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What Does The Following Transvaginal Scan Report Suggest?

Posted on Wed, 17 Jun 2015

Question: My wife had transvaginal scan yesterday and the impresion says: LMP :04.04.2015. GA By LMP :7Weeks 4days. EDD By LMP:09.01.2016. Uterus-Gravid uterus. Single intra-uterine gestational sac noted with irregular margin and internal strands. CRL measures:3.5mm (corresponding 6weeks). GS measures:16.6mm(corresponding 6weeks). Cardiac activity not made out at present. Growth of the embryo does not correspond to the gestational age. IMPRESSION: -Features suggestive of: Missed abortion. -Suggested clinical correlation.
We also took a serum-HCG test yesterday which has result 43662 mIU/mL. We will perform serum-HCG test in 48hrs ie tomorrow, 29thMay. Is there a chance for an alive embryo. Also she has been diagnosed with fatty liver, extremely high levels of Alkaline phosphatase, ALT, AST, GGTP etc. and will it jeopardize her pregnancy. Please help.

Answered by Dr. Sameer Kumar (46 minutes later)

Brief Answer:
MISSED ABORTION....

Detailed Answer:
Hello,
Thanks for the query to hcm,
The ultrasound says missed abortion with no heart beat and irregular sac corresponding to 6 weeks and also the CRL. This shows that the heart beat stopped 1 week back and hence the hcg levels are still high.
A fall in the hcg levels after 48 hrs shall confirm missed abortion.
Also the fact that she has fatty liver and high levels of liver enzymes, this itself may be a possible cause of missed abortion with possible increased serum bile acids which can cross placenta and can harm the foetus ( likely what has happened). Acute fatty liver of pregnancy is a dangerous manifestation to have and should be treated soon. UNFORTUNATELY THIS PREGNANCY has failed due to high bile acid levels and hence next if planned should be after 6 months of complete treatment of the liver disorder.
Regards

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Sameer Kumar (23 hours later)

Thank you Dr XXXXXXX XXXXXXX for your quick reply and briefly detailingabout her condition. We got the serum HCG test results after 48Hrs and instead of reducing it has increased but not doubled. The two results are 43662 mIU/mL on 27th and 44929 mIU/mL on 29th May. Why the level has increased more than 1000mIU/mL, can we wait for a week and take another trans vaginal scan or this increase is not enough to confirm that there is still chance for the foetus. Please suggest. If no chance will the foetus automatically be eliminated by the body or medicines will help to clean the uterus. D & C will be a last option if that stage is reached. Please help.

Thanks...

Answered by Dr. Sameer Kumar (12 minutes later)

Brief Answer:
answered

Detailed Answer:
Hello,
As the serum beta hcg levels have just mildly increased after 48 hrs when it should have been somewhere around 90000IU, it indicates that its a failed pregnancy. The HCG levels are still forming but not so as in a normal foetus, there is no heart beat seen and the gestational sac has become irregular. You may wait for another week before a medical abortion can be contemplated just to give a chance to nature to naturally initiate abortion.
I am afraid this is a missed abortion and latest by next week should be terminated if no bleed is initiated naturally to expel the foetus.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (18 minutes later)

Dear Dr XXXXXXX

Thank you very much once again for your quick reply. The truth that the foetus is not alive is very heart-breaking, but we have to cope up with it. Sure we will wait for natural abortion till next week and if not successful will be terminating it. We will be starting her liver treatment from tomorrow and hopefully the liver condition will be back to normal soon. Hope planning for a baby after her condition is fully treated will not have any problem and that this condition will not re-appear at that time.

Many thanks once again.

Kind regards,
XXXX

Answered by Dr. Sameer Kumar (2 minutes later)

Brief Answer:
Thanks

Detailed Answer:
my empathy for both of you and at the same time wish her a speedy recovery from liver ailment.
Thanks and take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (7 minutes later)

Dear Dr XXXXXXX

Thank you for your wishes! Many thanks for taking your valuable time in answering my questions. Hope to consult you in the future.

Take care...

Kind regards,
XXXX

Answered by Dr. Sameer Kumar (5 hours later)

Brief Answer:
thanks.

Detailed Answer:
Thanks and you are most welcome.
Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar