Stillbirth causes?

[walster]

My best friend's membranes spontaneously ruptured at 41w3d. Group B strep test negative, no baths. She was advised to go to hospital for nonstress test -- did not go til 41w5d due to fear of induction resulting in Cesarean. Noticed decreased fetal movement, and hospital found no heart tones. Pitocin, epidural, 51 hours labor resulting in C-section.

I need some closure and a clue as to what could have happened. Why would her water have broken and then no labor? And what could have caused the stillbirth? Infection? Something earlier? Any light you could shine on this would be much appreciated.

[Belle]

The thing that comes to my mind first is a prolapsed cord. This can happen when the water breaks and the baby's head is not already engaged in the pelvis.

I'm sorry for your friend's loss.

[kcparker]

Originally Posted by walster

My best friend's membranes spontaneously ruptured at 41w3d. Group B strep test negative, no baths. She was advised to go to hospital for nonstress test -- did not go til 41w5d due to fear of induction resulting in Cesarean. Noticed decreased fetal movement, and hospital found no heart tones. Pitocin, epidural, 51 hours labor resulting in C-section.

I need some closure and a clue as to what could have happened. Why would her water have broken and then no labor?

That happens sometimes and, in and of itself isn't something to worry about, but might be something to act on to try to get labor started. Risk of infection does increase the longer the membranes are ruptured. That is why most hospitals have a '24 hour' rule. But, a BOW can be broken for days and the baby can be born fine.

And what could have caused the stillbirth? Infection? Something earlier? Any light you could shine on this would be much appreciated.

It could be an bacterial or viral infection, a cord accident (compression, a knot), a congenital heart problem that wasn't detected, some other physiological problem with the baby, but often, even after an autopsy and pathology report on the placenta, no cause is ever found for these term deaths. They are often just sad mysteries.

[wombatclay]

My heart goes out to your friend. (Were there no heart ones when she arrived at the hospital? I'd imagine a hospital would do a crash c/s automatically at that point instead of an induction and long labor. If there were tones/movement when she arrived, she may be able to get more information from her hospital records.)

There are many possible reasons for what happened, and it is possible that the sort of closure you want simply isn't available. A babe in a poor birth position (posterior or asynclitic even if they were head down) sometimes results in a "long" pregnancy ending in ruptured membranes without contractions starting up. Infection can also cause the membranes to rupture and although it's not common, there are cases of the babe having an infection while mom doesn't (and mama being GBS free at the time of the test doesn't always mean mama is GBS free at the time of the birth though again, it's not common).

Once the water is broken, the risk of infection does go up even with best practices (though best practices keep those risks fairly low, and "one size fits all" hospital guidelines don't have much research support)... think of bladder infections for example. Sometimes bacteria "moves up" into the bladder despite the general downward flow of sterile urine and good toileting practices. The same thing can happen after the membranes rupture. Also without the cushion of the amniotic fluid it is easier for the cord to get pinched or prolapsed as mom and the babe move around. Sometimes the prolapse is dramatic, sometimes it's a "now and then" pinch that still compromises the babe's ability to function.

I'm so sorry your friend is going through this... if she is up for it, there is a forum here at mdc that may help, and internet groups like Solace that have crisis lines (and I think Solace also offers support for friends/family of mamas in need).