Foetal Distress

On 16th August, Angelina, a 23-year-old first-time mum, delivered a macerated (already decomposing) stillborn baby. The baby had died of foetal distress, a condition where the oxygen supply to the baby through the placenta and umbilical cord is compromised, causing heart deceleration or inactivity.

This condition is especially common when a woman has induced labour because then, the contractions are strong. The very strong contractions may compromise the exchange of gases and nutrients in the placenta. I was on duty when Angelina came to the hospital; she was referred to us by a local clinic with a letter that read in part ‘reduced foetal movement with a failed induction’. The failed induction meant that she had been induced (with oxytocin) but the drug had failed to work. The letter also stated that the foetal heart rate was faint. To reconfirm events preceding her visit to the hospital, I enquired from Angelina; whose account differed from the clinic’s.

I did the basic tests-checking blood pressure, temperature and foetal movement. I did not detect any foetal heartbeat so I urgently informed the doctor. The doctor too listened to assess the foetal heartbeat,t and concurred that something was indeed wrong. There was no heartbeat and the doctor instructed that she undergo an ultrasound scan. The scan would show what was going on in her womb. While preparing her for an ultrasound, we counselled her on the possible outcomes. But Angelina was convinced that the baby was fine because, she said, when she slept on her sides she could feel the baby in her womb move from one side to the other.

Angelina got married last year in October and she conceived the following month. She was due to deliver her baby on 21 August this year. According to her, the pregnancy was smooth all the way. She did not experience any morning sickness, or nausea as many women do during pregnancy. She was also lucky to escape the food cravings associated with pregnancy. Neither did she develop any dislike for any food or anything for that matter. She was happy to have had a stress-free pregnancy.

Throughout her antenatal clinics, there were no indications that anything was amiss. Like all first-time mothers, she worried about the baby but the nurses attending to her regularly assured her, that all was well and that there were no foreseeable complications.

On 16 August she developed signs of labour at around noon. She was taken to the health centre where she attended her clinics; she had booked to deliver in the same place. At the clinic she was checked and told that everything seemed fine. She was advised to go home and return after three hours for review, as she was in early labour.

Angelina recalled that while at the clinic, she had complained that she was not feeling the baby’s movements. However, she was assured that everything was fine and so she went back home though she told me, all that was checked in the clinic at that juncture, was her blood pressure. Foetal movement was only examined the second time she went back to the clinic. Strangely, she indicated that she had not been induced, which contradicted the note from the clinic.

Three hours later she had returned to the clinic for review as advised. This time after the examinations were done, the person attending to her noticed that indeed there was ‘reduced foetal movement.’ As the ultrasound procedure progressed it became apparent that the baby could be dead.

Babies doing well in the uterus have strong and stable heartbeats, even with contractions. They show increased activity to appropriate stimulus. Babies in distress however, will respond in a variety of ways, including passing the first stool called meconium while still in the uterus.

Finally the ultrasound confirmed intrauterine foetal death. Meconium was found in Angelina’s amniotic fluid (the liquid which surrounds the foetus in the womb), indicating foetal distress as the reason for the death.

Angelina could hear none of that. She had been totally convinced that her baby was alive. She went into a state of shock. She could not believe that after carrying the pregnancy to full term, she had lost her baby at the last leg. How she had longed to hold her baby in her arms! We also had a hard time trying to explain to her husband, that their baby had passed away.

Nonetheless, I encouraged them by telling them that it was not the end, since they were young and could conceive another baby in future. It was sad to hear her say that she would give away all the baby clothes and accessories, that she had bought. She felt that keeping them would always remind her of the baby she had lost, and make it hard for her to recover from her grief.

END: PG 4 DEC 06-JAN 07/18-19

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