probably find out for you now or you can simply wait until she gets pregnant again and undergoes the routine screening early in pregnancy. Good luck to you both and sorry for your loss.
Dr T
At Mon Jun 08, 06:37:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Jelena April 13:
Personally, I would not have recommended the amnio with those results. The risk of the amnio is greater than the chance you have a baby with Down syndrome or trisomies 18 or 13. Sorry I could not get back to you until now. But, if you happen to catch this response, tell me what you decided to do and how things turned out. Best wishes.
Dr T
At Mon Jun 08, 06:44:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Angela:
I am not sure what the mechanism is for the increased risk of premature rupture of membranes with prednisone. I have always suspected that it increases the risk for developing an ascending infection becuase of its immunosuppressive effects that might be associated with premature cervical changes (cervical insufficiency), rupture of membranes, and preterm contractions. It also places you at great risk for developing diabetes during the pregnancy at those doses. However, one must always be cognizant that the 'disease' being treated with the prednisone might also be the underlying cause of the problems and not the prednisone by itself. Of course with twins, the risk of cervical insufficiency (incompetence) is also high and could have been the underlying cause of your problems. I am sorry for your loss. Kind regards,
Dr T
At Mon Jun 08, 06:47:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Sherry and John April 24:
The simplest way to answer your questions would have been to do the ultrasound! That takes all the guesswork out of the equation and provides you with a definitive answer at the stage of the pregnancy you were at when you wrote.
Dr T
At Mon Jun 08, 06:55:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Sara:
There could still be many causes for your losses such as chromosomal abnormalities, subclinical endometriosis, and an inadequate immune response to pregnancy. The empiric therapy with Lovenox is certainly a safe enough approach, however, even if you carry successfully you will not know if it was the Lovenox or simply your 'time'. You do have one autoimmune condition and that increases the risk for an inadequate immune response that is probably necessary to help early pregnancy implantation and placental formation for reasons that are not fully understood. Please let me know what you try next and how things turn out and I might offer some other suggestions if that is not successful.
Regards,
Dr T
At Mon Jun 08, 07:00:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous May 5:
My thoughts are to continue having the peak systolic velocities in the middle cerebral artery performed by Doppler weekly and not to do anything until the levels are greater than 1.5 MoM. If that is at 35 weeks, there is probably not much benefit to performing a cordocentesis over delivery. You would probably be a good candidate for corticosteroids to accelerate fetal lung maturation anticipating early delivery. Let me know what happened and how things turned out.
Dr T
At Mon Jun 08, 07:02:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To TXan May 8 and anonymous May 18: Thank you for the kind words. It is readers like you who have inspired my return as of TODAY. Regards,
Dr T
At Mon Jun 08, 07:07:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Kimberly May 20:
There are so many possible causes but at your age, the odds are in your favor that you will be successful and you have lots of time to find out why if you do lose another pregnancy. It might not be a bad idea to go on birth control pills for awhile to give your body a rest from the recent pregnancy losses. I always recommend simple things at first to help: eating well, taking a prenatal vitamin and perhaps some extra folic acid, avoiding alcohol and smoking, and getting regular exercise. Good luck to you and thanks for writing! Dr T
At Mon Jun 08, 07:13:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous May 31:
Yes your babies have a "chance" but it depends on the reason for the cystic hygroma. If the babies are chromosomaly abnormal, that is not good. If this is an early manifestation of twin-to-twin transfusion syndrome, you are going to probably need laser ablation of the vascular connections to give the babies a reasonable chance. If the baby has the cystic hygroma as the result of a heart (or other) malformation then the survival of that baby will depend upon what the malformation is. By the way if there is a thin membrane between the babies, they are probably monochorionic, diamnionic (identical) twins which have a better prognosis than monoamnionic twins. Best of luck and please let us know how things turn out.
Dr T
At Mon Jun 08, 07:17:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous June 4: I am always hesitant to pass judgment on ART pregnancies under these circumstances. Wait for the ultrasound results and perhaps that will answer the question soon. I wish you luck!
Dr T
At Mon Jun 22, 05:47:00 PM 2009,
Anonymous said…
I am 28 yrs old and 12 wks pregnant. I took my first trimester screening and received a call from my doctor. She stated my ratio for down syndrome was 1 in 397 but with my age being 28 my ratio was 1 in 797. She told me to come in for genetic counseling because the ratio for my age was higher than she expected. I'm not sure what this means but this is sort of scary and I need a bit of insight as to what this ratio really means for my baby. Basically does my baby have a high ratio of having down syndrome.
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