Evan and Postmaturity
The autopsy we had done after Evan’s death said that Postmaturity was the cause of death. I have been doing ton’s of research on this since that day. Thinking about it today.
- When post-mature the neonate has lower than normal amounts of subcutaneous fat and reduced mass of soft tissue.
- The skin may be loose, flaky and dry.
- Fingernails and toenails may be longer than usual and stained yellow from meconium.
(My Evan had all of the above, his finger nails were long, like abnormally long, his skin was loose and flaky and he had passed meconium)
- Before delivery there may be reduced fetal movement.
- A reduced volume of amniotic fluid may cause a reduction in the size of the uterus.
- Meconium stained amniotic fluid may be seen when the membranes have ruptured.
(I did notice reduced fetal movement, no one told me this was reason for concern, instead I was told this is normal in days leading up to delivery especially with such a big baby. When my waters broke, it was obvious that there was Meconium staining, but again, I have been told that he likely passed meconium in labor and that is normal for post term babies and does not explain stillbirth)
Previous prolonged pregnancy increases risk of recurrence in subsequent pregnancies 2-3 fold.5
Few pre-natal risk factors are known. However recent work suggests an association with:
Well-only one of the three apply here, I did not consume fish as I hated the taste and smell of it during pregnancy, I have only had one pregnancy so Primigravidity does not apply here as I am 0 for 1, however, my current BMI is 35, so that is a boarderline risk factor accoding to many studies. I am always boarderline-
- BMI over 35 is bad they say, I am 35 just on, BUT was 33 when I get pregnant with Evan.
- Lupus Anticoagulant test-1.3 (Normal is 1.2-so this is mildly mildly significant)
- PTT-40 (Normal is 36 so something to watch for…)
Management of prolonged pregnancy in the absence of other complications is controversial.
- The Royal College of Obstetricians and Gynecologists guidelines recommend that women should be offered induction after 41 weeks.2
- Women who decline induction should be offered increased antenatal monitoring from 42 weeks, consisting of twice-weekly cardiotocography (CTG) and ultrasound estimation of single deepest amniotic pool. A pool depth of <8cm indicates increased intrapartum risk to the fetus.9
- If expectant management some sources recommend labour should be induced at the beginning of the 43rd week.8
However in a recent randomised trial there were no differences between induced (at 289 days) and monitored groups (every 3 days) in neonatal morbidity, mode of delivery, and general outcome
****Sigh!! So in the end it all means nothing, we have made no leaps nor bounds, there is evidence that the risk of stillbirth does increase after 42 weeks, but there is evidence that monitoring or induction does not necessarily change anything or increase your oddsof better outcome. So where does that leave me? Back at square one I suppose with nothing but hope on my side. I do wonder every day why they didn’t offer an ultrasound or Non Stress Test after I hit 41 weeks, I mean it was my first pregnancy, how the hell was I supposed to know what I needed, I had just finished reading a crapload of power birth books that assured me my body knew how to do this, I figured he just needed a bit more time and ripen and would come when he was ready, I wanted to let him choose his own birthday instead of me choosing it for him. I realise in hindsight, I had no clue, I did not read any materials outside of possitive birth and natural birth, I think I should have had a more well rounded view of pregnancy and birth. I thought I was invincible, I am hubled now. I also find myself appaled that Miscarriage and SIDS are part of the regular prenatal classes, we learned 101 things about SIDS but not once was Stillbirth mentioned. It should be, it’s scary I know, but so is SIDS, mothers should know, numbers, odds, and signs of distress. I sure wish someone had told me, I know now that I knew Evan was in distress and I second guessed myself, talked myself out of it and my child died as a result. This could have been at least partially prevented with education, I just really beleive that. ******
Ok. Back to work now.