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Delivered via C-section, baby died immediately due to lung problem. What is the problem and what are the preventative steps?

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My name is XXXXXXX,and i am from Andhra Pradesh.I had delivered a baby girl through c-section on 23rd march 2012 and our bad luck was the baby immediately expired with in 10-15min.It was my first delivery and i am completely depressed.Just before delivery also the fetal movements and heart rate were good.

my LMP is 12-06-2011 and my Husband is My Mothers Elder Brother Son.

The doctor told us that the baby was not able to take breath and there was some lungs problem.They were not able to tell the exact problem;the gynic told us that when the baby came out she cried for a second and immediately stopped crying,and the heart rate went low,then they immediately called a pediatrician very closeby and they tried to pump air in the mouth and tried pressing the heart,inspite of all the efforts the baby girl was not able to survive and she immediately died.


What i want to know is by the above symptoms,can we tell what the problem is and what can be the preventive steps to prevent this.The delivery happended in a district headquarter called "Anantapur" which is in Andhra Pradesh.Actually till ninth month starting we had consultation in Fernandez Hospital which is in Hyderguda,Hyderabad and every test perfomed was normal till that time[BP and sugar were also normal],so we came to our hometown for delivery.


The Doppler Test taken one day before the delivery is attached.According to Doppler the EDD is 25/04/2012
The ultrasound scans done on November and January are attached.According to Ultasound scan's and as per by gestational age, the EDD is 20th March 2012.
can you please explain Why this difference between ultrasound and doppler report?
Does this tell that Ultrasound Test is Not Reliable?
In the Attached Fetal Anamoly Report,it says the lungs are normal.Does this mean that after November the lungs didn't grow as expected (or) the Ultrasound Report is not precise?
Are there any tests which can access lung's functionality and tell us the complete lung growth?
Posted Mon, 21 May 2012 in Child Health
 
 
Answered by Dr. Santosh Kondekar 1 hour later
hello there
Dear XXXXXXX

here are the answers to your queries:

can you please explain Why this difference between ultrasound and doppler report?
---The EDD (expected date of delivery) estimations by machines depend on what part of fetus was easily seen and measured. some errors do occur for example cross sectional head size if measured by machine one cm higher than widest, can make the baby look small and give a delayed EDD. Both machines use similar principles.

Does this tell that Ultrasound Test is Not Reliable?
=== single reading is most unreliable especially later in pregnancy. earliest USG EDD will best correspond to EDD by dates. Serial repeated scans may give more clear idea. if the baby growth is affected for some reason, it may show a small size and hence late EDD with single scan.So if sonography shows 35 weeks at full dates, may mean, either the baby is really 35 week premature and /or growth of head is retarded due to some reasons.

In the Attached Fetal Anamoly Report,it says the lungs are normal.Does this mean that after November the lungs didn't grow as expected (or) the Ultrasound Report is not precise?
=== Lungs are solids till birth. Normal means , no gross abnormality. It cannot pick up minor points. major development of lungs is only at birth, with first cry, lung solid fluid is squeezed out and lungs becomes aerated. So scans before birth cant comment how much lung is normal. Even after birth, we take xray and not USG scan to check lung issues.
Severe oligohydramnios(as in your report its is 5, normal is 10 plus) is also known to be associated with severe (non correctable) lung abnormalities.
Are there any tests which can access lung's functionality and tell us the complete lung growth?
==== not easy before birth, in fact it may be risky before birth. After birth, there are some tests for lung maturation done with amniotic fluid. Lungs usually don't expand if the surfactant responsible for opening of lungs to normal may get affected, as in premature babies. But there are many possibilities like say congenital nonexpandable lungs, swallowing of amniotic fluid by baby or swallowing of meconium by baby or some rare congenital defects of lung and esophagus (food pipe), all cannot be easily diagnosed easily after birth and all may present as delayed cry or no cry. Also, general anesthesia if given to mother may make the child respiration depressed. Also, the doctors may explain a newborn death in simpler words, whatever the problem may be , like say "lungs didn't open or heart did not beat". Doctors often ask a postmortem of baby in such situations. Occasionally there wont be a reason, that is called as a stillbirth (baby couldn't breath or beat)
SO the possibilities behind baby couldn't breath are too many to make a firm diagnosis. In my practice, often it is a serious heart disease since birth.
In your case, there is possibility of some lung issue in view of severe oligohydramnios, though nothing could be proved.
I hope this answers your concern. Write back if any details needed.
thanks
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XXXXXXX had already written to me for this, here is the answer that i posted last time.

Dear,

It's sad to note such a mishap. Following is the explanation for the same;

1. The sonography reports do suggest that child was premature (35 week) even though dates show full term (dates can go wrong). Premature babies have a probability of having underdeveloped lungs, that fail to breath and can cause serious issues if not intervened in minutes. Further heavy (2.5 Kg) premature babies also may be related to sugar disturbances in mother, such instances can complicate the matter. In this case there were no sugar issues with mother.
2. If the pediatrician had arrived late (which I hope it is not within 10 minutes), the golden hour for resuscitation may have lapsed. Complications are higher if golden hour had elapsed.
3. Reason for Caesarian section isn't understood; maybe it was due to oligohydramnios. A Non Stress Test (NST) test before surgery would have helped to know if baby had problem inside the womb. You were told all was normal.

I understand you would have been deeply hurt by this event. My suggestion for prevention are:

1. Register for delivery at a central institute like say Apollo Hospital, which has a Neonatal Intensive Care Unit (NICU) attached and has a pediatric doctor available round the clock.
2. Insist for presence of one relative and also a pediatrician inside Operation Theater or labour room even before baby is born.
3. Get evaluated before next pregnancy for mother's and father's chromosomal studies.
4. Conduct fetal anomaly scan in first trimester. Blood Pressure and sugar needs to be checked regularly during pregnancy. Let mother be on folic acid and iron supplements in advance.
5. Frequent monthly Ultrasound/ doppler to check circulation/placenta will help.
6. NST whenever any issue is noted like say leaking, infection, fever , labour pains etc, will help understand distress to baby and take adequate measures if feasible.

Right now, Visit a psychological counsellor to adjust coping with depression , especially for mother.

Hope this helps. Thanks for the query. Feel free to ask any further query if any.
Above answer was peer-reviewed by
 
Follow-up: Delivered via C-section, baby died immediately due to lung problem. What is the problem and what are the preventative steps? 33 minutes later
Thanks For the Reply

With the below point

"Lungs are solids till birth. Normal means , no gross abnormality. It cannot pick up minor points. major development of lungs is only at birth, with first cry, lung solid fluid is squeezed out and lungs becomes aerated"

In my case,i can assume that since the baby cried once,the lungs functionality started and it immediately stopped working due to some severe lung defect issues.Is it right?Will Ventillator help in this case?

 
 
Answered by Dr. Santosh Kondekar 14 hours later
hi again
i think you have understood most issues well.
The cry needs to ve vigorous to open up lungs. often single cry equals no cry.
The possibility mixed hidden defects cannot be ruled out.
Ventilator and prompt ICU stay could have theoretically helped some way. My concern is with presence of child specialist in operation theater will have a better impact on survival.

good day and thanks.
Above answer was peer-reviewed by
 
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