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Miscarriage

Miscarriage or spontaneous abortion is an unfortunate event that occurs in about 25 % of pregnancies. Most spontaneous abortions occur at about 8 weeks of gestation. That would be about 4 weeks after the first missed period. It is sad when a pregnancy loss occurs and it requires time to heal. We recommend at least three to six months of time before attempting pregnancy again. Often there is a rush to get pregnant again as soon as possible. Most miscarriages are a natural but undesirable event and occur because of abnormal chromosome numbers- either too many or not enough. Sometimes there are abnormalities of the sex chromosomes (see Turner's below). Most women begin to have some spotting and cramping at first. This often progresses to increased bleeding ( like a severe period) and uses one pad per hour. The cramps become more intense. These symptoms often require immediate medical attention either in the office or the emergency room. Ultrasound today can identify an abnormal pregnancy before any outward symptoms occur. A sonogram at 6 weeks of gestation must contain certain characteristics to be considered a viable pregnancy. We always give the benefit of doubt : wait and repeat the sonogram before recommending any treatment. However, most of the time if the blood pregnancy tests ( beta HCG) do not match the sonogram finding then a problem with the pregnancy exists. This news difficult for the prospective parent to understand because they are expecting a normal pregnancy. Therefore, we want to provide compassionate caring. About 25 % of the time the pregnancy will be completely expelled from the uterus and the bleeding will slow down. The other 75% of the time the bleeding and cramps are progressive and require a D &C. The D&C requires either local or general anesthesia. The blood type and Rh factor must be tested and Rh negative patients must receive RhoGam® prior to discharge.

Molar Pregnancy

Gestational trophoblastic disease is a rare type of pregnancy and occurs about once in every one thousand two hundred pregnancies. There is no fetus in this type of pregnancy and some types of molar pregnancies contain abnormal cells which require close follow up because they can contain cancerous cells.

Emotional healing takes time and the feeling of loss of the pregnancy can be very intense. The loss cannot be prevented so do not blame yourself. Furthermore, your partner should help you. Sometimes counseling is needed but most women recover without any problems and go on to have a healthy pregnancy.

DATE: June 12, 2003

Turner’s Syndrome (45 XO) is a sex chromosome abnormality that is estimated to occur in 1/ 2500 phenotypic females. It results from the lack of a full sex chromosome complement and some types may result from a partial deletion of the second X chromosome rather than a complete absence of it. In 78% of individuals with 45X, the X is of maternal origin, indicating that the other X was lost during meiosis ( not mitosis). At least 99% of these 45XO pregnancies spontaneously abort during the first 12 weeks.

Short stature is a hallmark ( 4 feet 5 inches). These individuals also have gonadal dysgenesis and are thus are infertile. Other common somatic abnormalities are prominent ears, arched palate, widely spaced nipples, cardiac and kidney abnormalities ( coarctation of the aorta), webbed neck, lymphedema and micrognathia. Hypertension, diabetes, thyroid deficiency and osteoporosis often develop later in life in these individuals. Patients with Turner’s syndrome have normal intelligence but verbal IQ is greater than performance IQ which results in a visual –spatial deficit. Behavioral characteristics are variable ( they may act a little odd) with no tendencies toward psychopathology. Supplemental estrogen-progesterone therapy in adolescence can establish secondary sexual characteristics and menses. Treatment with human growth hormone can increase stature above 5 feet.