MFM Consult Question (lurker from TTCAL)

sunflwra · August 2014

Hi ladies- I know that everyone's situation is different but I was hoping a few of you may have some insight or recommendations.

I had an uneventful first pregnancy and delivery and have a wonderful almost 3yo daughter. Last year, I got pregnant but found out at our 20 week anatomy scan that the baby had no heartbeat. The loss was ruled a cord accident due to some strictures found in the cord. Some basic loss testing was done to rule out clotting issues, etc but nothing abnormal was found. Four months after our loss, I got pregnant again and we then found that the baby had no heartbeat at 15 weeks (though everything was fine at my appointment the week before). No specific reason has been found for this loss.

In both situations, we had the Panorama blood test done at 10-13 weeks and both pregnancies were found to be extremely low risk. My husband and I have also had genetic testing and no chromosomal abnormalities were found. I had some extensive RPL testing done after this most recent loss and everything came back normal yet again. Because I seem to have no issue getting pregnant and making it through first tri, I've been referred to a MFM (versus an RE where I know a lot of loss ladies are referred). My consult is in 2 weeks.

I'm guessing many of you are being monitored by MFMs but don't know if any have had a situation like mine. Would any of you have insight or recommendations for my consult? I've been with my current OB since my daughter and she's sending all of my records and testing results over. I'm requesting the hospital's records from my live birth and 2 loss deliveries. I don't believe there will be much of a physical exam at my first consult, probably just a lot of questions. I was hoping to get this referral with some sort of explanation for what's been going on, but it sounds like there may not be any true answers, so I'm just not sure what to expect or if there's anything else I should be doing. Thanks ladies.

luvboston · August 2014

Did they test the two fetuses? I hope this never happens to you again but if it does I would insist the fetus be tested. Also perhaps you need an amnio or cvs the panorama is not 100% and does not test for everything. Have you had immune testing? What about prophylactic Lovenox for clotting and prednisone for immune issues? Weekly monitoring when you get to 11 weeks.

sunflwra · August 2014

Thanks for your response @luvboston . Autopsies were done on both fetuses. Due to their sizes, there was only a certain amount of testing that could be done, but it's my understanding that what was tested was normal (no infection, no placental issues, etc). I've had a laundry list of drug tests run- what would the immunity tests be called? I've had Thyroid, PT and PTT, Anticardiolip, Factor V, MTHFR, T4 and TSH. She ran Protein C and S but the results were inconclusive, so may need those to be redone. My OB had me on a baby aspirin for the last pregnancy. I'll make a note about the prophylactic prednisone and lovenox and see what's mentioned. My issues seem to happen between weeks 14-20, so hopefully there will be additional monitoring during that timeframe no matter what. Thanks for your note!

itsmevkb · September 2014

I second asking about immune testing (natural killer cells specifically) along with thoughts on using Lovenox, steroids and IVIG or IV intralipids. Just a warning, many doctors don't believe in immune issues causing miscarriages so if you get the blow off, you may want to seek out a reproductive immunologist.

I'm very sorry for your losses.

sunflwra · September 2014

Thanks @itsmevkb - I appreciate the insight. I wouldn't have even heard of half of this stuff without TB!

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