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Re: lost babyFrom: anonymous@obgyn.netSun, 27 Jul 1997 02:05:49 -0500 (CDT)
At Sat, 26 Jul 1997, D. Ashley Hill, M.D. wrote: > >At Sat, 26 Jul 1997, Lowanna wrote: > >>We called the Dr., went to the hospital to be checked, the nurse couldn't >>find a heartbeat, called the Dr. in hospital for a u/s and determined that >>the baby was dead. > >Lowanna- > >I am very sorry that your family has suffered this loss. One of the >first questions I am asked by a patient who has suffered the death of a >baby is "why", followed later by questions on how to prevent a similar >tragedy in the future. You have many important questions. > >>1. How can stillbirths due to umbilical length and other similar situations >>be prevented? > >Unfortunately, they can't be prevented. Although many of us are quick >to blame the umbilical cord for unexplained fetal deaths, it is >impossible to state with certainty that a cord, in fact, caused the >death. For example, many babies are delivered each year with cords >around the neck that do just fine, so having a cord around the neck, >called a nuchal cord, does not automatically mean a fetal death. So, >when I deliver such a baby, I always look for other causes to be sure >nothing is missed. It may be the cord, but it may not. > >>2. How long can babies be without oxygen and still be safely revived? > >This depends on the health of the baby. There have been a few case >histories in the literature of babies surviving 20-30 minutes after the >mother dies in a car accident, but this is very rare. In general, >babies may die, or be brain damaged, within 4 minutes or so of >*complete* lack of oxygen. Please remember, though, that complete lack >of oxygen is very rare, and is usually due to such things as maternal >heart attack, a blood or amniotic fluid clot to the mother's lungs, a >huge tear in the afterbirth (abruption), or severe maternal trauma (i.e. >car wreck, being shot, etc). > >>4. Is there any way the Mother can monitor the unborn baby for distress or >>problems? > >Somewhat. We usually tell patients to keep track of their "kick >counts". In general, most babies in the third-trimester will kick at >least 10 times in 10 hours. Of course, many babies kick a lot more than >that. If a patient's baby kicks the most, for example, after dinner, I >ask her to lie down for 1/2 hour and count the kicks. If the kicks drop >off by half or so, she should come in for a fetal heart-rate evaluation. >This is not set in stone, and I'll bet that every doctor and midwife has >his or her own scheme for this. > >>6. Would an u/s have been helpful in recognizing a "cord problem"? > >In some cases an ultrasound may identify a cord problem, but not >usually. Plus, we're not sure how to monitor a pregnancy if the cord is >found around the neck on ultrasound. It's probable that the few deaths >caused by this are quite quick, and other than hospitalized, continuous >monitoring, I can't think of any other way to prevent a problem. There >is no value on a baby's life, but nothing in life, including medical >care, is free. It costs about $1000 a day to stay in a hospital, and >since around 10-15% of pregnancies have nuchal cords, you can see how >fast billions of dollars will be spent. Only a few of these 15% result >in a fetal death. So, we need a better way to monitor this situation. > >>7. Is it possible that the babys heartbeat could be so weak that it >>doesn't show on the u/s? > >Possible, but unlikely. Sometimes the mother's heartbeat causes >pulsations of the baby's heart. When this happens we usually quickly >break the water bag and put a scalp monitor on the baby's head. It it >is still in doubt, we do a c/section to give the baby every chance, but >this is very rare. Usually it's straightforward and there is simply, >and sadly, no heartbeat. Although our sadness cannot compare to that of >a mother, father, and their family, I can assure you that when a patient >comes to the labor unit for an evaluation and we cannot find a heartbeat >that it creates a profound sadness for the labor and delivery staff. >Many cry for the mother and father, and all are saddened by the loss. > >>8. The Dr. on call in the hospital said that on the u/s there didn't seem >>to be a lot of amniotic fluid, would this make it difficult to hear or see >>the fetal heartbeat? > >Not usually. The decreased fluid is either a cause, or, more likely, an >effect, of the fetal death. When a baby dies it does not make urine any >longer, and fetal urine is the largest component of the amniotic fluid. >So, the amniotic fluid level drops, and sometimes is gone completely. In >some conditions the baby is not getting adequate oxygen and nutrition >from the placenta, which will decrease the amniotic fluid. If an >ultrasound shows this, we institute fetal heartrate monitoring and, in >some cases, ultrasound evaluation of the baby. We may not find the >cause of the low fluid, but it's an extremely high risk condition. This >may have happened in your daughter's situation, but it's probably >impossible to tell now. > >I hope that with the support of your family that the pain of losing your >grandchild is easier to bear with time. You may want to accompany your >daughter to her doctor's appointment to discuss what testing was done >and to discuss the situation with him. Good luck to you and your >family. > >Ashley > >-- >Ashley Hill >D. Ashley Hill, M.D. >Associate Director >Department of Obstetrics and Gynecology >Florida Hospital Family Practice Residency >Orlando, FL >dahmd@gate.net >
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