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Recent 2nd trimester and full term loss

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  • Recent 2nd trimester and full term loss

    Dear Dr. Cusick,

    Thank you so much for reviewing my question. I am the mother of a healthy 4 year old son. My pregnancy with him was blissfully uneventful. When my son was 2.5 years old, I became pregnant a second time. At 39 weeks I went into labor naturally and when I got to the hospital my daughter had passed. Based on her appearance, they felt that she had passed about 12 hours earlier. All testing on my daughter came back normal and the MFM that I consulted with told me that her passing was a "fluke" and I should not have any future problems. At that time I questioned if I should undergo some additional testing before TTC and was told that was not necessary because I have a healthy son. Four months later I became pregnant again, only to lose another daughter at 17 weeks. After my OB told me that I was "due for some good luck" I went to a very respected RE for RPL testing. I was tested for standard genetic issues, blood clotting disorders, thyroid, CF, etc. and everything came back normal. The only thing that I tested positive for was Hetero MTHFR A1298C and I was told that was not a problem. The RE suggested Lovenox with my next pregnancy and told me to follow-up with a MFM. I went to a well regarded MFM in the area and showed him my test results. He ordered some additional tests (glycoprotein and additional clotting tests) which were also normal. I talked to him about trying Lovenox with my next pregnancy and he was opposed to the idea. He said there have not been enough studies to warrant it safe and there is a link to osteoporosis. He told me he had no problem with me taking baby aspirin though. He final statement was that all I could do was "roll the dice and hope for the winning combination that gave me my son, but there was nothing that they could do to increase my odds."

    After that, I started to reach out to other women online who had repeat losses and did ultimately have a successful pregnancy. Most women that I came across were put on Lovenox or Herapin, extra folate and b-vitamins, and baby aspirin with their subsequent pregnancy. A couple were also put on progesterone for the duration of their pregnancy and one woman was put on Plaquenil.

    I would like to know what type of treatment you would recommend to a woman with my type of losses. My OB is open to putting me on Lovenox next time I get pregnant. I have also met with a nutritionist who as me on a b-complex, flaxseed oil, fish oil and calcium/magnesium/vitamin D.

    Thank you so much for taking the time to read this.

  • #2
    Sorry for your losses
    There is no data to suggest that patient's with a single copy of the mTHFR mutation are at higher risk for adverse pregancy outcomes- similarly, no treatment trials to support use of Heparin
    A recent review of major thrombophilias in general have failed to show a benefit of heparin in improving pregnancy outcomes- at the present time, Heparin is indicated for the prevention of VTE (clots) in mother
    Daily baby ASA started ealry in pregnancy would be the most to recommend, though data in your particular circumstance is unknown

    best of luck


    • #3
      Thank you for your input, Dr. Cusick.


      • #4
        Dr. Cusick,

        We will be using an egg donor for our 3rd IVF cycle.
        I will soon be 46 years old and close to 47 when I deliver.

        Are all pregnancies over 35 labeled "high risk"?

        Using DE, what kind of risks can I expect?
        Should I talk with a high-risk ob-gyn now or after we get pregnant?
        Would it be possible to deliver at home using a midwife or are the risks still too great?

        Thanks for your reply!