©Pregnancy bliss 2008

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Pregnancy and Childbirth: The answers

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Maternal conditions that may lead to stillbirth

The readily identifiable condition is what is termed as anti-phospholipid syndrome. In this condition, the mother carries antibodies in her circulation, which attack small vessels in the placenta, seriously compromising its function. This may lead to early miscarriage or, if the pregnancy survives till late, a stillbirth.

People with SLE are quite prone to this problem. However, the majority of women who are eventually found to carry these antibodies are otherwise healthy and there would have been no cause for concern prior to the miscarriage or a stillbirth.

Every woman who experiences the tragedy of stillbirth is investigated for presence of these antibodies.

 

Dealing with anti-phospholipid syndrome after a miscarriage or stillbirth

For somebody confirmed to have anti-phospholipid syndrome, the one bright ray in the bleak aftermath of a stillbirth is a realization that, there is treatment to prevent the effects of the syn­drome in future. This is despite the fact that the underlying condition cannot be completely eliminated.

 

An appropriate treatment regime (which lasts the entire course of the pregnancy) has a potential for a successful outcome of about 75%. This is compared to a possibility of less than 25% of the baby surviving if no treatment is used.

 

 

Other maternal causes of stillbirth

Conditions such as chronic kidney failure and rare clotting abnormalities may lead to fetal death in the uterus. The latter condition, if identified, can be successfully managed in subsequent pregnancies.

 

Infections causing stillbirth

Every protocol for investigating stillbirth will include screening for possible viral infections. The known rogue viruses which may infect the fetus and lead to its demise include parvovirus, CMV, Rubella and a few other less common ones.

 

Non-viral infections which may cause stillbirth include toxoplasmosis and syphilis.

 

Haemorrhage inside the womb leading to stillbirth

The afterbirth (placenta) sometimes detaches, either partially or wholly, from its base. This leads to bleeding which could be so severe as to lead to fetal death. Sometimes the bleeding remains concealed with no visible outward blood loss. This condition is almost invariably associated with abdominal pain. When the placental separation is extensive, fetal death is so rapid as to be practically unpreventable. This condition is called abruptio placenta or ‘placental abruption’.

Placental abruption is associated with cigarette smoking. Cocaine drug abuse in pregnancy is a definite cause. However, for many cases of abruption, no cause or risk factor can be identified.

 

Prenatal care and its role in preventing stillbirth

Standard antenatal care has a crucial role to play in preventing stillbirth. Not infrequently, a pregnancy may be identified where progress is unsatisfactory.

 

Growth of the baby may be noted to be slow and an ultrasound scan may confirm this as well as identifying reduced amniotic fluid volume. The latter is often (not always) a sign that all is not well with a pregnancy.  The scan could also show reduced blood flow in the umbilical cord. All these features may be identified at the time when the mother is unaware of any problem.

 

 

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