Understanding Infant Loss & Down Syndrome During Pregnancy

Question
Dear Elayne,

My niece lost her infant daughter a week before her due date. The night before she felt her moving, but when she got up the next morning there was no movement. Not clear if they ck the heartbeat before inducing labor but during delivery she said the doctor was crying and said you have a healthy baby girl then they came back and said she lost all her amniotic fluid and the baby was dead. They also said the baby had Down's Syndrome. My niece informed them that she miscarried earlier that year. She had no prenatal care during the first 5 months because she didn't know. We're all confused about the death. It seemed like she should have been a high risk pregnancy they did no tests to confirm. Can u lose amniotic fluid and not know it? My niece said she felt no leakage at all.

Answer
I am sorry to hear of your niece's loss.  The baby's chromosomal defect could have resulted in the fetal demise, although sometimes the cause is undetermined.  The death of the baby could then have resulted in the decreased amniotic fluid that was noted.  However, it is also normal for amniotic fluid to decrease in the last weeks of pregnancy, and measuring this on ultrasound is more of an art than a science, with two different people able to come up with drastically different measurements on the same person.  It is unlikely that the amniotic fluid was lost due to a leak, as it would have been noticeable to your niece.  The previous miscarriage alone would not have caused this pregnancy to be classified as high-risk, but the Down's Syndrome might have had it been detected.  Noninvasive testing for Down's Syndrome, however, is not 100% reliable, and amniocentesis itself carries a risk of miscarriage and stillbirth, so it is not a test that is performed lightly.

The good news is that none of this should have any bearing on a future pregnancy for your niece.