In occasional pregnancies thedies at some time between the twentieth week of pregnancy and its birth. Some of the more frequent causes of this mishap have been mentioned in this article: toxemia, premature separation of the placenta, and placenta praevia. The death of a fetus within the uterus does not jeopardize the mother’s health; in fact the maternal organism shows no reaction to it except for gradual loss of the weight gained in pregnancy and regression of the swollen breasts of pregnancy to their pre-pregnant size, a sign pointed out by Hippocrates, the father of medicine, twenty-four hundred years ago.
Psychologically, it is very difficult both for the patient and her family. It all seems so useless and unrewarding. Then, too, there is a certain revulsion to carrying anything dead within the body. This is a complication of obstetrics which thoroughly tests the maturity and emotional stability of all concerned, even the doctor’s.
The diagnosis of fetal death is frequently called to the doctor’s attention by the patient’s reporting that she has not felt the baby move for a day or two. This prolonged absence of fetal movements is significant only in the last few months of pregnancy; previous to this the patient’s failure to note such fetal activity for a day or two is wholly normal. Care- ful examination by the doctor fails to detect a heartbeat. These two pieces of evidence—the cessation of fetal movements in late pregnancy, and the doctor’s inability to hear the fetal heartbeat—are not absolute, since the occasional healthy fetus may be quiet for twenty-four or forty-eight hours, and in rare instances the sound of the fetal heart is temporarily impossible to detect. A new diagnostic tool is the fetal electrocardiograph. When in doubt, a tracing is made through the mother’s abdominal wall A live fetus almost invariably gives a positive tracing (EKG).
Labor may begin spontaneously any time from a few hours to sixty days after the fetus’s death, the average interval being two to three weeks. When labor occurs it is usually normal and relatively easy. A few days after fetal death the doctor may attempt to initiate labor by the injection of Pitocin or by a brand-new technique we call ‘salting out.’ A needle is introduced into the uterus through the abdominal wall at a point just below the navel. A half-pint or more of amniotic fluid is withdrawn, and a half-pint of very strong sterile salt solution injected into the uterus through the same needle. Labor then commences in twelve to twenty-four hours. We have had no failure yet in a moderate number of cases.