# Bloodwork after stillbirth



## expatmommy (Nov 7, 2006)

I posted in someone else's thread, but thought I should start one with my own questions.

We asked for *all* the testing when Max died in utero at 22 wks on Feb 3, but they didn't take any blood from me on the day of my delivery. Did I miss a window of opportunity to take the blood?

They did do an autopsy (although they waited 4 days & I think may have missed vital info as a result) and testing on the placenta, results pending.

My doc told me I'd have to wait until my levels were down to test for the clotting issues. Is that true?

Would my blood show if it was listeria or some other infection? That is my big concern about why he died. Am I too late to find that out?

Should I ask for bloodwork now & if so, what do I specifically ask for?


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## AbbeyWH (Feb 3, 2009)

i was told my midwives to wait (Ugh!) the 6 week postpartum to get tested
and we too are waiting on autopsy and placenta results which we are told could take months!!!
The waiting is hard
i want to DO something because the powerlessness i feel is so strong
but my guess is that if you had listeria it would show up in the baby or placenta
and we have to wait for our bodies to get back to normal to know what our little loved ones were living with
Let me know what you find out
and i'll be curious to hear the wisdom of the mothers who have already paved this painful route for us


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## Megan73 (May 16, 2007)

I'm sorry you're having to wait - it's SO hard when you need answers.








But yes - you do need to wait six weeks after delivery to see you if have a genuine clotting disorder or just a normal increase in clotting factors during pregnancy.
Here's a link to common tests done after stillbirth:
http://www.stillbirthsupport.org/tests.htm


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## Vermillion (Mar 12, 2005)

I had a ton of blood work done right away. I think they were looking for Thyroid issues, infectious type stuff, antibodies, etc. I had a concern about BV, I tested + for it shortly before my little one passed. My midwife told me that if that had been the cause of death, they would have known from the waters and the baby. I'm not sure if that would be the case with listeria.

Quote:

you do need to wait six weeks after delivery to see you if have a genuine clotting disorder or just a normal increase in clotting factors during pregnancy
I never had any more tests after the delivery, not blood work anyway. Is this something they could test me for now? Before TTC again, or does it have to be in a certain amount of time after delivery?

Sorry to barge in with my own question, but I didn't even know about having to wait for clotting tests, I figured that was part of the original blood work.

So sorry for your loss


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## SMR (Dec 21, 2004)

they took a ton of blood from me while i was in the hospital giving birth. Then a couple months later ran the blood clotting stuff. FOUND NOTHING!


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## mamacita angelica (Oct 6, 2006)

first of all, i am sorry for your loss. they should have taken blood and urine at the hospital to rule out an infection with you, but i believe they would test max during an autopsy for infections. they will test the placenta for that as well. i heard about infections first from the urine sample in hospital, and then later, from placenta pathology. but everyone else is right, they have to wait until all your pregnancy hormones are gone for testing for the clotting disorders. maybe i am an ignorant about listeria, but wouldn't you have an infection for listeria, and then your child get it? meaning, would you be really quite ill from listeria first?


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## expatmommy (Nov 7, 2006)

Apparently you can have no symptoms with listeria & minimal symptoms with 5ths Disease & it can still cause stillbirth.

Part of my angst in all of this is due to where we live in the world. I feel like something in my environment or that I ate played a part in the death of Max. If it did, then it would be motivation for us to change some things before having another child and would open discussion with dh's employer about our living situation.


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## orangefoot (Oct 8, 2004)

Quote:


Originally Posted by *Vermillion* 
I never had any more tests after the delivery, not blood work anyway. Is this something they could test me for now? Before TTC again, or does it have to be in a certain amount of time after delivery?


You can have thrombophilia (blood clotting) screening at any time as long as you aren't taking any blood thinning medications.

I am so sorry for your loss and the pps too. For those of us with blood clotting disorders we see that things like Protein S deficiency, Protein C deficiency, Factor V Leiden, MTHFR and others are common culprits of losses like yours but often undiagnosed.

You may have to press your care providers for testing but if you are found to have any thrombophilia there is medication you can take which will protect you and your child in a new pregnancy so finding out is something worth doing.


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## JayJay (Aug 1, 2008)

Good on you all for getting the work done







It was so obvious why Josie had died that we never did have an autopsy on her. But then at the time, I just couldn't handle the idea of anyone dissecting her - I couldn't have it anyway - so I said an outright "no". I think autopsies are great and SO useful, but emotionally at the time, I couldn't do it. I don't regret that decision - I mean, she died of blood loss following a placental abruption and we already know what caused that.

I wonder, I might have felt differently after if she'd died of unknown causes, I expect. But then like Shannon said, sometimes they still don't find a darn thing...

*HUGE hugs* to all of you!! XXX


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## expatmommy (Nov 7, 2006)

Quote:


Originally Posted by *JayJay* 
I wonder, I might have felt differently after if she'd died of unknown causes, I expect. But then like Shannon said, sometimes they still don't find a darn thing...

For me, this was my 4th pregnancy with the first 3 having absolutely no complications & with 3 healthy babies at the end. The only difference is that now I live in another country with a marginally safe food supply.

There was nothing to indicate to me that this one would be any different, except I didn't get a very big belly & baby didn't move as much as I remembered. I tested positive before my period was even due. I had the same morning sickness for weeks on end. I didn't spot or bleed or anything. At 15 wks Max had a good strong 156bpm heartbeat. My first inkling that something was wrong was at 22 wks when the u/s tech said "you know your baby is dead, don't you?" What kind of mom doesn't even know her baby is dead?!?

I need to know that I've done everything I can to find out "why?" If it was environmental (infectious disease) then it will affect whether I can feel confident trying again in the country where we live. If it was chromosomal, then I want to talk to a perinatologist to see what that means. If it is possible to know, I need for my own healing to know I've done all I can to find out.


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## JayJay (Aug 1, 2008)

Oh, totally expatmommy - I totally agree. It's different for everyone, you know - there's a right choice for everyone. I mean, there's no "right" way to deal with any of this - the process is so individual. I dearly hope you get a whole ton of answers and that they can be resolved







*HUGE hugs*XXX


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## Jane (May 15, 2002)

I'm so sorry for the loss of your son.

This is the best article that outlined tests that can be done after the loss of a baby older than 20 weeks. It's a little rough, perhaps, on a greiving mama, so consider when/if you want to read it. http://emedicine.medscape.com/article/259165-overview

Here's the relevant quote

Quote:

Commonly accepted tests

* Thorough maternal history
* Fetal autopsy
* Placental evaluation
* Karyotype
* Indirect coombs test
* Serologic test for syphilis
* Testing for fetal-maternal hemorrhage (Kliehauer-Betke or other)
* Urine toxicology screen
* Parvovirus serology

Useful in some circumstances

* Thrombophilia evaluation to include the following:
o Lupus anticoagulant
o Anticardiolipin antibodies
o Factor V Leiden
o Prothrombin mutation
o Protein C, protein S, and antithrombin III deficiency

Uncertain utility

* TSH
* Hemoglobin A1C
* TORCH titers
* Placental cultures
* Testing for other thrombophilias
The ones that are time sensitive (the ones you perhaps can't have because of the time delay) are:

* Testing for fetal-maternal hemorrhage (Kliehauer-Betke or other)
*Your body will rapidly remove his blood from your bloodstream, if present, so this isn't useful now. However, if he sustained that much bleeding, there is usually clinical evidence that you'd already know about.*
* Urine toxicology screen
*Only helpful to the medical personal in detecting unknown drug use. Not a big issue if you're the one inquiring - you'd know if you used drugs.*
* Parvovirus serology
*You can still be tested to see if you have been exposed. If it's a concern, you should still be able to get two test 6 weeks apart to see if you're developing antibodies over time (a sign of infection)*

TORCH titers - ie, listeria, that you'd get from food - these usually cause really evident changes in the baby's brain. It's not someone that's subclinical (no evidence seen) in most all cases.

I do think it's frustrating that they didn't draw blood, if just for the idea that they care about finding out the answer to the mystery of his death. But you haven't lost the chance to get answers in this.


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## expatmommy (Nov 7, 2006)

Thanks Apricot, that was really helpful.

I am going in tomorrow for bloodwork. I think my doc has ordered most of the things on your list, except for the prothrombin mutation & TORCH titers.

I'm not sure what to do about the TORCH titers because I'm not exactly sure what the pathologist is testing. Apparently those results will take 6-8 weeks.

Also people keep mentioning MTHFR & I'm not sure what test actually tests for that.


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## MI_Dawn (Jun 30, 2005)

Bumping this for some of those who have just joined us... great resources here for tests you can have done after stillbirth.


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## expatmommy (Nov 7, 2006)

Funny coincidence, I got the final bloodwork in yesterday.

Nothing. Nada. No reason given for why my baby's placenta hemorrhaged. No clotting factors. No infections.

My homocysteine was high immediately after birth, but now it is within normal limits.

The one thing that will haunt me always (and make me unreasonably mad at my doctor) is that she didn't take an amniotic fluid sample at the birth to be tested for Listeria. She knew I worried about that but didn't know how to test for it & so we missed that window of opportunity. It is the one thing they can't test for by autopsy.

I want to trust that it won't happen again, but I don't know how to do that.


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## MI_Dawn (Jun 30, 2005)

Quote:


Originally Posted by *expatmommy* 
Funny coincidence, I got the final bloodwork in yesterday.

Nothing. Nada. No reason given for why my baby's placenta hemorrhaged. No clotting factors. No infections.

My homocysteine was high immediately after birth, but now it is within normal limits.

The one thing that will haunt me always (and make me unreasonably mad at my doctor) is that she didn't take an amniotic fluid sample at the birth to be tested for Listeria. She knew I worried about that but didn't know how to test for it & so we missed that window of opportunity. It is the one thing they can't test for by autopsy.

I want to trust that it won't happen again, but I don't know how to do that.

Why did you suspect listeria?


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## expatmommy (Nov 7, 2006)

I live in a very big country in Asia where the food supply is constantly suspect. It was my gut reaction as soon as I found out Max had died. I had the worst all day vomitting for months sickness with this pregnancy, so if I had contracted listeria I likely wouldn't have even realized it.


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## AbbeyWH (Feb 3, 2009)

i don't know for sure?
but i think if you had lysteria bad enough for it to have effected your son it would have shown up in the autopsy no matter how late they got to him? it's so hard to know if your vomiting was food related and not just hormones? i know that when my placenta came back with signs of infection my midwives and consulting ob said it was probably post bacteria and not actually an infection because Milos' autopsy was clean, and i had no fever or irregularity in my pulse. so maybe you can ask your care giver if they remember any other more conclusive signs of infection you might have had prior to your loss. hope this is helpful?


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## tillfordburrows (May 24, 2009)

I'm so sorry that Max isn't with you and your family, mama. In the physical sense, anyway...









The testing after the stillbirth of my son was an obsession in those early weeks. It is so hard to go through all of that stuff hen you are so deep in the grieving process. My husband and OB thought I was just making things worse, but there was no way I couldn't investigate everything. We did have the autopsy done on our little Benjamin, and that is hard to think about, but I am glad we did. I couldn't stand having lingering doubts. Everything came back (autopsy, placental pathology, labs) negative so we are at a loss for what happened to Benji at 35 weeks. It is so hard for me to accept that there are no answers for me. It really makes you start to distrust the medical community a little doesn't it? I also have no answers as to why I have had a previous miscarriage at 10 weeks and have had complications in other pregnancies. Blind faith is really hard to have. But I hope that you exhaust every avenue you can in trying to find answers. Even if you don't find anything, that is all we mothers can do now. Please take care.


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## MI_Dawn (Jun 30, 2005)

Quote:


Originally Posted by *tillfordburrows* 
It is so hard for me to accept that there are no answers for me. It really makes you start to distrust the medical community a little doesn't it?

I don't understand their attitude, generally. If there was a 40% unknown medical explanation rate in any sort of other death, they'd be all over it! Why not with stillbirth? Why isn't the research happening? It's like it's invisible until it happens, and even after it does, no one wants to talk about it anymore...


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## expatmommy (Nov 7, 2006)

Quote:


Originally Posted by *MI_Dawn* 
I don't understand their attitude, generally. If there was a 40% unknown medical explanation rate in any sort of other death, they'd be all over it! Why not with stillbirth? Why isn't the research happening? It's like it's invisible until it happens, and even after it does, no one wants to talk about it anymore...

Exactly!!

I think the 40% unknown rate is due in large part to doctors telling shocked & grieving parents "we'll probably never know why, better just to grieve and move on" and then not doing time sensitive investigations into why it happened. If every one was investigated fully, I am convinced that much much more would be known.


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