Question: Hi Dr, I was diagnosed with PCOS. Underwent treatment for ovulation during July. Within a month I was pregnant. Had light brownish spotting last week. Gestation Age by my dates 13 weeks, 4 days. Went for a a scan and found the baby's growth corresponded to only 8 weeks 1 day and henceforth a missed miscarriage. My scan report showed " Uterus normal. No cyst/mass. Trophoblastic reaction is inhomogeneous. Yolk Sac mildly irregular (2.5x2.7x2.9). Foetal growth - 1.63 cm. No cardiac activity/movement."
It was the worst trauma in our life. Had performed D/C and doctor said that the placental and foetal tissues were strong that they could not be easily expelled from the body and also the Trophoblastic reaction being inhomogeneous will not indicate genetic problem. Hence it might be oxygen deficiency for the foetus and hormonal supplements could have sustained the pregnancy. I have few queries:
1) What is meant by Trophoblastic reaction? And in my case, is it true that this indicates there were no genetic defects?
2) Will inducing Progesterone hormonal injections and taking proper rest and sleep in future pregnancy reduce the risk of (missed)miscarriage.
3)How should I make my body normal (the diet, the supplements, the essential factors) and have a healthy pregnancy in future and avoid miscarriage? Thanks for your time and patience. Regards. D.B. (USA)
Answer: Pregnancy loss can be extremely traumatic as your case demonstrates. Let’s look at your situation: you have been found to have Polycystic Ovarian Syndrome (PCOS). As it happens, you conceived quite quickly after the diagnosis was made. You have not said if you had been trying for a long time or not. In any case, if your conception was spontaneous, that augurs well for the future. I am sure you are now aware that PCOS manifests itself to varying degrees. When severe, there can be real issues with fertility in general but the main problems tend to be erratic conception and subsequent difficulty in conceiving. The other fertility issue is a significantly increased risk of miscarriage. Without the full picture of your PCOS, it is not possible for me to give you individualised assessment of the potential impact of PCOS in your quest for a successful pregnancy. Factors such as your body weight, pattern of your periods, presence and degree of insulin resistance etc. are all important. As a general statement, it is appropriate for me to say that, if you are or can get your weight to as close to the ideal as possible (BMI of 25-29), that is a major part of the battle won.
Going next to your specific questions: Trophoblastic reaction is a description of the appearance of the developing tissue and membranes which will lead to the formation of placenta and amniotic sac. In a developing early pregnancy, this appears smooth and regular (homogeneous). With a failing or failed pregnancy as is the case with a missed miscarriage, this might appear inhomogeneous. I am completely at a loss to explain how the appearance of inhomogeneous trophoblastic reaction was somehow equated to absence of possible genetic defects. There is simply no relationship. You can only give this sort of reassurance by doing proper laboratory (cytogenetic) tests. Unfortunately, with an early miscarriage, this is not always possible. I am not prepared to comment on the other theories put forward by your doctor as possible explanations for your miscarriage. Suffice to say, it is simply not possible to prove any of those one way or another.
Using Progesterone hormone injections has not been shown to be of benefit for a naturally conceived pregnancy (as opposed to IVF). They certainly wont do any harm but it will be misleading to present it as a panacea. If you feel you are overworked to an extent of getting stressed, rest and adequate sleep will be a good idea. What you shouldn’t do is to force yourself to rest. That is of no value and could be counter-productive.
Regarding general measures you should take to minimise risk of another miscarriage, I would refer you back to my earlier suggestions. Ensure normal body weight if at all possible, if there is insulin resistance, get medication for this and in general, maintain a healthy lifestyle. My best wishes.
Question: I am 24 weeks pregnant. Should I have the swine flu vaccine and is it safe? How much has it been tested? (Ireland)
Answer: We have answered this question a few times now, reflecting on the prevailing anxiety around this subject. There is strong evidence that the injectable swine flu vaccine is safe for everybody including pregnant women. You should also be aware that pregnant women as well as toddlers have been shown to be the most at risk population groups with potentially lethal outcome following an infection. There is really a strong case for the vaccine during pregnancy but the decision, ultimately, has got to be yours.
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