Chances of pregnancy after a stillbirth

Dear Dr Mitchell,I had a stillbirth at 36 weeks. I had no unusual signs before labour. My membrane ruptured at home and I was told to go to the delivery room in anticipation of delivery. It was there, after using the foetal heart monitor and ultrasound, that they discovered our baby wasn’t breathing.

Prior to delivery (vaginally), I had movements, so I couldn’t decipher when the baby stopped moving. The pregnancy period had been wonderful and enjoyable with no abnormalities or complications. During the last trimester, my urine analysis first showed protein, then later an infection – leukocyte. The leukocyte led to a urine culture which showed I had staphylococcus aureus.

The doctor said I couldn’t take drugs to treat the infection due to my pregnancy, and two weeks later, my water broke.

I would like to know if the protein and leukocyte influenced the stillbirth, and if not taking drugs at the time for the infection contributed to it.

I would love to get pregnant again…soonest. I am 33 years old and the pregnancy was my first.

I am truly sorry to learn about the loss of your baby. Premature rupture of the membranes and premature labour can occur as a result of an infection. In fact, an underlying infection is thought to be the most common cause of preterm labour accounting for over 50 per cent of the cases. If an infection is picked up before the onset of contractions or the rupture of the membranes it should be treated. If the membranes rupture or labour is established, it should still be treated to reduce the risk of complications in the neonate and the mother. The newborn will be at an increased risk for infections such as pneumonia, bowel infections and meningitis. The mother is at an increased risk for infections in the uterus and sometimes this spread to the blood causing overwhelming sepsis in the body.

At 35 weeks, the lungs of the foetus is usually mature, but infection in the lungs can cause severe breathing difficulties after birth resulting in admission to the neonatal intensive care unit.

The source of the infection is sometimes the urinary tract, vagina or cervical canal. Bacterial vaginosis and group B Streotococcus are common causes of premature rupture of the membranes and premature labour and these can be readily treated to improve the outcome. Other infections such as gonorrhoea or chlamydia, which are sexually transmitted, can also result in premature labour. A high vaginal swab, an endocervical swab and a urine culture should be done to try and identify the underlying cause of the infection so that specific treatment can be started.

Antibiotic treatment is usually started immediately before the cultures are processed. If necessary, the medication can be changed later if there is a particular resistance to any of the antibiotics based on the culture report.

In the absence of respiratory movements and decreased foetal movements the outcome could be improved by doing an emergency caesarean section to expedite delivery and reduce further distress to the foetus. An ultrasound scan can be done to determine the amount of amniotic fluid that is left back in the uterus and determine the tone, gross movements and respiratory efforts of the foetus. If there is significant comprise of the foetus as evidenced by these parameters, then expediting delivery under antibiotic coverage is the best option for both mother and baby.

Once you have had premature labour with premature rupture of the membranes, it is important to get a swab done at 28 weeks to determine if there is any infection on board. Infections are sometimes silent and so you have to be screened to detect them. Any abnormal bacteria should be treated. You should also get dexamethasone injections to induce maturation of the lungs of the foetus in the event that you have premature labour again. This is usually given at 28 weeks of pregnancy. Screening for toxoplasmosis, cytomegalovirus, herpes simplex virus (HSV-2), rubella, syphilis and human immunodeficiency virus (HIV) should also be done. Toxoplasmosis is contracted from exposure to cats so you should avoid cats (both wild and pet).

Smoking also increases your risk for premature labour and causes growth restriction in the foetus.

The outcome is unfortunate but you are young and will have many normal children. Start taking your high dose folic acid and consult your doctor to ensure that your Pap smear is normal and then you can try for another baby. I wish for you and your family all the very best in the years ahead.

Best regards.

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 Avenue, Kingston 5; or fax to 876-968-2025. 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.