Patient's Query
Hello doctor,
I am writing for my daughter, who is staying away from us with her husband. She is 30 years, 5 feet 1 inch, and 138 lbs in weight. She has been married for the last three years and has been seriously trying for conception for a year. She missed her period once at the beginning of this year. During her obstetrics consultation, beta hCG was done. It was repeated after two days. A transvaginal ultrasound scan was done and repeated after 10 days. The end result was diagnosed as a blighted ovum. So, it was evacuated by D and C.
Our daughter is of normal build and nutrition. Her menstrual history was normal since the beginning in terms of cycle, duration, and flow. But, one month after D and C, she did not have her period. On the doctor's advice, she took some medicines, and bleeding occurred. She was known to be hypothyroid. So, she was taking Thyroxin 50 mg or 75 mg to keep the TSH near about 2.5 mU/mL. Her Hb % and sugar are within the normal range.
Again, she tried to conceive three months ago along with Aspirin and folic acid. She missed her period last month. Her beta hCG was 9.20 mIU/ mL. It was repeated after two days. It came down to 1 mIU/mL, suggestive of 'chemical pregnancy. This time, after a few days, spontaneous jelly-like bleeding occurred for two days. I would like to add that her husband requires to take Penegra 50 mg tab before a performance. Our daughter is immunized with triple antigen, polio, MMR, chickenpox, and hepatitis B vaccine in childhood. The transvaginal scan (done at a later phase of the first conception) showed a normal anatomical and physiological pattern of the ovary and uterus to me at least (report attached). Two consecutive miscarriages brought great disappointment to all. Presently, the doctor told her to take Aspirin 150 mg, folic acid, and a Vitamin B12 combination tablet and to try for pregnancy again. I want your valuable opinion regarding subsequent management or the right line of treatment and suggestions or tests (if any) to get a successful pregnancy and healthy baby.
Hello,
Welcome to icliniq.com.
I have gone through your daughter's reports (attachment removed to protect patient identity). From the detailed information that you have given, the first pregnancy was a blighted ovum (miscarriage). The second pregnancy is a chemical pregnancy and not a true miscarriage. This is best considered as a single miscarriage only.
Since your daughter's tests are within normal limits, the next pregnancy should be fine. Folic acid is important, apart from continuing Thyroxine. Low-dose Aspirin can also be started as soon as the fetal heart is visualized on the scan. I would like to know her rubella IgG status, that is, immunity status. Even though this is not directly related to miscarriage, it is part of the prepregnancy workup. I would like to know the results of the histopathology of POC (products of conception) of the first pregnancy, if available.
I hope this helps. Regards.
Patient's Query
Hello doctor,
Regarding rubella IgG, she was tested during the early phase of the first conception. The result was suggestive of a previous rubella infection or was immunized. I wrote to you that she was given MMR vaccine in childhood. The histopathology exam of products of conception was not advised after D and C. So, I do not have the report. She already started folic acid and vitamin B12 combination, Aspirin 150 mg and Eltroxin 50 mcg. My question is, can she try for a pregnancy immediately or after a gap?
Hello,
Welcome back to icliniq.com.
Two months gap is advisable for physical and emotional recovery.
I hope this helps.
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Answered byDr. Gowrimeena
Medically reviewed byiCliniq medical review team
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