Tuesday, October 2, 2012

Intra uterine foetal Death ( IUFD)

Intra uterine foetal death is a morbid topic to talk.But it is a fact of life and pregnancy.No gynaecologist can escape it and neither could have I.
Yesterday I was revising my RCOG Guidelines on IUFD.It is always good to study.Keeps you up to date and makes you a confident doctor.You know what your talking or dealing with.
And slowly as I was reading my mind wandered to all those IUFDs which (Late Pregnancy losses inside the womb) my patients had in my last 5 years of private Practice as senior Consultant at Max Gurgaon.I could recollect 3 of them very vividly.
First one was in the very first year of my practice.I am not sure wether it was IUFD or fresh still birth which happened after the admission .That is an enigma to me still.There was this lady who had PCOD,had conceived under my treatment for PCOD.Her scans till level 2 scan were reportedly fine.She was obese and was gaining constant weight as pregnancy advanced.It looked like an avg size baby.She was gaining 1,5 to 2 kgs every month.And then she came in labour at terh.I as well as my registrar put a CTG machine and thought there was the foetal heart beat which vanished suddenly.Asked for scan.Showed a loss of heart beat.Baby was growth retarded.I had failed to pick the growth retardation it seemed due to belly fat.The liquor around the baby was hardly any.Baby had potters syndrome.The ultrasonologist had missed it.So I delivered a dead baby.I don't know whether the baby was live on arrival and died after the CTG machine was put in or actually we mistook the MOTHER'S PULSE FOR BABY'S HEART BEAT,
 The baby's father then mentioned that ultrasonologist suspected some problem with bladder filling but she never mentioned it on paper.The HOD radiology came to the defence of his team witha book which suggested that for bladder problem a repeat scan at 24 to 26 weeks was needed.So if I didn't ask for it ,it wan't  his team who was at fault.My HOD tried to 'save' me by saying the baby had died before the mother came to the hospital.I like a stupid fool kept on insisting....I did hear the heart beat on admission.Any ways the parents wished to sue the radiology team.I insisted'the fault was mine if I took body fat for baby's growth'.Sue me if you have to.And despite their grief they said a big NO.Doctor.......you can't be wrong.I felt their pain.And then for a short while till they left the town they always came back to me for any gynaecological advice.I was the blessed one.My patient's trusted me.Atleast they trusted my intentions.
Second one was even more sudden.A on going healthy pregnancy.C/o sudden loss of foetal movement at 32 weeks.She kept on waiting for 24 hours of loss of foetal movements.Primigravida.Usg later.....No heart beat.Was actually difficult to break the news.I cried and they cried.It was bad.Anyways....terminated the pregnancy.6 weeks later showed antiphospholiid antibody positive.I had a reason and a treatment to offer.They never returned back to me for their second pregnancy.But it was painful.
Third one had a happy ending.There was this too well read a lady with PCOD with GDM who had big fights with her husband and her in laws.In my opinion all of them were contributing to the fight.At 34 weeks,reported to Max emergency with no foetal moveents.USG.IUFD.Counselling wasn't too difficult.She was prepaired for the worse due to loss of foetal movements and being a well read person as she was.Her in laws thought me to be an unlcky doctor for her,suggested change of doctor and suggested me to do a hysteroromy.Challenged their daughter in law if her doctor would be able to deliver the baby vaginally.Anyways she did deliver vaginally.Even I thought she was someway responsible for foetal death due self induced hypoglycemias with insulin leading  to foetal hypoglycemia.But baby was born it had 5 to 6 tight loops of cord around the neck.I felt ashamed to have been judgemental.Anyways despite her family's objection she returned back to the doctor i.e me whom her family had declared unlucky.She had her whole pregnancy on insulin.At 38 weeks I induced her and she had a bonny baby girl.
It was a roller coaster ride for me all the three times.
Usually following an IUFD the doctor is considered unlucky whether actually contributing to it or not.It was good that my patiets showed faith and returned back to give themselves and me a second chance.
Believe me IUFDS are no less traumatic for a doctor.....

No comments: