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How To Confirm Miscarriage?

Posted on Mon, 15 Dec 2014

Question: My wife is 9 weeks pregnant now. We had an ultrasound done in 6th week and a heartbeat was detected. We had another ultrasound done in 9th week and there was no heartbeat. The OBGYN advised my wife to either get a D&C done or take tablets for the miscarriage to complete. She said the embryo measure about 1 cm and the growth should have stopped in the 8th week.

My wife already had 2 miscarriages and this is the third one. Please advise if we need to wait for sometime and get another ultrasound done and we can conclude that this is surely a miscarriage and proceed with doctor's advice.

Answered by Dr. Dalia Muraleedharan (24 minutes later)

Brief Answer:
Yes, get a scan repeated

Detailed Answer:
Hi,
Thanks for writing..
I understand your concern..

Yes, get a scan repeated at the earliest to confirm the fetal heart rate.. If fetal heart rate is absent, I am sorry to inform you that there is no point in continuing the pregnancy.. Because the heart beat once appeared, if it disappears it is unlikely to reappear again..

I would advise to undergo a D and c as the oral medication will take longer time as the baby is 8 weeks.. Moreover it can cause heavy bleeding as the fetus more than 7 weeks.. D and C will take lesser time and less painful for her.. Sent the Products of conception for karyotyping to rule out any chromosomal abnormalities..

Since this is her 3rd abortion, get a APLA screening, PT, APTT, Blood group, if she is negative group ICT to know the cause of abortion.. If all these are normal karyotyping of both the partners is advised..

Hope I have answered your query.. Feel free to ask any doubts.. Good day..

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Dalia Muraleedharan (12 hours later)

Hi Dr XXXXXXX

Thanks for your detailed response. I have some follow up questions.

1) If she gets D & C done, will it negatively impact her chances of conceiving again ?
2) We got the below tests done in San XXXXXXX this year.
a) APL antibodies ( for my wife )
b) detailed blood test ( for my wife )
c) Karyotyping ( for both me and my wife )
d) thrombophilia test ( for my wife )

While we were in XXXXXXX she got FSH, AMH tests done. She had her fallopian tubes examined. All the reports came out normal. My XXXXXXX karyotyping report says I have 14p+ abnormality and the San XXXXXXX report says I am normal. My wife is pre-diabetic and has HbA1c average of 6.0.

Previous pregnancies terminated even earlier ( 5th and 6th week ). With this information, do you see any possible cause for the recurrent miscarriages ? We really want to know the root cause as each time our hopes are shattered and we are really interesting to become parents.

Any advice regarding the root cause and future course of action will be very helpful to us.

Thanks and Regards,
XXXX

Answered by Dr. Dalia Muraleedharan (12 hours later)

Brief Answer:
Get your karyotyping repeated

Detailed Answer:
Hi XXXX
Thanks for writing..

I would suggest to get a D and c with an expert doctor.. Overcurretage can cause adhesion and improper currettage will lead to retained products.. Correct method cause less effect on future pregnancy.. If you have a worry regarding that, first medical abortion can be tried.. If there is a retained products or excessive bleeding, then you can get a D and c if required..

Get the karyotype of the D and C products to see whether the fetus had any chromosomal abnormality.. Get your karyotyping repeated in a reliable lab to rule out 14p+ abnormality..

If everything is normal, you can try for pregnancy after 3 months.. Continue folic acid.. In the next pregnancy as soon as the heart beat appears start taking aspirin tablet and low dose heparin injection after consulting your doctor..

Hope I have answered your query..Feel free to ask any doubts.. good day..

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju