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in immediate danger, even if she has an ectopic pregnancy, so the prudent approach in situations in which the pregnancy is desired is to simply wait, repeat the hCG levels periodically, every 2-3 days, and perform an ultrasound to look for...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:December 22, 2007
this could be another early pregnancy, it could be an ectopic pregnancy, or ot could be choriocarcinoma arising from your pregnancy in December. I am sorry, but it does sound like you had a very early pregnancy loss - sometimes referred to as a...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:March 16, 2007
Indeed, we have found that one of the primary advantages of first trimester screening and midtrimester screening, coupled with ultrasound, is that we have found ourselves performing far fewer invasive procedures than we have done in the past...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:January 4, 2007
The risk of the amniocentesis is probably only a tenth the risk of your having a baby with Down syndrome, but with the odds you quoted to me, if you did happen to lose the baby, and the loss was related to the amniocentesis, the odds are that you...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:April 27, 2007
If the AFP is abnormally high, and there are no apparent abnormalities of the baby to be seen, then that "false positive" result may actually reflect an underlying placental problem (that may not manifest itself as a problem such as fetal growth...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:September 1, 2007
So what you are saying if the father has say A- blood type and the mother has a postive blood type there wont be no need for the shot.Its only givin if the mother is rh negative correcet.I was just wonderin cause my blood type is a+ but we dont...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:February 14, 2007
i am 42 and currently 12w1d with twins.baby B "looks" normal.baby A has cystic hygroma.lots of fluid behind the neck, in the abdomen, and all over it's body underneath the skin.doctor said baby A has a 95% chance of dying in utero.i burst into...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:August 22, 2007
Microdeletions of this portion of chromosome 22 are clearly associated with congenital heart defects, especially conotruncal defects, such as Tetralogy of Fallot, that have narrowing of the pulmonary artery and ductus arteriosus and...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:February 7, 2007
My baby girl had cystic hygromas on both sides of her neck.We went to see our fetal specialist at 17 weeks and he told us that even though the baby looked normal and the chromosome tests came back negative, that cystic hygromas are a signal or...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:January 29, 2008
Recently, we had a woman diagnosed late in pregnancy with intrahepatic cholestasis of pregnancy, or obstetric cholestasis (OC) Despite reassuring fetal heart rate testing, the baby died. I just logged in and read about the "Inrahpatic Cholestasis...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:January 10, 2007
Trofatter, This posting is timely as I have just received back my results of the first trimester screening and received a positive with a risk of 1:33 for Down's. Many women with your risk in first trimester simply opt to have a careful...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:March 30, 2008
All the symptoms continued and the sickness and dizziness, hunger etc seemed to get stronger but then going back to the day after the positive pregnancy test i was told to go to hospital to see gynacologyst, when they did a urine test and a blood...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:March 15, 2007
First trimester screening for aneuploidy, or as it is commonly referred to as combined first trimester risk assessment, has gained widespread acceptance in other developed nations over the past decade, and is slowly coming into its own here in...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:December 13, 2006
then this year on 07/2008 I had another miscarriage I was about 6wks and now I dont know if it was because of my abortion that Iam having miscarriages because I want to get pregnant again Iam very regular in my periods and as soon as I try to get...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:August 12, 2007
I am not exactly sure what they found but are adhesions are a growing problem in OB because of the high rate of cesarean sections and REPEAT cesarean sections (and things are NOT going to get any better with time) It is doubtful the adhesions...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:May 10, 2007
The blighted ovum was very likely to be a chromosomal abnormality as well and trisomy 16 is actuallly one of the more common chromosomal abnormalities that results in early pregnancy losses (those babies rarely get past 8-9 weeks) So, your...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:March 25, 2007
Concerns Regarding Methotrexate Therapy. The queries below should be of general interest to many women who undergo methotrexate therapy either for ectopic pregnancy or for other medical conditions, such as autoimmune or neoplastic diseases, that...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:October 15, 2007
Because of the rising incidence of ectopic pregnancy, the risk (maternal and medical-legal) of not identifying and treating an ectopic pregnancy in a timely fashion, and the widespread acceptance and success of MTX therapy as an alternative to...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:September 11, 2007
To begin our discussion of actual causes of recurrent early pregnancy loss, lets start with the one that is probably the most commonly touted, though still the least well-understood (and to me the MOST confusing) HORMONAL CAUSES.
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:March 24, 2007
That is a high risk for Down syndrome and somewhere between 3 to 10 times higher than the risk of amniocentesis. By the textbook, things look a little scarier, but the odds are in your favor the baby is chromosomally normal - and if you cannot...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:July 19, 2008
Understanding Interpretation of First Trimester Screening Results. Based on the very large number of comments and questions I continue to receive related to the interpretation of the results of combined first trimester screening for aneuploidy.
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:April 22, 2008
The questions are excellent and summarize the concerns of many of our readers who have a low PAPP-A value detected at the time of first trimester screening for aneuploidy, so I thought it worthy of a full post.
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:March 27, 2008
Before I get into details regarding specific abnormalities of the maternal immune system and clotting system that appear to be related to recurrent early pregnancy loss, let me tell you a story about one of those special patients in my life who...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:April 3, 2007
Recurrent Early Pregnancy Loss - 1 - Implantation. 1) Endometriosis/adenomyosis is probably a MUCH mote common cause of recurrent early pregnancy loss than most physicians are aware of. Factors that contribute to recurrent early pregnancy loss...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:March 22, 2007
Symptoms Accompanying Methotrexate Therapy for Ectopic Pregnancy. Fortunately, with early diagnosis, facilitated by rapid quantitative assays for hCG (human chorionic gonadotropin, the pregnancy hormone measured in most pregnancy tests) and...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:March 8, 2008
Due to the difficulty in routinely obtaining a definitive assessment of the nasal bone, and its current limited usefulness in screening women of all ages and ethnicities, many providers have elected not to include that in their certification for...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:July 6, 2008
There is not a week that goes by in my practice that I do not have to address questions regarding cytomegalovirus (CMV) infections and pregnancy. Anonymous has left a new comment on your post "Cytomegalovirus (CMV):
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:November 18, 2007
Women with single MTHFR polymorphisms do not need special treatment unless they have pregnancy problems that seem to be related to this. If you continue to have miscarriages, prophylactic heparin or lovenox can be started as soon as a pregnancy...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:September 7, 2007
Intrahepatic Cholestasis of Pregnancy - Outcomes and Management. If your itching has completely resolved, it is unlikely that you have true obstetric cholestasis - there are many other causes of itching (and of cholestasis) in pregnancy.
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:January 13, 2007
from midtrimester on is mostly fetal urine, and CMV is excreted in large amounts from the kidneys following congenital infection, and often for years afterwards, even in 'asymptomatic' cases) However, unless we have confirmatory maternal...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:September 27, 2006
In a subsequennt pregnancy I WOULD recommend a good cerclage at about 13 weeks gestation, frequent assessment for evidence of GBS urinary tract infections and aggressive treatment for the same, adequate prophylactic therapy in labor, no stripping...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:December 19, 2007
Recurrent Early Pregnancy Loss - 7 - Immunologic and Hematologic Causes. Indeed, the triad of recurrent pregnancy losses or poor obstetrical outcomes (related to severe preeclampsia, intrauterine growth restriction; fetal deaths, and preterm...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:April 5, 2007
I was sent home untill the tuesday when i had labour pains,i had a long difficult birth and when my son Khian came out he wasnt breathing, i had to make a desion to take him off the venterlator, the doctor said some tests came back and that i had...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:October 22, 2006
1.in 17th week, 2.In 25th week and 3.was a preterm birth in 24th week - the last one was a twin pregnancy I have this Prothrombin mutation and take Low Molecular Weigh Heparin during pregnancy plus baby aspirin,Progesterone, and Predisone (5mg)...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:August 17, 2007
Management of an Rh-Isoimmunized Pregnancy. This is very interesting.I've been concern with my pregnancy (I'm 28 weeks pregnant) This is my second pregnancy and with my first pregnancy my baies blood got mixed with mine and now I'm positive with...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:February 23, 2007
Amniotic Fluid - 4 - Consequences of Decreased Amniotic Fluid. , and in the case of placental insufficiency, decreased fetal oxygenation (ultimately the cause with its own consequences, not the effect, of decreased amniotic fluid) Normally, I...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:May 11, 2008
The readers who sent in the comments below related to recurrent early pregnancy loss (RPL) have what we could consider to be 'borderline' indications for 'treatment' and several questions related to their therapy.
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:December 9, 2007
*** Just wanted to know your thoughts on this matter and I don't know much about Choroid Plexus Cysts. 'choroid plexus cysts' and labeling these as an "ABNORMALITY" is one of the greatest disservices ever done to obstetrical patients.
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:January 25, 2008
PAI-1 - 55 which had tapered from 141. Many women carry one dose (heterozygotes) for the MTHFR A1298C and PAI-1 4G polymorphisms and have no trouble at all with pregnancy. Lastly can we keep PAI-1 level test as the marker from 15th week for the...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:November 5, 2007
The other day, tjtiger left a new comment on my post "MTHFR Mutations and Congenital Heart Defects" Her many questions made her comment worthy of a post of their own and the query related to the possible assocation of MTHFR polymorhisms and...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:October 3, 2007
(In other words, after birth, once the mothers Rh-antibodies are eliminated, the baby will no longer attack its own RBCs, although the destruction can continue after birth until such time as the antibodies are gone) There are several consequences...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:February 18, 2007
Patients at risk for or suspected of having Ashermans syndrome, who still have pain occurring at the expected time of menstruation in the absence of significant or any menstrual flow, may have obstruction of the cervix by scar tissue and are then...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:June 10, 2008
With regard to recurrent early pregnancy loss, however, the anticoagulation properties of lovenox and aspirin may be LESS important than their roles in improving trophoblast. If you pregnancy losses are indeed related to a "clotting problem"...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:January 26, 2008
Invasive Diagnostic Testing after Reassuring First Trimester Screening for Aneuploidy. today, but after a brief ultrasound (I don't recall him looking for any specific markers) and reviewing my first trimester screening results he said that...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:January 22, 2008
This is not at all unusual in early pregnancy losses, especially if a chromosomal abnormality was present, however, it can also be difficult to differentiate from a condition called "molar pregnancy. I didn't take any drugs during this pregnancy...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:December 18, 2007
Im 22yrs old and recently found out i was pregant,This will be my 4th pregnancy,my other 3 ended in miscarriages and they were 2 my ex at the time,now with this pregnancy im worried i will miscarry again,i havnt had tests as 2 why i have...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:September 17, 2007
Amniotic Fluid - 6 - Polyhydramnios: The babies can have complications related to electrolyte imbalances and respiratory difficulties, usually the consequence of premature delivery resulting from polyhydramnios (excessive amniotic fluid) Survival...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:May 16, 2008
These early events in formation of the placenta are critical to pregnancy outcome and, when abnormal, are associated with miscarriage, intrauterine growth restriction (IUGR) of the baby, pregnancy-induced hypertensive disorders, fetal death in...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:May 1, 2008
Recurrent Early Pregnancy Loss - 5 - Introduction to Immunologic Causes. The last two major categories I would like to discuss related to recurrent early pregnancy loss are. In the next post, we will address specific abnormalities of the maternal...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:April 1, 2007
In fact, if anything, since the drug is now formulated at compounding pharmacies across the nation, and is not under the scrutiny of BIG PHARMA (the product is no longer made by a pharmaceutical company just wasnt worth holding onto over the...
Author:Kenneth F. Trofatter, Jr., MD, PhD
Date:January 14, 2008
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