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Pregnancy Bliss | Reproductive Health Hub

Missed miscarriage at 8 weeks

Comment:  Obstetrics sonography of my wife 38 yr of age, body weight 56 kg, reads as :

LMP 02.02.2012 GA 08 WEEK 01 DAY EDD 08/11/12

OBSERVATIONS:

The uterus is bulky & shows few intramural fibroid in the anterior& RT anterolateral wall of upper segment largest measuring 2.3x1.9 cm

A single gestational sac is noted in uterine cavity>with irregular margins and poor trophoblastic reaction.

The yolk sac is not seen.

The foetal cardiac pulsation are absent.

The foetal movements are absent.

The C.R.L. is 16.3mm.corresponding to 08weeks 00 days.

Cervix is adequate. it measures 3.2cm.

The internal os is closed.

IMPRESSION:F/S/O MISSED ABORTION/(EMBRYONIC DEMISE) AT 08 WKS 00 DAYS OF GESTATIONAL AGE,

Please advise:

1.Is there any hope/what to be done now

2. Scope for a healthy baby in future as this was our first one

3. Treatment.

Thank you doctor for reading this. A.K.S. (India)


Answer: The scan findings are pretty conclusive. I think there is no doubt that this is a fetal loss. It is always very difficult to establish the reason of such fetal demise in the early phase of pregnancy something that adds to the anguish to the prospective parents. You would have seen in the details on this site about ‘missed miscarriage’ that most such cases are sporadic and recurrence is quite uncommon.


It is impossible to predict the outcome of any pregnancy up-front but, statistically, it is reasonable to be hopeful of a better outcome next time. Regarding treatment for the current situation, at 8 weeks gestation, all three options are available to your wife. She could have surgical evacuation of the uterus, an option who want rapid resolution. Medical management involves taking tablets and having a vaginal pessary 48 hours later. This will enable to the contents of the uterus to come away. The whole process takes around 72 hours. The third option is the so-called ‘expectant’ management where nothing is done in the expectation that the miscarriage will conclude spontaneously in a matter of days. The problem with that strategy is that it can take several days or even weeks before that happens, something that can be quite distressing for the mother.


Your wife’s weight is certainly not an issue. My best wishes for the future.



Breast changes in pregnancy

Question:  im worried there may be something wrong with my pregnancy. I have read that the nipples are supposed to go dark but mine aren’t. Is something wrong? Im now seven months gone. J.A.(UK)


Answer: This is unlikely to be a problem and, in all probability, you don’t need to worry. It is true that many women experience pigmentation changes in the area surrounding the nipples during pregnancy. However, the extent of the darkening varies a great deal, from the very dramatic to the hardly noticeable. You most likely fall in the latter group. If your pregnancy is progressing normally, the apparent lack of areola pigmentation should not worry you at all. Take a look at the images below, both representing breast changes in advanced pregnancy and you can see the striking difference in the areola skin pigmentation.



Congenital heart disease and future pregnancy

Question:  My daughter was born with tetralogy of fallot, AV-canal disease and now has tachycardia. She had reconstructive heart surgery at age 3 and again at age 12. She was given a pacemaker after the 1st surgery which was replaced with a defibrillator at age 18. Her pulmonary valve was removed during the first surgery and later replaced when she was 12. She is now awaiting yet another replacement.She also was born with reverse organs. Will she be able to conceive and have a successful pregnancy during her lifetime?

Please give us hope as she has been a champion all her life in dealing with this. We want her to fulfil her dream of motherhood through pregnancy one day. A.S. (USA)


Answer: This is a difficult case that is going to need not only the expertise of all those professionals looking after your daughter but also wisdom and grace on her part to take whatever advice she may be given by them regarding this specific matter. There is no doubt that your daughter has overcome formidable challenges placed upon her by the major congenital heart defects she was born with. It would be unwise on my part to try to give advice on the specific question you posed here without the crucial information regarding the current functional capabilities of her heart and the cardiovascular system in general. If, for instance, she was found to have developed pulmonary hypertension, carrying a pregnancy would pose an unacceptable level of risk to her life. There are a number of other complications with which a pregnancy can pose a significant risk of precipitating heart failure. It is important therefore that this question is answered by the specialist who is looking after her now and who, therefore, has all the information required to give an informed advice.


As I mentioned at the outset, my plea to your daughter would be for her to heed whatever advice is proffered, even if unpalatable. The media is full of stories with the general theme of ‘I defied the doctors and won’. You and I know that those who ignored the doctors’ advice and suffered the consequences are usually not around to say so. I do sincerely hope that your daughter’s condition would be found to be compatible with future pregnancy and that she can realise her dream. If that isn’t the case, she can at least take comfort in the knowledge that, assisted conception, using her own eggs but using a surrogate mother, is available as a fallback option to enable her to be a biological mother. Surrogacy is discussed in more detail here: My best wishes.