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Advice:
Pathologist Report on Fetal Tissue
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The pathologist report came back from my D&C and showed NO ABNORMALITIES! However, they said that there was not any "fetal tissue" examined because there was not any "boney structure" inside the sack. The pregnancy was too early, at 7.5 weeks, and therefore there was not anything to examine. I still do not have a period at almost 8 weeks and my OBGYN was very dismissive and just passed the buck and said talke to RE about hormones. I am at a loss. Has anyone ever heard fo this?
Posted on 06/08/10, 02:17 pm
12 Replies | Most Recent Add Your Advice
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Reply #1 - 06/08/10  6:47pm
" Ugh. I hate dismissive doctors. How are you supposed to talk to an RE about what happened and why when your doctor isn't giving you enough information to understand what happened ?!?

I am not a doctor so what I'm writing is based on what I've been able to learn from the web and from what my own doctor taught me. Consider it as a basis to ask questions rather than an "answer".

From what I know there are many reasons for a lack of boney structure inside the sack, but to know which one applies to you will require another conversation with your not-so-responsive doctor. Either that, or you would need your ultrasounds and pathology report and know how to read them.

- the zygote turned into an embryo but stopped developing prior to 8 weeks. A precursor to spinal cord bones develops in the 4th week (6th week after last menstrual period). However, actual bones don't start developing until the 6th week after fertilization. (8th week after last menstrual period). The arm buds they show in those week-by-week pregnancy pictures are pretty much just soft tissue - the precursors of what will later become multi-layered skin, and muscles, and fatty tissue.

For more information on development: http://www.scienceclarified.com/El-...

- anembryonic pregnancy, a.k.a. blighted ovum - sometimes a sack develops but the zygote never develops within the sack or stops developing so quickly that it begins to be reabsorbed and can't be seen on an early ultrasound - see http://en.wikipedia.org/wiki/Anembr...

- molar pregnancy - the zygote develops into a random clump of cells rather than moving through embryo and fetal stages - see http://en.wikipedia.org/wiki/Hydati...

Since they didn't test the embryonic tissue, I'm guessing no abnormalties probably refers to your own body - the uterine lining and possibly to the sac being a normal sac and not one from a molar pregnancy. But again to fully understand you will need to ask your not-so-responsive doctor to tell you what they meant by "no abnormalities".

The most common reason for miscarriages is a problem with the genetic code. The first trimester is a severe test for the DNA codes that our babies inherited. A tiny clump of general purpose cells is differentiating into highly specialized organs and bones. Each bit of differentiation into a new kind of organ tissue tests a different part of the DNA and sometimes a missing part of DNA or an unusable sequence is found and the process suddenly stops.

There are a few other causes as well - inadequate development of the uterine lining sometimes attributed to low progesterone levels, auto-immune reactions to the fetus, and various sorts of other hormonal problems. When there are 3 or more miscarriages in a row, doctors often suggest testing to rule out these other factors. Many of these other factors can be dealt with medically so it is a good idea to check. S/He's not just brushing you off when s/he suggests you consult an RE.

However, even with 3 it can sometimes be just bad luck, especially if we are trying to conceive when we are older (I'm 45): As we age and our partners age, miscarriage rates go up. Since birth defect rates also go up, one theory for the increased miscarriage rate is that the probability of an embryo with incomplete or scrambled DNA increases. "
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Reply #2 - 06/08/10  7:07pm
" I was so frustrated when the pathologhist's report came back on the third baby I lost. I had miscarried at 10 weeks and my OB's report said there were recognizable fetal body parts. My husband saw them too in the jar that was sitting right by him. Then I get the pathologists's report and it said that it was only placental tissue and there were no recognizable fetal body parts. WTF???? I was not happy. That's the only one I've ever lost at the hospital so it was my only chance out of 5 to have the testing done and somebody F'd it up.
8 weeks does seem pretty long not to have had a period yet. You may have to take progesterone for a bit and then stop it in order for AF to come back again. "
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Reply #3 - 06/08/10  10:18pm
" Diagnosis:
i am beyond frustrated and the level of service just keep getting better. I have called 4 different doctors offices; the one who was covering and performed the d&c because my regular ob was out of town, the maternal fetal doctor, regular ob, and the RE's office.

The nurse at the RE's office said "it is a moot point. If there wasn't anything to test then there just wasn't anything to test" WTF!!! Are you kidding me! So what happened to my baby? Where is the embryo I had been looking at in all the ultrasounds?

The pathology report was vague and I am looking up all of the terms.

Products of Conception: Hypersecretory Endometrium, chrionic villi and decidua, no fetal tissue seen! That is what the pathology report says.

Gross:
received fresh labeled and "products of conception" is 9gm, 4.5 x 4.2 x 0.9 cm aggregate of tan fragmented soft tissues specimen is submitted in RPMI for chromosome studies. Representative sections of the specimen are submitted, with villi in cassette 1.

Thank you so much ladies for responding to me! "
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Reply #4 - 06/08/10  11:56pm
" I don't know much so I won't be of much help.. but I can add that my results came back also with "no abnormalities" and it broke my heart. Why did the baby die then if there was no abnormalities!!! Grrrr.

Massive hugs to you! "
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Reply #5 - 06/09/10  4:04am
" Hi,

If it's any consolation, I had a similar situation back in March. You are not alone :(

A few weeks after the d&c I phoned the hospital to find out why they had never sent the results they said that I had never given them the address of my Dr. Hmmm, I don't remember them asking for my GP's name or that of my gynecologist....so I waited.....

They eventually arrived. I was expecting to find out the sex of the baby and if there were any chromosomal abnormalities. I was really hoping that I could have had some reason as to why this happened. I had a d&c and remember specifically asking if testing would be done. Testing, to me, means finding out what went wrong.

When I showed the results to my old Dr. she said "oh, yes there was a pregnancy". When I asked her what she meant, she said that they had identified the type of tissue and that indeed, it was conception products. Great. No genetic testing was ever done and I will never know why it happened. They simply tested the "tissue" to identify what it was - tumor or fetus. I could have told them that myself. I know what I saw on the screen!!!! They saw it too.


I'm now having my 2nd MC in 3 months. This time it was very early (first one was at 10 weeks). No D&C this time so I'll never know why this one is happening either.

I recently got a letter back from the hospital because I complained about the lack of information given out before, during and after the op.

It states in the letter that the hospital is used to this type of situation because they deal with about 25 D&C's for MCs every week.

I think that just about sums it up. There are too many and it' too common to be high up on their list of priorities to try and find out answers for the ladies that suffer and try to bring them some peace during this nightmare. Like a factory line, pumping them out, day in day out. It's routine and clinical for them. They see it every day. We however, have to live with this for the rest of our lives and personally I would have liked to have known at least he sex of the baby so I can name it and provide it with some kind of identity.

I know that all "tissue" at our hospital goes to the incinerator. I wouldn't have known what to do with it anyway.

I hope you you manage to get some peace and don't be afraid to ask as many questions as possible and be a real pain in the ass.
They may see this every day, but we have a right to be treated with respect and if that means hassling constanly for information then do so!!
xxxx "
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Reply #6 - 06/09/10  6:49pm
" have they checked to see if your Beta has dropped to zero? It took me 4 months to finally get a negative pregnancy test because there was some leftover placental tissue left inside my uterus. I MC on Nov 29 and didn't get AF until Feb 14. "
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Reply #7 - 06/09/10  7:11pm
" I have negative pregnancy tests and still no period! So I have to go in now for an anemia screening and may possibly be insulin resistant. I just got off the phone with the nurse...so more poking me! Ugh! Thank you all of your support and information. It was very helpful to me today when speaking with the doctor's nurses. I agree with you locopoco that they are desensitized to miscarriage and treat you like a used car! I know they see it day in and day out but they need to learn to treat each person as if it is their first time dealing with this kind of devistation. So the journey continues! "
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Reply #8 - 06/10/10  10:58pm
" I'm so sorry for your loss. The pathology report that I got also was that no abnormalities were detected and that my baby was a girl. I was 13 1/2 weeks along.

I figured that nothing was wrong with the baby, but wanted it ruled out as I was 39 years old, nearly 40, at the time and knew that the assumption was be abnormalities due to my age.

I caught swine flu and the fevers got too high (105 F)and I'm sure that is what caused my sweet baby to die.

My experience was that my OB was very cold and clinical about the whole thing. It makes it so much harder to have to deal with insensitive people and doctors.

I hope that you find the answers that you are seeking and receive peace. It took about 7 weeks for my period to return, by the way.

Take care



W "
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Reply #9 - 06/11/10  5:47pm
" Unfortunately, just because you have a d and c doesn't mean that you will get the answers you are looking for. I think that you have to specifically request pathology be done for a first miscarriage, most of the time if its "just one" they don't bother to do anything. I would have been seriously angry if the pathology was not done based on hospital error. Honestly, I think the hospitals and labs just get used to the "routine" of miscarriage and they don't think that this was OUR baby that was lost....not just another medical procedure/test. In my case I was lucky to have pathology done and I found out the reason for my miscarriage (an entire extra copy of chromosomes) but the hospital STILL messed up because they missed that I also had partial molar pregnancy! Because they missed this, I went though HELL 2 months later when I was experiencing many problems. Bottom line...if your doctor/hospital is not helpful and respectful 1. complain 2. get a new doctor!!! I switched to a new doctor and hospital and I am THRILLED to get away from the people who made so many mistakes... "
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Reply #10 - 06/11/10  6:30pm
" I had a similar report back from the pathologist. In my case there was an empty sac because the developing embryo had just disintegrated and had been reabsorbed (as another poster indicated above). The doc said there was nothing left to test, so that's that. The key from the pathology report was that it was not a molar pregnancy, so that was one worry taken care of. She said that these cases usually result from a faulty egg and the chromosomes were probably so messed up that it was shut down very early in the process. Nothing we could do.

As for the length of time it's taken to get your period... please know that it takes some of us a long time. I didn't bleed till six weeks after my D&C, and even then, it ended up not being a real period -- it was just leftover stuff from the D&C. My first real period didn't come until 31 days after that. And I've heard from other women who waited much longer (one woman was still waiting after six months).

You might talk to the gynecologist about how long you should wait before getting progesterone or another medication to "kick off" the process. If you don't get a satisfactory response, I'd go to another gynecologist or go to your primary care doctor (who can refer you to a more caring gynecologist).

My gyno also basically dismissed me after my D&C and said "hope for better luck for you" as if I was just starting all over again fresh. She never prepared me for the hiccups that can follow in the months ahead for so many of us. "

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