Last week was a very busy week. Wonderful patients had successful pregnancy outcomes of beautiful babies. I saw lots of antenatal patients for mid-pregnancy routine checks. I saw patients for their first pregnancy visit who were both excited and nervous. I saw postnatal visit patients who were very happy and grateful. Also, I saw patients with gynaecology needs and problems.
I saw one patient who was nine weeks pregnant in her second pregnancy. It was her first antenatal visit. She attended with her husband. They were nervous. I recall the first antenatal visit of her first pregnancy. That visit had also been at nine weeks pregnant. In her first pregnancy, there had been no concerns on history and no vaginal bleeding. When I did an ultrasound scan my heart sank. I saw there was foetal demise. They were devastated. As well she had a large dermoid cyst of the left ovary. I did a suction curettage of the uterus and left ovary cystectomy. The chromosome study of the pregnancy tissue indicated her baby had Trisomy 16. That would have been the reason for foetal demise.
I scanned her at her first visit in this her second pregnancy at nine weeks with an excellent result. Her baby was the right size, had a good heartbeat and baby was even doing a little dance for mummy and daddy. They were so nervous when I put the ultrasound probe on her abdomen. When they saw all was well they were so relieved and overcome with joy. I also was thrilled and so happy for them. I reassured them I anticipate a good pregnancy outcome and that the reason the loss of their first baby should have no bearing in this pregnancy.
Last week I saw another patient who in her first pregnancy had lost twins at 12 weeks pregnant. Pregnancy tissue obtained at her uterine curettage was sent for chromosome studies. The chromosome studies indicated 69XXX. That was the reason for the pregnancy loss. She is now eight weeks pregnant in her second pregnancy. It is a singleton pregnancy and all appears well. I reassured her and her husband I anticipate a good pregnancy outcome and that the reason she lost her twins has no bearing in this pregnancy. So exciting!
A third patient I saw last week has had two miscarriages in the past and no successful pregnancy. The first miscarriage was at six weeks pregnant. She did not have chromosome studies of the pregnancy tissue and we don’t know the cause for her pregnancy loss. The second pregnancy loss was at seven weeks pregnant. That time she decided on a suction curettage of the uterus. Tissue was sent for chromosome studies and the result was 69XYY. She is only three weeks pregnant in her third pregnancy. She wanted to see me as soon as pregnancy was confirmed because of her obstetric history. She was excited but more nervous. As we don’t know the cause for the first miscarriage and it is unlikely to be the same as the second pregnancy loss I have commenced her on progesterone pessaries. She will be having quantitative HCG and progesterone assay monitoring. This way we can be very confident about baby’s wellbeing even before the baby is big enough for her first pregnancy scan.
A fourth patient I saw last week for her first antenatal visit had an unsuccessful first pregnancy. The chromosome result was Trisomy 18. She is now 12 weeks pregnant in her second pregnancy. It is progressing well. She awaits the result of an NIPT. I reassured her I suspect a good NIPT result.
Every woman has a different pregnancy journey. It is a privilege to be able to support and care for my patients on their various pregnancy journeys. It is a privilege to be there not only to celebrate life with the birth of a new baby but also in the darkest times of despair when a woman has a pregnancy loss wonders if she will ever have a baby.
