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Izabela, 30, was 22 weeks pregnant when she was hospitalized in Pszczyna. There was an anhydrous situation and the doctors were to decide on a “waiting attitude”, that is, wait until the fetal heartbeat ceased. The woman died within 24 hours. How does septic shock occur in pregnancy? What is the standard procedure for anhydrous 22 weeks gestation? And what has changed after the judgment of the Constitutional Tribunal in the last 12 months? In an interview with Medonet, a Polish gynecologist asks for anonymity.
- Przypadek 30-letniej Izabeli wstrząsnął całą Polską
- Today, many women directly say that they are afraid of getting pregnant in our country. They fear that they may find themselves in a similar situation
- – Personally, I very often see women in my office who directly declare to me that they are afraid of pregnancy, that the child will have defects, and they will not be legally able to terminate such a pregnancy. They are afraid of what they will be able to do in such a situation – admits the gynecologist
- More information can be found on the Onet homepage
The text is part of Action # 20 million reasons. Articles, editorial materials and analyzes will be published on the TvoiLokony website and on the websites: Ofeminin.pl, Noizz.pl, Onet Women, Plejada and Medonet, as well as on Forbes Women. the situation of women, family planning and the situation of prenatal medicine in Poland.
Agnieszka Mazur-Puchała, Medonet: What mechanism worked here? How can septic shock be caused by anhydrous or dead fetus?
Gynecologist: Septic shock can occur as a result of anhydrous effect caused by rupture of the membranes. Facing the disruption of the membranes, an “open gate” is created for the spread of infection from the vaginal side. The environment of the amniotic cavity is sterile, and when a bacterial infection occurs, a straightforward pathway to generalized inflammation of the body is created. Sepsis, on the other hand, is a condition in which the body responds inappropriately to inflammation and infection. The body’s response is then excessive, and as a result, other organs may be damaged, first of all the kidneys.
- Check also: Journalist TvoiLokony: Don’t make us die [COMMENT]
On a case-by-case basis, we cannot say with certainty what mechanism worked here. We don’t really know what happened. We are dealing only with a fairly highly targeted media message, while there is a lack of medical data, hence it is difficult to assess it unequivocally. There are too many unknowns about this.
The rest of the text is below the video.
What is the standard procedure when anhydrous occurs at 22 weeks gestation? What are you doing then?
He waits, he watches, but there is little else that can be done. An amnio-infusion procedure may be performed, consisting in the intra-aquatic administration of a saline solution that is closest in composition to the amniotic fluid. As a rule, however, it is more diagnostic than therapeutic. Because if the membranes are ruptured, the fluid will leak out anyway, there is no way to hold it for a long time.
If, on the other hand, we are dealing with another cause of anhydrousness, such as malformation in the urinary tract of the fetus, then by artificially increasing the amount of amniotic fluid, we can slightly increase the comfort of the fetus, but we will not “repair” its kidneys. Therefore, we will not eliminate the defect responsible for the waterlessness.
What is the risk of anhydrous and what is the survival rate – mother and child?
It is associated with a risk similar to oligohydramnios, and therefore: growth restriction, lung underdevelopment, the risk of intrauterine death and various deformities. As for anhydrous, it is not a condition that is immediately dangerous for the mother, but for the fetus it is. However, the consequences of rupture of the membranes, e.g. in the form of infection, may be dangerous for the mother.
If anhydrous occurs early in pregnancy, the fetus may be completely non-viable as the lungs will not develop properly.
In such a situation, is it somehow possible to detect sepsis in good time and intervene?
Speaking of the waterlessness caused by the outflow of amniotic fluid, each such patient is hospitalized, and antibiotic therapy is also introduced – prophylactically, already at the time of admission to the hospital – precisely to reduce the risk of infection. Inflammation and welfare parameters of both mother and fetus are also monitored regularly.
Therefore, patients are subject to very strict control, monitoring, just to be able to detect as early as possible whether the condition is not deteriorating and, if necessary, be able to react quickly enough.
More than 12 months have passed since the Constitutional Court’s judgment on abortion. Was this year different from the previous one? Has something changed in your daily work?
Zmieniło się to, że obecnie mamy okazję obserwować coraz więcej schorzeń genetycznych płodów. Widać to na oddziale, gdzie przebywają pacjentki z trisomiami, najczęściej 21. pary chromosomów. Dlatego, że w przypadku innych wad i trisomii najczęściej dochodzi do samoistnego obumarcia płodu, a pacjentki bardzo rzadko mogą takie ciąże donosić.
In the case of a trisomy of the 21st chromosome pair, the fetus very often has a chance of survival. However, pregnancy complications such as reduced growth of the fetus or premature rupture of the membranes are significantly more frequent, which requires hospitalization. So there are many more such fetuses with genetic defects today.
What is the situation with prenatal screening? Are they still being done? What if the fetus is found to have a fatal defect? How do the patients cope with it, what do the doctors do?
Of course, when it comes to prenatal testing, absolutely nothing has changed. They are performed in the same way as before, and patients receive exactly the same information about fetal defects, anatomical abnormalities – just like a year ago.
Prenatal testing, especially in the first trimester, in addition to assessing the risk of the three most common trisomies (chromosome 13, 18 and 21 pairs), provides very important information on the anatomy of the fetus and the risk of pre-eclampsia and fetal growth restriction in the later stages of pregnancy.
However, when it turns out that the fetus has a fatal defect, the doctor cannot take any action. Before the introduction of the anti-abortion law, the patient could apply to the commission for termination of pregnancy. Now, even if such a request is submitted, it is rejected. According to the law in force, the patient cannot terminate such a pregnancy.
Personally, I often see women in my office who directly declare to me that they are afraid of pregnancy, that the child will have defects, and they will not be legally able to terminate such a pregnancy. They are afraid of what they will be able to do in such a situation. As a result, some of these women even begin to consider the decision to abandon their procreation plans.
Have women in Poland stopped performing abortions in such situations? Do they keep doing it, only in a less secure way?
It is extremely difficult for me to answer this question. A situation in which in wards more pregnant women with genetic defects can be observed than before, this would indicate that women decide to terminate pregnancy much less frequently than before.
It is worth emphasizing once again that in a situation where the fetus has a genetic defect, the pregnancy is automatically classified as an increased risk pregnancy. These pregnancies are not developing in a normal, physiological way, and the patients then require close monitoring.
A wide selection of supplements for pregnant women can be found at Medonet Market.
Also read:
- “If I had known how seriously ill my child would be, I would not have made up my mind to give birth to him”. Hospice doctor: yes, I sometimes hear these words
- A pregnant woman died after a caesarean section. “Great tragedy”, a storm online
- The doctor joked that “a child gives birth”. Then he jabbed his elbow in the stomach
- Human childbirth in Poland? The gynecologist says why it is so rarely possible
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