u/Fuzzy-Chemistry-1476

Hi All,

I (35F) lost my baby ar 24 weeks this July (stillborn) due to smaller than 3rd percentile placenta and small cord. I was also diagnosed with APS (beta 2 glycoprotein Igg 33 the day after delivery and 51 post 12 weeks).

I had sent my placenta slides to both Dr. Parast from UCSD and Dr. Kliman from Yale.

Dr Parast says she did not see any evidence of MVM or maternal autoimmune disease, but she sees evidence of FVM. She thinks the demise was due to short cord leading to smaller placenta and FVM. Although she did say FVM may happen due to APS but it is not typical.

Dr Kliman says he also did not see any clots or evidence of maternal autoimmune disease. He thinks the placenta was small likely due to some sort of genetic issues (he mentioned irregular trophoblast inclusions). We did some genetic testing and fetus genetic microarray that came out ok, we will do some more genetic testing soon just to be sure.

I had a preconception consultation with an MFM who thinks it is APS. Which I kind of agree with.

Whatever the actual reason is, I will go on the usual APS medication if I can conceive again. However, I was wondering why the placental pathology reports did not show any evidence of autoimmune disorder and/or clots? Has anyone else face similar issues? That you had APS but pathology did not show any evidence? Although I think the very small placenta and small cord itself can be evidence of APS even though placental pathology did not show any other typical evidence, right?

If anyone else is also positive for APS but had only a smaller placenta/cord/FVM and placental pathology did not show any other hard evidence (MVM/clots etc) for APS, please let me know!

The reason I am asking is I really want to know if there could be things other than APS that may have caused the loss. Trying to figure out if I have missed anything before I try to TTC.

Hello,

I am 35 year old female and moved to San Diego ~2 months ago. I lost my baby at 24 weeks (stillborn) this July. I likely have a condition called APS (antiphospholipid syndrome) which is a blood clotting disorder (tested positive pne marker - beta 2 glycoprotein igg twice).

I want to TTC again but very scared. I am currently seeing Dr. Kim Bui at IGO Medical after moving to San Diego. She referred me for a preconception consultation at Scripps Perinatology but their waitlist for that was 6 months long. I ended up seeing Dr. Elizabeth Teal at UCSD for preconception consultation. But I did not really feel she is very supportive.

If I manage to get pregnant, I want to see a good OB/MFM who hopefully has experience with treating patients with APS. I like Dr. Bui (IGO) but I am not sure if I should see some other OB who has experience with APS? I am also kind of nervous about MFM. I saw Dr. Shahram Dhaneshmand in Scripps Perinatology has listed clotting disorder as his specialty but apparently his wait times can be very long (I am not sure though if it is just for the consultation or for post pregnancy appointments too).

I am looking for some suggestions from people with similar conditions as mine (APS) on OB/MFM in San Diego area (I live near Mira Mesa). I would really like to be listened to and taken seriously by my doctors, and seen frequently if I have another pregnancy.

I would really appreciate any advice/suggestions!

Hello All,

Sorry, long post alert!

I suffered a fetal demise around a month ago. I was 24 weeks pregnant, and during a routine prenatal checkup, no fetal heartbeat could be found. Up until then, all of my lab results and ultrasound reports had been normal.

Based on my hospital's pathology report and my blood tests/genetic tests, my OB-GYN mentioned several possible contributing factors, including:

1 shorter-than-normal umbilical cord (30 cm) and likely cord compression.
2. Antiphospholipid antibody syndrome. I tested positive for beta 2 glycoprotein from blood tests done the day after the vaginal delivery. It was slightly above the normal range (33 instead of <=20) but other 2 tests were normal. However, my OB-GYN said I need to repeat the test after 12 weeks to confirm, so I will do the test again early October.
3. Smaller Placenta. My OB-GYN suspects that the baby may have passed away at around 20/21 weeks since my 20 weeks ultrasound looked normal (the baby was weighing normally). However, post-delivery both the baby and the placenta were smaller. According to the doctor, if the baby had indeed passed away at ~20/21 weeks and delivered at ~24weeks, that delay may have caused decomposition and the placenta to be smaller (although this is only a suspicion and not any confirmed diagnosis).

I had sent my placenta slides to Dr. Kilman at Yale for a 2nd opinion on placental pathology. His main diagnosis was that: "Placenta was extremely small weighing less than the 0.01% ile for gestational age which led to the fetal demise. Trophoblast inclusions (1.8+/-2.5, n=5 out of 7 slides) were detected that suggest a genetic/developmental abnormality and likely caused the smaller placenta. No evidence of maternal immunologic rejection or decreased maternal perfusion of the placenta."
 
Both my husband and I have done genetic testing (Horizon 27 panel by Natera), NIPT tests (Panaroma by Natera) during pregnancy and there was a Genome microarray test done post-delivery as well. All test results were normal except I was a silent carrier of alpha thalassemia, but my husband was not. All these results made me a bit confused about the "genetic anomaly" diagnosis.
 
I want to start TTC again. I will discuss these reports with my OB-GYN and I have an MFM pre-conception consultation scheduled in 2 weeks. However, I wanted to ask a few questions here as well in case someone has gone through a similar experience and give me some advice on what the next steps maybe (I am very nervous to TTC):

(1) Should I ask my OB/MFM for an Expanded Carrier Screening (500+ carrier screening)?

(2) Should I ask my OB/MFM for a prenatal Karyotype screening?

(3) Should I consider IVF or wait for the above mentioned test results first?

(4) Can smaller placenta or small umbilical cord happen again? Is there any way to prevent this?

(5) Is there any way to know whether the small placenta happened due to genetic anomaly or due to the baby dying much earlier in the womb and placenta shrinking due to that?

(6) APS is another suspicion that the doctors have. If the 2nd APS test comes out normal, should I still go through the baby aspirirn and heparin (lovanox) injection? I heard that if I don't have APS and take aspirin/lovanox, it may lead to excessive bleeding. Will that be harmful to the pregnancy?

(7) I reached out to Dr. Parast from UCSD as well. She said I might need to send her a request through my doctor for her to do placental slide review. I will ask my doctors about that but if they don't agree, do you think I should ask Dr. Parast for only a consultation with the existing reports without the placental slide review? (Has anyone done this before?)

(8) I am of advanced maternal age (35 now, was 34 during pregnancy), could this have contributed to the genetic anomaly?

(9) Any other advice for me?

Finally, if anyone can give me some reassurance that even with APS or smaller placenta or any chromosomal disorder (especially someone who is 35 or older since I just turned 35), you were able to successfully have a rainbow baby later, I'd really appreciate it! This was my first pregnancy and I am so scared to try again :(