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Will my next pregnancy be successful?

Wednesday, 10 December 2003
Answered by: Puneet Bedi
Consultant in Obstetrics and Gynaecology
Apollo Hospital
New Delhi
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Q. When I got pregnant the 1st time, the scan in the 8th week showed that there was no fetal cardiac activity so I had to undergo D & E - the histopathology report showed that it was hydatidiform mole. The 2nd time when I was pregnant, I had some bleeding and had a scan in the 7th week; everything was normal. The impression of the sonographist was - evidence of chorionic separation. In the 8th week the sonography revealed that fetus shows sub-cutaneous oedema, hydrops and cystic hygroma and I again underwent D&E. After that a blood test was done which was reactive to Toxoplasma. I was prescribed Rovamycin Forte and the recent blood test shows that Toxoplasma is cured. Doctor, how does this happen and before going for the next pregnancy, what treatment would you suggest?

A.  The only thing that is important is what kind of a mole (H mole) did you have. Was it the kind which persists or the ones which are benign, either way it was in the first pregnancy. This must be diagnosed and sorted out before your next pregnancy. Since you had a pregnancy after that I will assume it was a benign mole. In case there is any doubt please talk to your treating physician and then go ahead with your next pregnancy. Toxoplasmosis is an infection of amoeba-like organisms and comes from contaminated food and cat faeces. I cannot understand what you mean by saying that toxoplasmosis has been cured. It is a once a lifetime infection and is self curing and mild. You cannot get the same infection since one episode leads to life long immunity. Infection with toxoplasmosis can lead to an isolated abortion if it happens to be a fresh infection during pregnancy (more often it leads to fetal disease) but cannot cause recurrent pregnancy loss. The cause of your two fetal losses was not the same. The two had different complications. I am also a bit surprised that at 8 weeks a diagnosis of hydrops/oedema was made. I wonder if you mean 18 weeks. Either way that pregnancy has also been terminated so we cannot do anything about it. Once the pregnancy has been terminated there is no need/reason to take rovomycin. The IgG against Toxoplasmosis once positive will remain positive for the best part of your life (20-30 years or more!) so please do not get the test done again. It is not required unless you are on steroids or get diseases in which immunity drops. Toxoplasma cannot come back again to affect your subsequent pregnancy (even if we assume that your last pregnancy was damaged because of it - which is unlikely, as you say that the fetus was damaged at 8 weeks and this cannot happen with toxoplasmosis infection). So at this stage you do not need any other treatment. Please get a proper evaluation by your doctor to exclude any other medical illness and if you have none please plan for the next pregnancy. Your next pregnancy will indeed be very difficult since you will keep believing you have complications since you have already had problems in the previous two pregnancies but please have faith in nature and remember that each pregnancy is new and you have already had bad luck twice this time on it should be OK. In case you are told that the fetus is abnormal or something like that please take a second opinion before you take a drastic step like terminating a pregnancy at 8 weeks on an ultrasound diagnosis which at best may be imprecise. I wish you all the luck for the future.

A.  The only thing that is important is what kind of a mole (H mole) did you have. Was it the kind which persists or the ones which are benign, either way it was in the first pregnancy. This must be diagnosed and sorted out before your next pregnancy. Since you had a pregnancy after that I will assume it was a benign mole. In case there is any doubt please talk to your treating physician and then go ahead with your next pregnancy. Toxoplasmosis is an infection of amoeba-like organisms and comes from contaminated food and cat faeces. I cannot understand what you mean by saying that toxoplasmosis has been cured. It is a once a lifetime infection and is self curing and mild. You cannot get the same infection since one episode leads to life long immunity. Infection with toxoplasmosis can lead to an isolated abortion if it happens to be a fresh infection during pregnancy (more often it leads to fetal disease) but cannot cause recurrent pregnancy loss. The cause of your two fetal losses was not the same. The two had different complications. I am also a bit surprised that at 8 weeks a diagnosis of hydrops/oedema was made. I wonder if you mean 18 weeks. Either way that pregnancy has also been terminated so we cannot do anything about it. Once the pregnancy has been terminated there is no need/reason to take rovomycin. The IgG against Toxoplasmosis once positive will remain positive for the best part of your life (20-30 years or more!) so please do not get the test done again. It is not required unless you are on steroids or get diseases in which immunity drops. Toxoplasma cannot come back again to affect your subsequent pregnancy (even if we assume that your last pregnancy was damaged because of it - which is unlikely, as you say that the fetus was damaged at 8 weeks and this cannot happen with toxoplasmosis infection). So at this stage you do not need any other treatment. Please get a proper evaluation by your doctor to exclude any other medical illness and if you have none please plan for the next pregnancy. Your next pregnancy will indeed be very difficult since you will keep believing you have complications since you have already had problems in the previous two pregnancies but please have faith in nature and remember that each pregnancy is new and you have already had bad luck twice this time on it should be OK. In case you are told that the fetus is abnormal or something like that please take a second opinion before you take a drastic step like terminating a pregnancy at 8 weeks on an ultrasound diagnosis which at best may be imprecise. I wish you all the luck for the future.

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