Friday, November 27, 2009

Reply to Sean Coles

Dear Dr,

my wife and I lost our daughter this week at 40 weeks. My wife had at least five ultrasound scans due to her age 40 years . We were informed that everthing was fine with the baby and it was developing as normal. Her last scan was at 37-38 weeks and again nothing was mentioned of conern. She visited the midwife on Tuesday 20th October, when she was informed that everything was alright. This appointment involved a blood pressure and urine test as well as the midwife listing to the baby's heart. My wife questioned the midwife about the heart beat not being very loud, but was assurred that it was ok. The midwife referred my wife to the hospital for a carbohydrate blood test the following day. We received the result as being normal on Thursday 22 October. On Sunday morning at 8.30 am my wife noticed a small jelly like discharge. We rushed to the hospital where the doctor conducted a scan and heartbeat monitor. Sadly no heartbeat could be detected a second doctor conducted a scan but this confirmed the same.Obviously devistated my wife then had to endure a 48 hour natural birth, knowing what the outcome would be. When the baby was finally delivered, it was found to have the umbilical cord wrapped around the neck tightly, no less than 4 times. There was obvious sore markes and damaged sknin on the baby's neck, presumably where the cord had been. Please can you help. Should the hospital have noticed this during the numerous scans that had taken place during my wife's pregnacy, or as one of the doctors told me , it would not have been possible to detect this.

The baby was difficult to birth as it's neck was pulled back
We have decided to have an autopsy and our daughter has been sent to a hospital in London. Her body is due to return this week.

Thank you for your time .

Regards


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Hi, Mr Sean Coles,

It is very regrettable for this terrible incidence happened to your family. You have my full sympathy. I hope your family could gain the strength and determination to overcome it.

Cord-round-neck is a common incidence to happen during antepartum period. However, this condition rarely lead to fetal in-utero demise. It is because the cord entanglement to the neck is usually very loose and rarely resulting in neck strangulation.

It is important to perform an autopsy to investigate for the cause of death before we can make any conclusion that the demise is related to the cord round neck.
The autopsy should include:
1) Fetal chromosomal constitute to exclude chromosomal abnormality.
2) Fetal blood for bacterial culture to look for possibility of in-utero fetal infection
3) Internal organs examination for any internal organ malformation
4) Placenta for any infarction/ infection/ blood clots.


After exclude all the possibilities above, then only we could possible link the death to the cord round neck.

Unfortunately, the clinical management guideline is not available in the Royal College of Obstetricians and Gynaecologists (RCOG) of London. Most of the doctors will consider cord round neck as a benign condition as far as the fetal heartbeat and the fetal growth rate are not compromised.
This condition could be detected by using umbilical Doppler scan to locate the position of the umbilical cord.
In my own practice in Malaysia, I usually perform cord round neck screening at 36 weeks of pregnancy.

If the cord tightly entangles the neck, I may advise the patient for early delivery.

i hope my opinion is useful for your reference.

Warm regards.

Dr. Jason Ong.

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