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Pregnancy Bliss | Reproductive Health Hub

‘Golf ball’ in the heart and clinodactyly on a scan

Question:  i am 30 years old. all my test for me 24 weeks foetus were excellent. except a golf ball at the heart and clinodactyly at the one hand. are they dangerous. should we worry for possible syndrome? help me asap please. i am desperate. E. (Greece)

Answer: The term ‘golf balls’ in this context refers to the bright oval shaped areas sometimes seen within the heart of a fetus on an ultrasound scan. They form a group of findings collectively known as soft markers. When there are no other abnormal findings on the scan, isolated ‘golf balls’ are usually of little consequence and, in fact, they are not that uncommon as they are seen in up to 1 in every 25 pregnant women scanned. However, it is also true that they have been associated with chromosomal disorders such as Down’s syndrome. The likelihood of such a diagnosis is increased if and when ‘golf balls’ are found together with other anomalies.

Clinodactyly is a description of a curved finger, almost always the fifth (little) finger. Again, this is an anomaly that has been associated with many different chromosomal anomalies including the more common Down’s, Klinefelter’s and Turner’s syndrome. There are many dozens of conditions which are associated with Clinodactyly. It is also important to  bear in mind that roughly 1 in 5 children born with this physical anomaly will have no identifiable underlying chromosomal or genetic disorder.

I have to say that the presence of cardiac ‘golf balls’ and clinodactyly is and should be a cause for concern. Whilst this baby may very well be completely healthy, it would be important, in my view, that you discuss the merits or otherwise of having a diagnostic test with your obstetrician. He/she will be the person best placed to advise you on whether that would be the right course of action. I do hope it all turns out well for you and your baby.

Hormone injections for recurrent miscarriage

Question: I had had several miscarriages wen i fell for my 27 year old son now i bleed a lot and was on a lot bed rest etc they started o off on 3 hormone injections weekly even though i threatened to miscarry i had a successful preg. The same thing happened with my daughter who is now 22 and again had hormone injections weekly BUT i heard that if you have these injections and it's a girl it's possible that she wont be able to have any children herself. My daughter has never used any conception and has never fallen preg. Is this the reason why? J.T. (UK)

Answer: The information you were given about the effect of the ‘hormone’ injections on a future female offspring is patently false and misleading. It is true that, in the past, it was common practice to administer progesterone injections to try to prevent miscarriage especially for women with such a history as the one you had. Since progesterone produced by the ovarian corpus luteum is responsible for sustaining the pregnancy in its early phase, this practice was based on the assumption that such women may have a deficiency of this hormone which made them prone to miscarry. There was never any evidence of this and the practice has since died out. Current practice is to find the real cause of miscarriage following which evidence-based treatment would be applied.

With regard to your daughter’s apparent difficulty conceiving, I can tell you with absolute certainty that it is not because of the hormone injections you had when carrying her pregnancy. I note that she is quite young but, if she has indeed been actively trying to conceive for sometime (more than 12 months) without success, a referral by her GP to a specialist at her local hospital for proper evaluation and investigations would be the appropriate thing to do. My best wishes.

Pulmonary embolism after childbirth?

Question:  My wife delivered twins babies and after 48 hrs she died. Before delivery her all tests are normal after delivery 30 hrs she is normal after that morning she complained breathing problem that time nurse given oxygen but the problem rises, then they taken to ICU AGAIN they done all test and morning 11 o’clock they said to arrange platelets and after 3 hrs doctors told us she gotten pulmonary embolism. I don't know what actually happened. V.D. (India)

Answer: This is a really tragic case and please accept my condolences. It sounds that the diagnosis given may very well be correct. The immediate post delivery period is the riskiest time  for the complication of thrombosis. Deep Vein Thrombosis (DVT), if unrecognised, can then go on to be further complicated by the far more serious pulmonary embolism. This is when a clot that has formed lower down, usually in the thigh or within the pelvis, is dislodged and travels via the heart to the lungs. It is then trapped in the smaller lung vessels and, tragically, this not uncommonly leads to loss of life. That is, unless it is recognised early and treated very aggressively. Your wife may have suffered this complication. I would hope you will have an opportunity to sit down with the doctors who looked after her to thoroughly discuss the events and have all your outstanding questions answered. This, in fact, should be done as a matter of course.

Positive pregnancy test after fetal death

Question: If the fetus is dead in the womb and there is no signs of miscarriage is it still we will have a positive urine pregnancy test? B.J. (UK)

Answer: Yes indeed. The urine pregnancy test works by detecting the pregnancy hormone called beta-hCG. This hormone is produced in the placenta. Cells of the placenta can remain functional for a long time after the fetus has died and, as such, will continue to produce the hormone albeit in steadily decreasing quantities. As it is, modern pregnancy tests are very sensitive and they will detect quite low levels of the hormone in the urine. The test can therefore continue to be positive for weeks after the fetal demise.