Doctor Steven R. Goldstein MD is a top Obstetrician and Gynecologist in New York City for pregnancy monitoring, miscarriage and recurrent miscarriage in NYC. He is a Past Chairman of the American College of Obstetrics and Gynecology, New York Section and Professor of Obstetrics and Gynecology, New York University School of Medicine. Dr. Goldstein is also a former Director of Gynecologic Ultrasound, NYU Langone Medical Center.
With over 25 years in private practice, Dr. Goldstein is most qualified to monitor your pregnancy, particularly if you are prone to recurrent miscarriages.
Miscarriage is the spontaneous passage of the tissue. This takes place one to four weeks after the pregnancy loses its viability. Dr. Goldstein has not had a patient miscarry in more than 25 years. Though Dr Goldstein has had patients experience pregnancy failure, not one has had spontaneous passage (i.e. miscarriage) of the pregnancy and ended up in the emergency room at 4:00 AM bleeding, cramping and needing an emergency D&C.
Why is this?
Thus serial observation with transvaginal ultrasound allows gynecologists following such pregnancies to be sure that they maintain the milestones that are very predictable and that are the best sign of embryonic well being. If a pregnancy were to fail, Dr. Goldstein is able to make such a diagnosis prior to spontaneous passage (miscarriage) and allow for an elective D&C (dilatation and curettage) so that miscarriage in the middle of the night, and emergency D&C is unnecessary.
Pregnancy monitoring and the early detection of a miscarriage prior to its spontaneous passage allows for an elective D&C (dilatation and curettage) procedure. This will allow for chromosomal analysis of the pregnancy tissue to give the couple a better understanding of why the pregnancy may have failed, possibly preventing recurring miscarriages in the future.
A developing pregnancy will produce detectable hormone of pregnancy by eight days post conception. That means it is there and present prior to being late for one’s menses. Home pregnancy tests turn positive at around the time of the expected menses (approximately fourteen days after conception). The rate of rise of hCG in normal healthy pregnancies is extremely well established.
Thus, if there is any concern for the health of a pregnancy, measuring the hCG rate of rise at 48 hour intervals will tell us a great deal about the health of the pregnancy (although, it does not tell us anything about the pregnancy’s location).
In addition to early pregnancy monitoring for miscarriages, there are additional conditions to monitor such as Ectopic Pregnancies, which may not be located in the uterine cavity.
Ectopic pregnancy is when the developing embryo is located outside of the normal uterine cavity. 98% of these are in the fallopian tube. If they develop and rupture, they can cause hemorrhage requiring emergency surgery and transfusion.
Ectopic pregnancy can occasionally result in a relatively normal early development, which may follow normal doubling times of hCG. Usually the hCG level doubles at 48 hours. However, there is a minimum rate of rise of approximately 35-45% in early pregnancy depending on the starting value of testing. Dr. Goldstein has published and lectures extensively on early pregnancy, both its detection by ultrasound and how to diagnose pregnancy failure before miscarriage, as well as, diagnosing ectopic pregnancy early enough to be treated non-surgically with medication.
Unfortunately, in the United States, ruptured ectopic pregnancy is still the most common cause of death in the first trimester of pregnancy. Sometimes there are risk factors for ectopic pregnancy but most cases are not predictable. Thus, it is extremely helpful when a pregnancy occurs to verify its location as being in the uterus as early as possible. This is done definitively with vaginal sonograms by locating the tiny gestational sac within the uterus. Usually this is seen by as little as one week after a patient is late for her period.
Fortunately, most of Dr. Goldstein’s patients call when they have had a positive home test and they can be seen relatively early so as to insure that the pregnancy is located within the uterus and, by serial observation, to be sure that the pregnancy is developing normally.
Research indicates that as many as 22% of conceptual events (in other words, when an egg meets a sperm) will develop minimally and then bleed at or around the time of the expected menses. These have been dubbed “chemical” pregnancies and may be as high as 22% of all conceptions. Many patients feel they have suffered a miscarriage.
Data, however, shows that the occurrence of such an event, although clearly sad, and parents can and should “mourn” the loss of their pregnancy—still need to realize that the prognosis for a healthy pregnancy is 35% in the next month and has high as 83% in the next six months! In other words, such a chemical pregnancy failure is a very good prognostic sign. It means that the woman is ovulating, her partner produces sperm, at least one tube is open, and she is capable of capacitating her partner’s sperm. The prognosis for a couple who have such a chemical pregnancy is infinitely better than her sister, friend or coworker who would like to be pregnant but simply gets her period month after month after month.
Doctor Steven R. Goldstein’s practice tailors appointments to the need of every individual. The Doctor personally deals with every patient, takes all inquiries and performs all tests and procedures. He is the only medical professional you will see on your entire visit. If you are pregnant or suffered a miscarriage please click the appointment below to schedule an appointment with Dr. Goldstein for either early pregnancy monitoring or to see if you are prone to miscarriages.
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