Placental insufficiency — The silent unborn baby killer

Placental insufficiency, also known as uteroplacental vascular insufficiency, is a pregnancy complication in which the placenta fails to transmit enough oxygen and adequate nutrients to the foetus.

The placenta therefore is unable to fully support the developing baby. It is hence also referred to as placental dysfunction. In this real-life account of placental insufficiency — the silent unborn baby killer — a maternity nurse narrates her first hand observations.

Rose was pregnant with her third baby and had come to the hospital believing she was in labour. ‘Rose, I don’t know how to tell you this,’ said the deeply pensive doctor. She looked up apprehensively, noticing that the doctor’s face had changed. Could this be the worst? ‘I cannot trace your baby’s heartbeat,’ the doctor continued…

During pregnancy every woman looks forward to the time when her baby starts kicking and playing. This actually happens from the third month, but the mother only begins to appreciate the joy of her baby’s movements from about 16 to 20 weeks (fifth month) of pregnancy. During this stage the baby kicks and turns, an important sign to the mother that her baby is doing fine.

Her baby did not arrive on the due date

Rose had been through a fairly uneventful pregnancy and was excited as she approached the delivery date. However, her baby did not arrive on the due date. This did not worry her because she knew that the due date was just an indicator and birth could actually be overdue by as much as two weeks. Just before her due date, she had visited the clinic to have her routine checkup. The doctor advised her that since her next appointment was after her due date, if she had not delivered by then, she should go to the hospital as the baby would have been overdue. She was also advised to closely monitor her baby’s movements and consult the doctor if the movements reduced.

Rose was not a first-time mother. She knew that as pregnancy advances and especially towards the end, one may notice that the movements of the baby are less vigorous, since the baby has filled up most of the space in the amniotic cavity and has very little room to play.

Her baby had virtually stopped moving — it was placental insufficiency; the silent unborn baby killer!

Rose had been advised to keep a record of how many kicks her baby made. She did this every morning upon waking up. She would count at least ten kicks in twelve hours, which is the expected level of baby activity.

Sometime during the week. Rose noticed that her baby had virtually stopped moving. She went to the clinic where the doctor found that the baby’s heartbeat was good but movement was constrained by ‘placental insufficiency.’ This meant that her placenta had reached its limit in supporting the baby in her womb, a situation that demanded immediate delivery of the baby.

We will have to admit you right away

‘Your baby cannot move and must be delivered immediately,’ the doctor advised. ‘You are facing a situation known as placental insufficiency. We will have to admit you right away.’

However, Rose knew exactly what she wanted — a natural birth like the one before this pregnancy. She would not let the doctor induce her, something she had only heard other people talk about. She would not accept a caesarean section either. After all, her baby was in great shape, was breathing well and the fact that she was past her due date only meant that labour could be expected any time from now! She opted to wait.

The doctor spent some time counseling her, explaining that she was taking a big risk. Rose was adamant that everything would be alright and that her normal labour would soon start. The doctor made some notes to the effect that she had declined medical advice and Rose signed off the declaration.

We must deliver the baby urgently…

A week later, Rose returned to the clinic early in the morning after suspecting she was in labour. When the doctor revealed that the baby’s heartbeat was suspect. Rose could have fainted, actually she thought she had. She looked up at the doctor, hoping he had not spoken.

She was just imagining things, everything was alright. ‘We must deliver the baby urgently, the doctor concluded.
Emergency measures commenced, with Rose holding onto the shred of hope that the doctor was mistaken. Now she was ready for anything: being induced, a caesarean section, anything. The doctor explained that she would be induced. ‘God save my baby,’ she prayed as the needle sunk into her flesh.

She was soon in labour, which lasted only for a short while before she was ready to deliver. After what seemed an eternity for Rose, the baby was finally delivered.

The doctor anxiously tapped the baby

Suddenly there was a chill in the room, a silence so scary. The expected first cry was not forthcoming! The doctor anxiously tapped the baby, his eyes seeming to delve into the baby’s silent world. ‘Come on…’ he urged. He continued to nudge the baby to respond, but the silence gnawed all hope from Rose. Finally, he turned to Rose and muttered, ‘I am very sorry.’

It was the most empty feeling Rose had ever felt. She could not believe that her baby, healthy with a strong heartbeat only a week ago, was now gone. How she wished she had listened to her doctor! She wept bitterly, mad at her own stubbornness and desire for a natural birth. After two days of counseling and post-delivery care, she was discharged. She knew more than anyone else that no birth is like another. She had come face to face with a silent baby killer — placental insufficiency.

Medical note on placental insufficiency 

As the placenta ages, it may fail to sufficiently meet the demands of the baby. This happens only in some cases and not in every pregnancy. Fetal movements are an important indicator of fetal well-being. It is especially important to pay attention to any significant reduction in fetal activity and discuss with your doctor who will review the status of the baby. The mother may be given a chart to mark the timing of the movements. This is helpful in assessing the baby’s progress and rule out placental insufficiency.

An ultrasound scan may help in evaluating the baby and would check several other parameters. Depending on the severity of the condition, the doctor will advise on the time and mode of delivery. Remember reduction in fetal movement is usually an early sign that all is not well. With the correct intervention the baby’s life can be saved.

END: PG 1/8-9

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