Q. One of the twins got miscarried. Are my reports worrying?

Answered by
Dr. R Balakrishnan Menon
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 01, 2018 and last reviewed on: Oct 09, 2018

Hello doctor,

I am 29 years old. 19 weeks and four days pregnant. My LMP was four months ago. Two months back, I had slight bleeding and passing of some brown tissue. I had a scan and the report showed an empty sac with bleeding and no cardiac activity. Another sac was also present with cardiac activity. And the doctor said one of the twins got miscarried. To survive the other, I took Prolactin injection and was given Susten tablets. Had one shot of hCG too. I had my NT scan which showed everything normal, nasal bone was present and NT was 1.5 mm. Though the doctor did not suggest any test, I chose to do the double marker test. In the result, my trisomy 21 risk was 1: 438. hCG level was 167. 793 ng/ml (3.44 MoM) and Papp-a was 0.53 MoM. This is really worrying me.

In my anomaly scan this week everything was normal except the femur length (26 mm) which is exactly the fifth percentile. The doctor advised for follow up scans. I am 5' 2" and my husband is 5' 4". I did not go for any other test for reassurance as I am really worried about my chances of trisomy. My doubt is am I at risk for trisomy? And I read short femur length is connected with trisomy. I am worried about taking any further test. Would you please clarify my doubts on this, doctor?



Welcome to icliniq.com.

How are you doing?

What you had, in the beginning, was a vanishing twin syndrome. The healthier of the twin survived. The baby which disappeared mostly had some genetic problem, which was not compatible with life. The brown discharge you had was implantation blood. Altered blood is passed without any pain.

As your NT scan was normal with normal appearing NT and nasal bone, this nearly rules out chances of Down's syndrome. Single soft tissue marker at this time is not significant. This could just be an error of measurement of the sonologist. Your age is also of low risk.

If I may suggest do have a 3D scan to rule out the anomaly of the baby. There is really no need to worry, with everything in low risk, why are you worried about one factor, which could just be an error?

Do have a second opinion 3D scan. It will be normal.

Hope I have clarified your query, do write back if any more queries. All the best.

For more information consult an infertility specialist online --> https://www.icliniq.com/ask-a-doctor-online/infertility-specialist

Hello doctor,

Thank you for the clarifying reply. Yet my nagging doubt is the high level of hCG (3.44 MoM) and low Papp-a (0.53 MoM). Do I have to worry about it? I do not want to take another test for trisomy as I feel worried. May I know why the levels are so high? Is my vanished twin responsible? There is a gap of almost six weeks between my vanishing twin and blood test.



Welcome back to icliniq.com.

All the visible tests have come normal. Now the only explanation I can think of about the blood values is the vanishing twin's fetal tissue which is producing the value, in a range that is abnormal for a single baby.

Even though the baby is not visible on the scan, there will be fetal tissue. This marker is not valid for multiple pregnancies.

Hope that relieves you of the query, do write back if any more queries. All the best.

For more information consult an infertility specialist online --> https://www.icliniq.com/ask-a-doctor-online/infertility-specialist

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