Creator: Dr. Sonal Prasad
Published: 2016-09-27T10:40:16-04:00

Patient's Query

Hi doctor,

My wife is 29 years old and we have a 5 year old son. It was a premature delivery in the 34th week and it was a normal delivery. After that, she had three abortions and all are because of no fetal growth and heartbeat. Currently, she is 10 weeks pregnant. Her recent ultrasound scan showed normal and good heartbeat found. From the investigation report, we came to know that her vitamin D level is 12 and B12 is 227. Will it impact the growth of the baby? Shall we continue the pregnancy? Fetal hemoglobin (HbF) 0.9%, hemoglobin A0 (Hb A0) 96.5% and above one year 94.3 to 98.5 hemoglobin A2 (HbA2).

Answer

Dr. Sonal Prasad

Childbirth Educator Lactation Counselor Obstetrics And Gynaecology

Hello,

Welcome to icliniq.com.

The vitamin D levels are in deficient range and vitamin B12 levels are normal. There is no need to discontinue the pregnancy due to these values. Vitamin D supplementation will help to have adequate levels in baby.

I suggest vitamin D supplementation Calcirol sachet 60000 IU weekly after the 12th week of pregnancy for eight weeks. Consult your doctor, discuss with him or her and take the medicine with consent.

I hope your wife is already taking Folic acid 5 mg daily and has already undergone routine investigations of pregnancy. Her hemoglobin, urine routine test, TSH (thyroid-stimulating hormone), FBS (fasting blood sugar), Hb electrophoresis, VDRL (venereal disease research laboratory), HIV (human immunodeficiency virus) and HBsAg (hepatitis B surface antigen) are all normal.

Also, I hope that the NT (nuchal translucency) and NB (nasal bone) are normal. Please review if otherwise.

In view of previous three abortions, please start tablet Ecosprin 75 mg daily (Aspirin). It will continue till 36 weeks. Also get tested for APLA - antiphospholipid antibodies for LAC and ACL. According to the report, we will decide whether further pregnancy support is required or not.

Do not take any medication except Folic acid, Ecosprin and Doxinate (combination of Doxylamine succinate and Pyridoxine hydrochloride for vomiting) till first three months (12 weeks) of pregnancy to avoid congenital malformations in baby.

Investigations to be done:

1. APLA screening for ACL (anticardiolipin antibody) and LAC (lupus anticoagulant).
2. Beta-2 glycoprotein.

Probable diagnosis:

G5P1L1A3 with 10 week period of gestation with vitamin D deficiency.

Treatment plan:

1. Low dose Aspirin.
2. Pregnancy support.
3. Routine antenatal care.

Regarding follow up:

Revert back with the reports to an obstetrician and gynaecologist online.---> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

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Patient's Query

Thank you doctor,

Most of the tests are done. I have attached my Hb electrophoresis test report. Please let me know if it is normal. She is taking Ecosprin. Also, I forgot to mention that she takes Enoxion 40 mg injection daily for blood thinner as the hemoglobin level is 10.3 g%. I will definitely get the tests for VDRL and APLA (LAC and ACL).

Answer

Dr. Sonal Prasad

Childbirth Educator Lactation Counselor Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

Yes, Enoxaparin (Enoxion) should be continued till 36 weeks of pregnancy. ACL and LAC will help us know whether we should continue with 40 IU or increase to 60 IU.

Hb electrophoresis is done to detect a genetic defect called thalassemia in individuals. The result can be normal, carrier or thalassemia disease. Usually, children with parents being a carrier or thalassemic have a risk of developing thalassemia.