Antenatal fetal death

Asked by: Elena

Female gender

Age: 26

Chronic diseases: not specified

Hello! I really need expert advice.
At 36 weeks, the pregnancy ended in antenatal fetal death. I saw 4 doctors. Everyone says different reasons and further actions. What to do? Who should you listen to?
1st doctor: (passed tests for hormones + infections), not even a month has passed since birth. She identified ureoplasmosis (in me and my husband), HPV (removed papillomas), and erosion. Conclusion: antenatal death occurred due to infection that entered through erosion. I treated erosion (with applications), my husband was treated with antibiotics, and I was treated with suppositories. Repeated analysis: no infection. I didn’t do a colposcopy, but she says it’s possible to get pregnant.
2nd doctor: (passed tests: Polymorphisms of genes of the hemostasis system, full examination, 11 indicators (new block) and Polymorphism of vascular tone genes. Predisposition to hypertensive conditions, disorders
placental function, preeclampsia, myocardial infarction. Microcirculation, vascular tone. 6 show)
Result: Polymorphisms of genes of the hemostasis system:
> FII - 1
> FV - 1
> MTHFR - 1
>PAI1 - 2
>FGB-3
> FVII - 1
>FXI - 1
>FXII - 1
>GP1ba - 1
> GpIIIa - 1
>PLAT-3
> 1 - homozygote common allele, 2 - heterozygote, 3 - homozygote rare allele > Polymorphism of vascular tone genes:
>ACE - 1
>ADD - 1
>AGT-2
> ATGR1 - 1
> ATGR2 - 3
> CYP11B2 - 1
> 1 - homozygote common allele, 2 - heterozygote, 3 - homozygote rare allele Doctor's diagnosis: hereditary thrombophilia, from January 2015 start drinking TROMBOL ACC and become pregnant in February, continuing to drink TROMBOL ASS and during pregnancy, as soon as pregnancy occurs, take a test D-dimer and at the appointment to decide on subsequent actions.
3rd doctor:
Hemostasiologist + obstetrician-gynecologist.
She confirmed thrombophilia, BUT ordered additional tests, exactly at the clinic recommended to her! For comparison, the difference is 6,000 rubles. With other laboratories.
4th doctor:
She says the uterus is ready, even if you’re pregnant right now and give birth! BUT, it’s not possible yet, I need to drink Trichopolum during menstruation for 3 months (since it’s unknown how long the dead fetus was in my stomach) and from the 16th day of birth - 10 days - drink duphaston. In 3 months see her. My head is a mess, who to believe? Please advise!

Sincerely,
Makarova Elena

I'm planning a pregnancy. Caesarean section 26.06. 2015 total detachment. Antenatal fetal death 05/26/2015 Premature abruption of a normally located placenta. Antenatal fetal death. Ber-ti -5. 2nd birth is normal. 2 abortions 1 C-section. I really want to get pregnant again. I can't wait a year or more. Please consult. The other day I took the following tests on my own: white blood cell count. Formula: leukocytes - 2.8. red blood cells - 4.63. hemoglobin 118. hemotocrit-36.8 average. Erythrocyte volume - 79.5 avg. Sod. Hemoglobin in an erythrocyte is 25.5. avg. Hemoglobin concentration in er-te321 platelets 124. platelet breakdown by volume 21.7. average platelet volume 12.90. coefficient of large platelets 43.7 neutrophils 1.50 lymphocytes 39.0. ESR - 18. Please tell me how to treat it.

5 answers

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Hello! What expensive test were you prescribed?

Elena 2014-12-27 20:38

Examination for APS (APA+AT to phospholipid co-factors: annexin V, b2glycoprotein, prothrombin) + determination of homocysteine ​​level
Control D-dimer + Sail test at 20-25 dmts

Logical, but you can wait. Contact a geneticist for additional tests on this issue. And you can take them in the laboratory where you want. She has no right to tell you. Ureaplasma and HPV do not lead to intrauterine death fetus - this has already been proven. Therefore, for now we can consider the working version of doctors No. 2 and No. 3

Thanks a lot! I understand you. But what to do about the next pregnancy? Is it possible to rely on a second doctor, take Thrombo ACC and plan a pregnancy in February of this year?
How to deal with erosion? Could it be she who influenced what happened?
Another thing, after giving birth, the doctors said that I had practically no water? With what it can be connected?
Thanks again for the advice!

Erosion does not affect the death of the fetus, which has also been proven a long time ago. The lack of water could be due to the fact that you have been walking with a dead fetus for a long time, this happens. In any case, I don’t recommend you plan for now. You need to wait at least half a year - the body must come to its senses and cleanse itself. Therefore, the recommendations of the last doctor with the prescription of metronidazole are justified. I advise you to do so. You take metronidazole for 3 months, then an ultrasound for control. Thrombo ACC can also be taken longer. And after at least 4 months you can try. But even better - in 6

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Please help me understand what happened and why. A month ago, our girl was born at 32 weeks - antenatal fetal death, intrauterine hypoxia, placental insufficiency. The girl was born ER, 920 g, placenta - 206 g.

I'm 35 years old, I've had my period since I was 13, my cycle is 28-29 days. Height - 1.62 m, weight - 68-70 kg.
Pregnancy:
1) in 2001 - EP at 38 weeks, boy, weight - 3.0 kg.
2) in March 2013 - ZB for a period of 8 weeks, honey. abortion.
3) in November 2013, pregnancy, antenatal fetal death at 32 weeks.
I. Ultrasound at 12 weeks: ktr - 63, tvp-1; NK - visualization. Blood screening showed a risk of diabetes of 1:85. Rarr - 0.51 MOM, hCG - 1.92 MOM. We decide to do amniocentesis at 17 weeks.
II. Ultrasound at 17 weeks: all parameters are normal, except for the NC - the placenta is shortened and the thickness is increased to 25 mm. We are waiting for the result of amniocentesis. The result is a normal karyotype 46XX.
III. Ultrasound at 21 weeks: shortening of the urinary tract (4.8 mm) and an increase in the thickness of the placenta to 28 mm. Fetal weight - 403 g (normal). Nearby water - 125 (norm). All other parameters and organs are normal, ultrasound the best specialist in the city. An ultrasound is recommended at 32 weeks.

I felt good throughout the pregnancy, no pressure, no swelling. Total weight gain - + 10 kg. The glucose test is good, I don’t remember the numbers, something like 4. I had ARVI - 2 times without fever, and the third time the temperature was 37.1 - 37.4 for 2 days at 29 weeks. My throat hurt all 3 times, I have chronic pain. tonsillitis.
Physically, I helped out at the dacha on the weekends - I was a little tired.
For the last 2 weeks there seemed to be little movement, she told the doctor. I asked about my small belly and whether I needed an ultrasound earlier. In response, don’t make things up. At 30 weeks, the trainee in the office measured the height of the uterine fundus - 25 cm, the doctor jumped up and measured it herself - she said 30 cm, and said that the trainee was a bad student. I wasn’t wary either, I trusted the doctor, and my first pregnancy, even though it was 13 years ago, proceeded without any complications or pills.
IV. Ultrasound at 32 weeks: no heartbeat, fetus at 25 weeks according to biometrics, grade 3 IUGR, anhydramnios.

I was tested for infections (PCR) before pregnancy and again during pregnancy - all negative. According to TORCH - only immunity. The coagulogram is normal, only the hemoglobin at week 21 was 138. I asked the doctor and said that on the contrary it was good.
Now, after reading about FPN, I realized that I had it. It’s not clear why my doctor didn’t see her; everything could have been different. I ask questions in order to exclude such grief in my next pregnancy, I hope it happens to me.

Questions and search for reasons:

1) Could my water leak unnoticed, and because of this, the death of the fetus occurred? At the last ultrasound they were completely absent, where did they go?

2) Work in the country?

4) Blood was donated for thrombophilia gene, 4 mutations were identified: FBG gene (g/a), PAL-1 gene (5G/4G), ITGA alpha 2 gene (C/T), MTHFR 677 (C/T). Maybe I need to inject LMWH? Which doctor prescribes this?

5) Pressure?
Before pregnancy, I didn’t control my blood pressure; on rare visits to the hospital with ARVI, it was 120/80 or 110/70. LCD measurements were taken during pregnancy - always normal. But suddenly they measured it carelessly. I bought a mechanical tonometer - I measure it for 2 weeks - the pressure is consistently 120/90. Could high diastolic pressure have such an effect on the baby and placenta?

6) Age?
What to check first, with which doctors, so that the situation does not repeat itself if there is a pregnancy?

7) How long after can you plan? Only dreams that I will get pregnant help me cope with grief...

The pathologist's report is attached.

Hello! Elena Petrovna, help me understand the situation. On January 15, I had an induced birth at 21 weeks due to antenatal fetal death. I'll tell you in order. First trimester screening was at 11 weeks 6 days. Then the doctor didn’t like the nasal bone (19 mm), everything else was fine. It was recommended to repeat the ultrasound after 2 weeks. I donated blood from a vein for defects on the same day. Everything is fine. The risks are low. A repeat ultrasound also showed that everything was fine. At 18 weeks I got mastitis. The gynecologist prescribed Amoxiclav antibiotics, took it on drink, and everything went away. I was worried that I did not feel the fetus moving (placenta along the anterior wall). Before the New Year, I saw a doctor, and she also said that I didn’t feel any movements. After measuring, the doctor said that the uterus was slightly smaller than normal. On January 4 I went for a second trimester ultrasound. Everything is fine with the fetus, the term was set at 20 weeks/2 days, but the doctor did not like the cervix (29 mm). Reading you, I know that the norm is 25mm and above. On January 14, I went to a consultation to have my cervix re-measured by another doctor. There it was discovered that there was no fetal heartbeat. At the same time, another doctor measured the neck at 43 mm. On January 15, she went to the hospital and had an artificial birth. The weight of the fetus was 450 g, height 23 cm. The fetus was not autopsied because the weight was less than 500g. A scraping from the uterine cavity was sent for histology. The answer came that chorionic villi were found in the scraping.

My husband and I were preparing for this pregnancy. We took all tests for infections in advance and took folic acid. During pregnancy, I often had headaches, sometimes I took paracetamol. At each appearance, the doctor measured the blood pressure: 120/80, 130/90. When I measured it myself at home it was 100/70, sometimes 110/80. My normal blood pressure is 100/60, 100/70. In the first trimester I donated blood for sugar, the result was 5.2. What did the gynecologist diagnose? diabetes and referred me to an endocrinologist. The endocrinologist did not confirm the diagnosis. I myself had my blood tested for sugar in another laboratory, the result was 4.3.

In 2013, I gave birth at 40 weeks. A boy was born, everything is fine. In 2006 there was a miscarriage at 7 weeks. (frozen ber). In 2010, I had a miscarriage at 5 weeks.

Answer please:

1. What could be the cause of antenatal fetal death? Could I have pregnancy hypertension or maybe diabetes?

2. I did not feel fetal movements until the very end. Could there be something wrong with the child, some kind of defects?

3. How can we explain the fact that one doctor measured the neck at 29 mm, and the other at 43 mm? Who to believe? Both measurements were taken with an external sensor.

4. After what time can you plan? new pregnancy? I don't want to wait long. I am 31 years old, my husband is 36 years old. What examination should be completed before planning? In what dose should I take folic acid?

5. What tests can be taken to at least somehow understand what was the cause of the death of the fetus? And how to reduce the risk of this happening again during the next pregnancy?

I will be grateful for your answer!

This is frozen as I understand it? I'll pick it up in 4 months. Only folic saw. In general, they don’t recommend six months somewhere, but I really wanted to... and my brother’s sister is on the trail. It's already been a month since the baby is already two months old. In general, it seems to me that it depends on the period at which it was cleaned....

- @darinkaalinkadominika I was in labor because... I was 34 weeks. what was your deadline?

- @vicky87 19 and 15 weeks, but cleaning😢😢. You had a long term... although after a normal birth, many also take it quickly, as the weather turns out

I was told to wait six months, only a month has passed, and I no longer have the strength to wait..

- @vika_dreamer and at what time did the VPS have trouble?

- @vicky87, 38 weeks

- @vika_dreamer what is the reason? I am in my 3rd month since the tragedy.

- @vicky87, placental abruption, but we don’t know exactly why yet, we’re waiting for the autopsy results

- @vicky87, it happened a year and a half ago, but we just decided to plan it. Psychological condition I haven’t returned to normal, I cry periodically, I avoid people. Did they tell you the reason? I was diagnosed with APS, the blood became thick ((

- @luckat the reason is entanglement and twisted umbilical cord

- @vicky87, everyone gives this as a reason, but in 99% of cases the reason is different. They also told me about the umbilical cord, but I know that there are serious entanglements and everything is fine, but if it’s bad, then a CS is prescribed. Of course, I checked for a long time in search of the cause, since the doctors kept saying about the umbilical cord and that this happens.

- @vika_dreamer, have you taken a genetic test for thrombophilia? Namely factor 7? If there is a mutation for this factor, placental abruption occurs.

- @luckat, to be honest, I just started training, I was told to wait 2 months. And if it turns out that there is such a mutation, is it somehow treated or controlled during the next pregnancy? Sorry if stupid question, I don’t really understand what’s what yet

- @vika_dreamer, as I understand, this happened to you recently?... It’s been a year and a half since I’ve been living with a knife in my heart, it’s hard, but I need to make a decision, it’s been many years now. So we started planning. During all this time after giving birth, I studied a lot of information in search of the cause of my grief. As a result, out of 12 mutations that affect pregnancy, I found 5, but they are general in the population and not critical. BUT!!! I was diagnosed with autoimmune thyroiditis and antiphospholipid syndrome, which most likely became the cause. If you are interested in mutations, I have a detailed post listing all the factors that can affect pregnancy #thrombosis

- @luckat, thank you, your post helped me understand a little, only 2 months have passed since the tragedy and it’s still difficult to get ready.. But this month I’m starting to analyze. I hope everything will be ok, they will find out the reason.

- @vika_dreamer, yes, the main thing is not to give up and hold on, although I understand that this is impossible... I’m still crying and a year and a half has passed since then.

- @luckat what time did you have?

- @vicky87, 25 weeks +1 day, beginning of the seventh month

- @vika_dreamer, more info for you)) in your case, you can suspect a deviation in factor 7, when the blood, on the contrary, does not clot well. During childbirth, this manifests itself in placental abruption, large blood loss, etc. Danko’s wife has such a problem, but she did not know about it, what happened to their youngest daughter is the result of this factor. If the mutation in factor 7 is confirmed, then at some stage of pregnancy they inject some kind of drug, then during labor and immediately after birth. A friend of mine had this happen in her first pregnancy, placental abruption, severe blood loss that she almost died, but the child was saved. During her second pregnancy, she set out to find out the reasons and found it. She was injected with the drug NOVOSEVEN, it is injected according to the schedule closer to childbirth and after, prescribed by a hematologist.

- @luckat well, there was no detachment and I felt physically great after giving birth, but mentally... I have an older daughter, the pregnancy went with a bang

- @vicky87, I wrote about detachment to @vika_dreamer, she had it. And you, like me, could have a predisposition to thrombophilia, on the contrary. In the first pregnancy it may not manifest itself in any way, but in subsequent ones it makes itself felt in such a terrible way ((

- @luckat how did it all happen for you?

- @luckat I have a girl friend who lost 2 children due to AFS. Now she already has 2 children. The third and subsequent pregnancy was successful thanks to timely therapy.

- @vicky87, yes, they told me as soon as I saw II immediately injections in the stomach and Metipred, I’m already taking Metipred at the planning stage. Some people have genetic thrombophilia, others, like me, have APS (((and the result is the same. I’m in Italy, but here they don’t really manage pregnancy like in other countries former USSR, they will look at the urine once, general analysis blood and TORCH, that's all. They consider that if she herself became pregnant, then there are no problems, but they begin to more or less control it when 2-3 pregnancies are lost. In general, immediately after what happened, I was allowed to get pregnant without examination, they said that it happens. I got ready and went to Russia, where our doctors found out everything. In general, it's a kick-ass. I became pregnant quickly from the second cycle, the pregnancy as a whole was normal, there was toxicosis and at 14 weeks I was saved, all screenings were perfect.

- @luckat, what was the cause of death told to you and the clinic?

- @vicky87, at first they talked about the umbilical cord, then that this happens (this is in Italy), and in Russia they named the cause as probable APS, I also had 5 out of 12 factors for thrombophilia, but they said that many people have such mutations, this is a general population variant (all 12 names are indicated in my post), autoimmune thyroiditis was also discovered, this is why I ended up in conservation, probably when TSH jumped. In general, APS is the reason, even when I showed the examination results to Italian doctors here, they agreed that this was the reason.

- @vicky87, this cannot happen without a reason, there is a reason for everything and you need to look for it. In principle, it is necessary to undergo several tests that affect this and this is quite enough. Unfortunately, I know several girls who have gone through the same grief and for all of them the reason is blood clotting, I read in someone that there was a blood clot in the umbilical cord, but this is also on the topic of #thrombosis and clotting. If you are planning a child, just play it safe and get tested for genetic mutations that affect thrombophilia. I have minor mutations, like those, and in most cases they give birth with such mutations, but there is a percentage of those whose pregnancies failed, plus APS apparently worsened the matter (((

- @luckat is all this discovered in the pre-pregnancy period?

- @vicky87, this was discovered after everything had already happened, unfortunately. I began to find out the reason in order to protect myself in the next pregnancy. You can generally take the test at any time, both pre-pregnancy and pregnant.

- @luckat the girl I talked about earlier, nothing was found in her during the pre-pregnancy period, and at the moment of pregnancy she took tests again and began treatment.

- @luckat have you already tried planning?

- @vicky87, we are planning the second month, but I think it has flown by, since I was prescribed Progynova for these 2 months to improve the endometrium, but this medicine suppresses or delays ovulation, so I didn’t really count on the result. I’ve finished drinking, I hope for the best 😊

- @luckat everything will be fine, I really want to feel this magical feeling again, but I don’t know when the fear will pass and my morale will return to normal

- @vicky87, yes, APS must be taken before pregnancy and during pregnancy, and a genetic test for thrombophilia is taken only once in any condition, since this is genetics and does not change

- @vicky87, after a while I can say that there is fear, the pain has not gone away, the moral state is shaky. Girls who have experienced similar things say it will more or less become easier when a healthy child is born. Then morally it will be better

- @luckat I honestly don’t know what it would be like if I didn’t have a daughter. Now I understand that driving myself into grief is not a solution. There is someone to live for and these people need me very much. The only thing I can say is that every day it gets easier, of course there are tears and pain, but I’m pulling myself out of the quagmire

- @vicky87, yes, it should be a little easier for you mentally just because of your daughter, it’s harder for me since I haven’t given birth to anyone yet

- @luckat everything will be and I concluded for myself that the more you worry and worry, that’s what happens. I went with my eldest and didn’t worry at all and everything was ok

- @vicky87, exactly, I agree. I think the excitement comes from a premonition that something is going wrong, the subconscious senses it. So, a week before what happened, I was very nervous out of nowhere, I really wasn’t myself and I had a dream that I was giving birth to a daughter ahead of time and she was taken away and not given to me. And then 3 days later what happened happened((((

- @luckat also stopped feeling movements or became bad?

- @vicky87, in the morning I didn’t feel any movement, I hoped that there would be, in the evening we went to the hospital, they started doing an ultrasound, the doctors looked at each other silently, I realized that something was wrong. Then the doctor came out and a minute later my husband burst into the office in tears and I understood everything, then everything was like a dream, it floated away... On wobbly legs I reached the room, in the morning they began to induce labor, there were contractions for 14 hours and I gave birth at night. My husband was with me at the birth, then they left us with the baby to say goodbye for 10 minutes and took us away. The next day, her husband took her to perform some kind of Catholic rite to the church at the hospital (because this hospital is from the Vatican) and the baby was taken for an autopsy. After some time, we were informed of the date of burial, my husband and I arrived at the cemetery alone in the morning, and we were given a small white coffin. In general, we buried her and now we visit her in the cemetery. In Italy, after 17 weeks, the fetus is considered a full-fledged child and, by law, is subject to burial at the expense of the state. Even if the parents are unable to look at their deceased baby and simply leave him in the hospital and do not want to know anything else, this child will be buried and there will be a cross on the grave. The mother's name and surname are on the cross so that she can find it when she changes her mind.