Fruit of the Womb

Metformin Use During Conception and Pregnancy

2009-09-25T16:02:00.000-07:00

The following recent query requested my opinion regarding the safety of metformin during the periconceptual period and throughout pregnancy. Although there are not many large or comprehensive studies addressing these concerns, the bulk of the data available to us is encouraging... Dr. T, Quick opinion if you don't mind. As you may recall, I miscarried on 9/12. I have since seen my PCP for a...

Absence of Fetal Nasal Bone in Midtrimester as a Marker for Down Syndrome

2009-09-06T19:25:00.000-07:00

Tamsen has left a new comment on your post "Amniocentesis is Not Without Risk": I am 29 years old and am 21 weeks along. I just had an ultrasound a couple of days ago and was told that the nasal bone is not showing up which puts me at higher risk for a baby with Down Syndrome. I have yet to have someone tell me how much of an increased risk. I did not have the 1st trimester screenings as I've...

Urinary Tract Infections with Group B Streptococcus (GBS) During Pregnancy

2009-09-03T17:00:00.000-07:00

The following comment was recently left on my previous post "Misunderstanding Group B Streptococcus (GBS)": Hi - I am getting a little confused about Group B Strep (GBS) and UTI (urinary tract infection) information. Hoping you can help me clarify. I am 7 weeks pregnant and was just diagnosed with a UTI with GBS (asymptomatic - it was done as part of my first visit screen). The nurse called and...

Polyploidy as a Cause of Early Pregnancy Loss

2009-08-31T09:21:00.000-07:00

Probably one of the most popular series I have written over the past few years is the one on recurrent early pregnancy loss. There is not a week that goes by that I still don’t get inquiries related to that subject, most accompanied by the pain, frustration, sense of loss, and feelings of hopelessness for future fertility. There are several points I always remind readers and patients about...

Methotrexate - Easy to Use, Easy to Abuse

2009-07-11T16:18:00.000-07:00

I received the two comments below from readers and use this opportunity of their tragic experiences to revisit a concern that I raised about two years ago regarding methotrexate therapy for the presumptive diagnosis of ectopic pregnancy…. Melissa O. said... I was told I had an ectopic pregnancy and was advised I was in need of a Methotrexate shot. I got it. One week later my hormone level was...

Composite Results are the Strength of First Trimester Screening for Aneuploidy

2009-07-09T18:42:00.000-07:00

The reader below faces what appears to be a growing dilemma for patients (and their providers) in the laboratory reporting of results from first trimester screening for aneuploidy. The data that supports this screening modality has always emphasized that the power of the screening test is in the COMPOSITE test results and NOT the individual ‘analytes’ which include the actual nuchal...

Abnormal First Trimester Screen in a Woman with Chronic Kidney Disease

2009-07-07T17:54:00.000-07:00

Hello Dr. T: I am also new to the whole blogging thing. I am currently 13 weeks 3 days, and was told at my last prenatal appointment that based on my first trimester screening, I have a 1 in 235 chance of having a baby with Downs syndrome. I am only 23 years old, and I wasn't sure if this is horrible. I thought most people had a 1 in 275 chance, but looked it up online and came to find out that...

A Second Chance

2009-07-05T17:14:00.000-07:00

Dear Readers, About a month ago, I started writing again and had at least tried to begin responding to the many queries that have kept coming in the door – some left on posts that are a year or two old. (And for all of you out there who have asked, those old posts are still ‘open’ so that you can leave a question or comment and they will be forwarded to me). Due to the volume of the queries, I...

A Loss of Twins and Missed Opportunities for Cerclage

2009-06-13T11:53:00.000-07:00

Recently, a reader left the comment below. The value and use of cervical cerclage continues to come into question. There are major institutions in this country where it is not considered to be a useful procedure and have abandoned or severely limited its use to selective patients in deference to ‘conservative management’, often now involving the administration of progesterone during the...

Low hCG and PAPP-A in a Patient with an Autoimmune Disorder

2009-06-09T19:39:00.000-07:00

The following comment was left on an old post "Affect of Smoking on PAPP-A Levels in First Trimester." The case is interesting because it reminds us that abnormal maternal serum markers in first trimester might be the result of factors unrelated to fetal chromosomal abnormalities.... Hi! I just got my 1st trimester screening test results today, and would love you thoughts. I will be 40 years...

Return of Dr. T

2009-06-08T17:57:00.000-07:00

It has been several months since I have written and I have missed all of you. I was a little burned out by trying to keep up with my interim Chair and clinical responsibilities as well as the blog, but the greatest reason was that ‘Blogger’ was misbehaving and had been for many months – you couldn’t leave your comments and I couldn’t respond. I felt like I was talking to the wall and it was the...

Quintuplet Story: A Physician's Perspective - 4

2009-02-09T08:20:00.000-08:00

On April 6, 2007, at 27 6/7 weeks, Joy began having more “pelvic pressure” and the decision was made to give her corticosteroids to accelerate fetal lung maturation. Serial ultrasounds had shown that one of the babies was developing intrauterine growth restriction and was having more difficulty pushing blood through its placenta as well, so the general sense was that delivery would probably be...

Quintuplet Story - A Physician's Perspective - 3

2009-02-07T18:08:00.000-08:00

...The following day, I had a long discussion with Joy and Andres about what to expect over the next 3-4 weeks, the discomforts, the psychological drain, the ever-present concerns for outcomes and the risks. The uterus is now the size of a term one. She had gotten to the point where she developed a rapid heart rate (tachycardia) and low blood pressure (hypotension) in almost any position. I...

Quintuplet Story - A Physician's Perspective - 2

2009-02-06T16:13:00.000-08:00

On the whole, the pregnancy progressed well. At about 13 weeks, we placed a high cerclage in her cervix. This stitch around the cervix was intended to help prevent subclinical cervical changes leading to early labor as well as a means of providing us a ‘safety net’ and perhaps some opportunity to interrupt premature labor should that ensue. Between 15 and 17 weeks, she gave me my first real...

Quintuplet Story - A Physician's Perspective

2009-02-05T17:53:00.000-08:00

Before I became distracted by a plethora of administrative responsibilities, I was in the middle of writing a series about multiple gestations. Although I did not want to spend a lot of time discussing 'high order multiples' (three or more babies) in this series, I did want to highlight some of the medical and ethical dilemmas of such pregnancies (which have again been raised with the recent...

Inauguration Day Thoughts

2009-01-20T18:01:00.000-08:00

At the time of the swearing in ceremony for President Barack Obama, I was supposed to be at two different meetings. I didn’t go to either of them. Instead, I went to the OB/GYN Residents’ lounge and turned on the television to watch what will surely go down as one of the most significant events in American history. The room was completely empty, except for me, and that in itself is unusual,...

Multiple Gestations - 3 - Common Complications

2009-01-02T16:47:00.000-08:00

Although we have focused our discussion of multiple gestations to this point on twins, higher order multiples (i.e., triplets, quadruplets, quintuplets, etc) also occur but, fortunately, much less often than twins. The hypothesis of Hellin predicts that if the frequency of twinning (n) in a population is known, the frequency of triplets can be estimated as n-squared, the frequency of quadruplets...

Multiple Gestations - 2 - Placentation in Twins

2008-12-29T10:22:00.000-08:00

Another area of confusion for patients relates to the actual development of the placentas (placentation) of twins. Perhaps this is where the patient mentioned at the outset of our last post had problems understanding – her different gendered babies did have a large, single, fused placenta. So, let’s spend a few minutes in this post clarifying the issue of placentation… In singleton...

Multiple Gestations - An Introduction

2008-12-26T18:43:00.000-08:00

Not long ago I was attending at a twin delivery – one boy and one girl. The mother knew from about 16 weeks into the pregnancy that she had one of each gender. Yet, at the time of the delivery, despite the fact that there really was one of each, her first question to me was “Are they identical twins?” My simple response was to remind her that she had one boy and one girl. “No. she said, I know...

Christmas Day - 2008

2008-12-25T19:05:00.000-08:00

I have not had many opportunities to write during the past month. In fact, other than answering the few comments that have managed to get through to me, it has been since Thanksgiving that I have placed a new post. It has not just been a hectic couple of months, but almost a whole year as a result of the time commitment I have had to make to functioning as interim Chair of our department. I...

Celiac Disease and Pregnancy

2008-11-28T20:44:00.001-08:00

In our last post, we responded to several questions from a reader named Kate concerning the implications of low PAPP-A levels detected during the course of first trimester screening for aneuploidy. Not addressed in our last post were her two other comments: Is there a correlation with celiac disease and placental health or low PAPP-A levels? I have read reports of celiac disease causing many of...

Low PAPP-A and Celiac Disease in Pregnancy

2008-11-26T19:06:00.000-08:00

One of the reasons I love the comments we get from our readers is that they often make me look at pregnancy-related conditions and complications from a different perspective. I stated from the outset of this blog that I was looking forward to participating in the learning experience with our readers. Such is the opportunity afforded to us by Kate’s concerns below… Kate said... Dear Dr.T, I...

Oral Contraceptives and Infertility?

2008-11-23T19:01:00.000-08:00

Hello to all my readers and Happy Thanksgiving! It has been about a month since I have managed to get any of your comments in my mailbox and I am afraid ‘Blogger’ is still having problems in that I cannot respond to about half of the questions I have received. Included in the batch I did receive is the comment from Andria below. She expresses concerns about one of the common myths and...

Prematurity Awareness Day - 2008

2008-11-12T19:04:00.000-08:00

Today is Prematurity Awareness Day. At a local press conference sponsored by the March of Dimes, I had the opportunity to discuss some of my thoughts on this subject with a reporter. When I started my residency, the prematurity rate sat between 8% and 9%. Today one in every eight babies (530,000 per year) in the U.S. is born prematurely and in my home state of South Carolina the rate is even...

Blogger Problems!?!

2008-11-09T18:23:00.000-08:00

Just a quick note to all my readers...I know many of you have tried to leave comments and would like my responses, but there apparently are some 'blogger problems' that are beyond my control and as yet unresolved. I do not have the opportunity to preview and select what appears in the 'Comments' sections of my posts. Once you submit a comment, it is screened by someone at Healthline and then...