Question: My wife & baby died due to rupture as stated by doctors,it was the first delivery,one hour before delivery doctors said the case is totally normal, they induced her and one hour before delivery the child died (they checked through ultrasound,no rupture) they did a normal delivery and after three hours my wife died, can anybody let me know that any natural cause could happened and could not be seen through ultra sound or it is a negligence or rupture happened during delivery? N.A.Z. (Pakistan)
Answer: Can I first of all extend my sincere condolences to you and other members of the family for this truly horrific event. This is clearly a case where you need to get full answers as to what happened. Regrettably, this may not be the place to get those answers because I or anybody else not involved in the management of your wife’s delivery does not have all the facts to give you a credible opinion. I can only give you general views. First of all it is exceedingly unusual for uterine rupture to occur in a first pregnancy. That is, unless the woman has had surgery to her womb previously. That is one thing that leaves me puzzled in this case. You said the baby died one hour before the birth. Presumably this is when the rupture occurred (if indeed this was a rupture). If a scan was performed after a rupture then the diagnosis should have been obvious and delivery would and should have been expedited. Normally if a rupture occurs, a vaginal delivery is very difficult if not impossible. An emergency caesarean section has got to be carried out to deliver the baby and, more crucially, to save the life of the mother. That should not take one hour. At most, delivery should be achieved within about 15 minutes to stem internal bleeding. Let me also add that a diagnosis of uterine rupture does not require an ultrasound. Any qualified person will recognise this event almost instantly. As I said earlier, since I do not have all the detailed facts of this case, I am unable to give you specific answers.
I expect that the hospital that conducted the delivery will arrange to meet you and your family to discuss this event fully and answer all your question. They have a professional, moral and legal obligation to do so.
Oligohydramnios (reduced amniotic fluid)
Question: oligohydramnios how to create? What are the pathological or genetic factors? E. (Ethiopia)
Answer: Oligohydramnios refers to lower than normal amniotic fluid for the stage of pregnancy. Normally, amniotic fluid increases steadily in quantities as the pregnancy advances, reaching a peak at around 36 weeks gestation. Thereafter the quantities gradually go down until delivery. In some cases, scans will reveal that the quantity of amniotic fluid is lower than normal. The first potential cause that will need to be looked at is whether there has been a membrane rupture (‘waters have broken’). This is easy to rule out since the woman will report draining fluid vaginally.
Other causes of reduced amniotic fluid are more difficult to establish. These could range from fetal kidney abnormalities, genetic or chromosomal disorders and quite often, obscure placental dysfunction. Reduced amniotic fluid always means careful monitoring of fetal well-being is required because these babies are at increased risk of perinatal morbidity and mortality. You will find more details on this subject here:
Question: I was wondering if you could help me. Reading about the botox for vaginismus treatment - would by any chance you know if this is carried out anywhere in the UK? J. (UK)
Answer: My advice would be that your first stop should be your GP for a referral to a gynaecologist at your local hospital. It may be the case that there is somebody with a special interest in this area at your local hospital who may be able to help, first of all by making sure the diagnosis is correct and discussing with you the management options available to you.
If you have already done all that then it may be the case that your GP may advise you on a specialist near you who is able to explore whether Botulinum (Botox) injections are a suitable therapeutic option for you. I note from your IP address that you are in the South East. The role of botox for vaginismus and painful sexual intercourse is discussed here:
Question: I am pregnant with six weeks.My doctor told me that gestational sac formed is not to interior part of uterus which is biconcavate in shape?She advised two weeks bed rest with some injections. Is my baby safe?Tensed very much. S.T. (India)
Answer: I think what you mean is that your uterus is bicornuate. This abnormality of the womb is not uncommon. It means the upper part of the womb cavity is partially divided into two. The cavity appears heart-
shaped (see image below). In a few cases this has been associated with increased risk of miscarriage but this is by no means the norm. Most women with a bicornuate uterus conceive and carry their pregnancies normally without any problems. The one potential problem definitely associated with a bicornuate uterus is the increased possibility of requiring a caesarean delivery. Because of the shape of the womb cavity, a baby is likely to lie in an abnormal position especially towards the end of the pregnancy. That may make it impossible to achieve a successful vaginal delivery meaning a caesarean section becomes inevitable. I am not sure why your doctor is advising bed rest. Bed rest has no role to play in preventing a miscarriage. It is an old practise which has been discredited and abandoned. It was common to advise this in the past in a case of threatened miscarriage. I am also unsure what the ‘injections’ offered are. They are probably progesterone hormone injections. These too have no role to play in a case like yours. I am afraid it appears unnecessary anxiety has been created in your mind. Unless there are other issues, a bicornuate uterus by itself does not justify those measures you mentioned.