2nd Pregnancy loss 22 weeks....

[Sasha2009]

I am a 36 yr old type 2 diabetic, w/chronic hypertension and overweight. Just lost my 2nd baby at 22 wks. This baby stopped growing@17 wks. I lost my first baby as well at 22wks at age 30. 1st pregnancy loss was due to pre-eclampsia which caused placenta to stop functioning at 20wks. 2nd pregnancy bled from 6 wks to 18wks off and on. No cause ever given for the bleeding. Midwife always stated that cervix was closed and tight, baby was fine and stop having sex. My sugars were controlled by diet & glyburide 2.5mg BID. My BP was never controlled! Ran from 146/85 to 150/90 to 180/103. Took Methyldopa 500mg BID up until 20wks when Labetelol 200mg BID was added at my request for better control.  W/Labetelol the BP went down, but #'s were still 138/80. Had headaches, blurry vision, saw stars and pelvic pain. I was seen once month by the MFM & OB. At appts they stated no protien in my urine but several times ketones in my urine. I received pathology report & blood work. Here were the findings.
Blood work:
All testing for blood clotting disorders ie.. Factor V leiden- Negative
Glucose- Normal
Lupus-Negative
toxoplasmis- Negative
Various virus-Negative

Final pathalogic diagnosis of placenta:
Immature placenta with unremarkable fetal membranes and degenerated three vessell umbilical cord.
Diffuse fibrosis of chorionic villi
retroplacental hematoma
placenta weight 57 grams

I still want to try to have my own baby.  I have decided to lose weight, exercise & continue BP/BS meds to make sure they are both under control prior to pregnancy. Also stayed on prenatal vitamins.  Do you think this loss was due to my BP being uncontrolled again? Pre-eclampsia? Is glyburide a safe med for pregnant women?

[Sasha2009]

Dr. B,
Thank you for your answer. Question...the testing of the lupus anticoagulant, anti-cardiolipin antibody, and perhaps a karyotype.  I know you stated that these tests are looking for any cause other than the obvious blood pressure/diabetes combination. My current OB stated that since I tested negative for other clotting disorders such as Factor V Lieden then there was no need to further test for Lupus. Is this true or rather is it possible to not have any clotting disorders and still test positive for one of the test you suggested? Also when is it necessary to get a HSG done?

[Elaine Brown, MD]

Hi!
I'm sorry for your losses!  And I DO hope you will perservere for a live birth!  You are on the right track with weight loss!  That will help your blood pressure and diabetes both. I hope a good aerobic exercise program is part of your weight loss campaign.

If you were my patient, I would want the blood pressures and blood sugars controlled BEFORE conception as that will reduce your risk of birth defects.  I would also advise you to stop smoking  if you do(you don't do you?).

I would also consider a few other tests (these can run into major $ however)  I would want to test you for lupus, the lupus anticoagulant, anti-cardiolipin antibody, and perhaps a karyotype.  These tests are looking for any cause other than the obvious blood pressure/diabetes combination.

Glyburide is safe during pregnancy, but for optimal control, you might consider switching to the gold standard/ time-honored insulin.  Your blood pressure medications were appropriate too, but even better if you can bring your blood pressure down without medication.  

Finally, for best results during next pregnancy, weekly visits with review of blood sugar charts, blood pressures, and a dietician and MFM from the very start!

By the way--have you had a good eye exam?

I wish you all the best!
Dr B