On the mother, we can do a lot of blood testing. We can test to see whether the mother has any evidence of the viral infection. We can check the mother's blood by a specialized test called a Kleihhauer-Becke test to see whether there has been evidence that the baby has been hemorrhaging into the mother. We can check the mother's blood sugar level to make sure she is not diabetic. We can check her thyroid level to make sure that the thyroid is working normally. And we can also check for disorders that increase the risk that the mother's placenta may clot. This would include diseases like the antiphospholipid antibody syndrome, automimmune disorders and protein S or protein C deficiency.
Finally when the baby is born, it is important to send the placenta for pathology because the placenta pathology can tell you whether there is any infection of the placenta, whether the placenta itself was malfunctioning and not working well. We can also get cultures from the placenta to see whether parts of the cord were from an infection of the placenta. Finally, it is important to sometimes send the baby for autopsy to examine the baby by the pathologist to see whether there are any defects inside the baby that may not be detected on the outside.
How do you go about effecting delivery?
Once we make a diagnosis of a still birth, obviously the mother has to deliver. There are two main methods of delivery. If the pregnancy is less than 22-24 weeks, some specialists may do a surgical procedure. The advantage of the surgical procedure is that it is short and is relatively painless. Otherwise, most parents probably delivery using some medications to induce labor. In that process it usually may be long but the advantage is that the baby is delivered intact and the mother may bond with the baby. The baby can also be sent for autopsy. Or the parents can decide to do some kind of burial services if they so choose.
How would you manage a subsequent pregnancy?
It depends on whether we found a cause for the still birth. In most studies that look at still births, you can usually find a cause in half of the cases. If there is a cause, that needs to be treated. For example, if the mother has severe diabetes or she has severe hypertension, that needs to be treated before she gets pregnant. If she has the antiphospholipid antibody disease or other disease that increase the risk for excessive clot in the placenta, she may need to be put on heparin during the pregnancy. If there is any infection, then that may need to be treated. If there is a risk for birth defect or chromosome abnormalities, she may need to have an amniocentesis done in the next pregnancy on every ultrasound to make sure that baby does not have that problem.
If it's unexplained, that is, we cannot find any cause why the still birth occurred, the next pregnancy is still somewhat high risk. It would be suggested that the mother live a very good lifestyle -- no smoking, no drinking, use of vitamins and also use folic acid. When she gets pregnant we'd like to do an ultrasound very early to make sure that the pregnancy is viable. And we'll probably also may have her using baby aspirin because that may sometimes help in the pregnancy.
During the pregnancy we will want to do ultrasound regularly to make sure the baby is growing well. And once she gets into the last three months of pregnancy, we want to start doing testing of the baby once a week to make sure the baby is doing fine.
The mother should probably be delivered when she gets 37 weeks to make sure that we get a live baby.
What kind of emotional support is available for families experiencing still birth?
Usually most hospitals have a support system that includes the nurse, a social worker, a psychologist and a minister that can help the mother and the family during the acute phase of bereavement. After the mother has gone home, most communities and most hospitals have therapies where there are groups of people that can lend support. There are actually some other programs where you may have somebody who have gone through the same process, call at home and offer words of encouragement. Some hospitals have very nice books with poems and a list of resources that you can follow on. Finally, there has been a lot of online programs that offer support services for people who have been bereaved.