Risks after neonatal death
DEAR DR MITCHELL,
Six months ago I had my baby via C-section and he lived for one day then died. I was diagnosed with polyhydramnios and the baby had a few complications too such as deformities of the ear, foot and finger. My main worry right now is that my period date has passed and I still haven’t seen my flow. I’m scared I might be pregnant again. Is it possible for me to carry the baby if I am? Or will I need to have an abortion?
I am truly sorry to learn about the birth defects and the death of your baby shortly after birth. The presence of polyhydramnios (excessive amniotic fluid) and the multiple deformities of the ear, feet and fingers should be investigated further. This may be associated with diabetes mellitus in pregnancy and so you should have had a blood sugar test done during the pregnancy to screen for this problem. This is especially important if you have a strong family history of diabetes mellitus, if your weight is in excess of 90 kilograms, or if you are on steroids for any medical complications.
A history of polycystic ovarian disease syndrome also increases your risk for diabetes mellitus in pregnancy. In a subsequent pregnancy you will need to be followed up closely and have a repeat blood glucose done at the beginning of the pregnancy, 24- 28 weeks, and at 36 weeks gestation. You should also do a blood test to screen for chromosomal abnormalities at 16-18 weeks gestation. A triple screen, quadruple screen or a harmony screen can be done. All of these tests are available locally. The harmony screen is the most sensitive.
A detailed ultrasound scan done at 20 weeks gestation (anomaly scan) can detect structural defects in the foetus. You should do a urine pregnancy test if your period is late so you can have early screening and prompt antenatal care if you are indeed pregnant.
Do not panic since you can have a successful pregnancy without any complications. The fact that the pregnancy is within six months of your last delivery by Caesarean section means you should get a repeat Caesarean section done at 38 weeks gestation. This will reduce your risk for rupture of the uterus, which is a real possibility after a Caesarean section. The risk is low so there is no need to panic. You should go for prenatal care as soon as possible and start taking high-dose folic acid (5mg daily) and prenatal vitamins. This will help to reduce the risks of birth defects in the brain and spinal cord.
Your delivery should be undertaken in a hospital with access to a senior obstetrician and nursery care facilities.
There is absolutely no need to do an abortion. Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
