QuestionHello,
I'm Ruth, I'm 36 and I'm from Colorado. I gave birth to my stillborn son in September of 2011 at 38 1/2 weeks. It was a very easy (first) pregnancy, but at a routine check up his heart had stopped beating. The autopsy showed that he was perfect. What caused the stillbirth was Maternal Floor Infarction (blood clots in the placenta). I was tested for a number of blood clotting disorders, all of which came back negative. We were told to wait 3 months before trying to concave again. We waited three months and were lucky to get pregnant right away (in Dcember). I was put baby aspirin for the second pregnancy. I had a missed miscarriage at 10 weeks, baby stopped growing at 8 weeks, so I had a d&c on Feb 24. My doctor wrote it off as a normal early miscarriage and said it had no relation to the stillbirth. My questions are:
When can we try again?
What should be done with my next pregnancy to make sure it all goes well?
What week would you induce the next pregnancy to avoid MFI?
Is being on aspirin enough or should there be more interventions?
Thank you for your help.
AnswerHello Ruth from the U.S. (Colorado),
I am very sorry to hear about your loss at such a late gestational age.
I'm not sure that I have answers to all of your questions since none of the studies have shown an inherent problem with clotting i.e. any kind of clotting disorder. Did they check for a Factor V Leiden disorder or MTHFR? In these cases, low dose heparin would be indicated to prevent microclotting. If those are negative, then low dose aspirin would be the treatment of choice.
In terms of delivery, with a prior history of stillbirth, your doctor will need to increase their surveillance from 36 weeks gestational age. Most doctors will not induce labor until 39 weeks, but if the dating is well established from an early ultrasound (8 weeks#, then delivery can occur as soon as 38 weeks gestational age. At the very least, you should have NST's #nonstress testing starting at 36 weeks gestational age).
Just so that you know, I agree with your doctor that the second miscarriage may not necessarily be related to the first loss, unless you have the disorder I mentioned above.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
