Pregnancy
Rarer complications
A few women experienced very unusual complications in pregnancy, sometimes with a risk of stillbirth.
Obstetric cholestatsis
One rare complication in later pregnancy is obstetric cholestasis, a problem with the mother's liver. The only obvious symptom may be that the woman's skin feels uncomfortably itchy, which makes it difficult to diagnose. One mother was told she had an allergic reaction and it took a while before anyone realised it was obstetric cholestasis. When the condition was diagnosed, she was offered an induction of labour within a few days. With hindsight she felt she could have asked for more tests earlier, and suggested there should be more information in pregnancy books about the condition.
Another woman with the condition was diagnosed very quickly, but was shocked to be sent home on the bus with information that said she could be at risk of stillbirth. She rang the hospital when she got home and was reassured, but had to wait over a bank holiday weekend for another appointment. After that she was checked every day and booked for an induction at 38 weeks, but went into labour spontaneously two days before the induction.
When she developed terrible itching the midwife sent her to hospital to check for obstetric...
When she developed terrible itching the midwife sent her to hospital to check for obstetric...
Mother' No. Then what happened was, everything was, everything had been fine with the pregnancy, completely fine. And then when I was about thirty seven weeks pregnant I woke up one night, and I had terrible it-, I was terribly itchy, from head to foot I was itchy. And it was a nightmare, really itchy. And it was a really, it was the start of the really, really hot summer, so it was an incredibly hot night. So I just assumed that, I had been a bit itchy on my tummy while I was pregnant and had been for tests once for obstetric cholestasis, because they do that as a routine. If you go to the GP here with itching they, as routine, send you for testing. So I'd been tested for it and there was nothing, they didn't find anything. It was just basically pregnancy itching. And so, but it hadn't been anywhere near as bad as this. So as it happened I was seeing the midwife, the midwife was coming to visit me the next day.
Father' And everybody was saying, 'Oh, you know, it's the hot weather'.
Mother' And everyone was saying, 'Oh, you're always itchy, it's really hot, you know.' And the midwife was pretty much saying "Well, it's really hot, you know. It's not at all surprising that you're itchy, but I would like you to go and be tested again for obstetric cholestasis. So I troiled up back to the hospital thinking, 'Oh, this is a complete waste of time but the midwife said do it, so I'd better do it.' And they tested me and I went away. And they then phoned me up that afternoon and said, "Well I'm sorry, we'd like you to come back in again. We need to do more tests, but we're suspicious that there might be a problem.' And so I went back into the hospital and they gave me a scan, and they did monitoring of the baby's heart beat. And basically it turned out that yeah, I'd got obstetric cholestasis, which is a liver condition.
And the reason why I was itchy was because of the bile acids in my body that weren't being processed. So they said, "Well, yes, it is cholestasis. And we've got some information about it. Here's some medicine for, you know, here's a prescription for the medicine."
But by this time it was 5 to 5 and the pharmacy closed, in the hospital, closed at 5. So I rushed off with the piece of information that they'd given me about cholestasis and my prescription for medication from the pharmacy, and got the medication, and then walked to get the bus home, and started reading the information, which basically told me that with cholestasis there was a risk that the baby could be stillborn. So I was standing at the bus stop with a piece of information off the Internet about obstetric cholestasis that told me I might have a stillborn baby. So I was completely in pieces.
(For more information see The British Liver Trust and NHS Choices).
Vasa praevia
Another, very rare condition is vasa praevia, in which one or more blood vessels from the placenta or umbilical cord lies across the entrance to the birth canal (the cervix), beneath the baby. Often the condition is not detected until labour begins, when the blood vessel may rupture. This can prove fatal to the baby, as a mother who had the condition explained.
Vasa praevia is a very rare condition in which a blood vessel from the placenta or umbilical cord...
Vasa praevia is a very rare condition in which a blood vessel from the placenta or umbilical cord...
No. Before my daughter was born I knew nothing about vasa praevia. I'd never heard of it. I don't think anybody in my family, or anybody I spoke to at that time had heard of it. Everybody's aware of placenta praevia, and other complications. I think they're quite well publicised, but before she was born, no I didn't know anything about it.
When the consultant came to say he thought that might be what had happened, did he explain what it was?
He did, the consultant did give a, a brief kind of description of what he thought had happened, about vasa praevia. He explained what that meant - that the vessels from the placenta are lying across the opening to the womb, and when they had broken the waters they had severed this, this main vessel, which had then meant that the baby had been haemorrhaging. But then again they wouldn't be able to confirm again until the pathology result came back, because that would show them exactly the aberrant vessel, where it was, and if that was the case we'd be able to see it. And as it turned out it was a velamentous insertion of the cord, and you could clearly see it through the placenta, so. But that took - we had to wait on that confirmation coming back.
Can you explain what vasa praevia is?
[laughs]
Just in a very ordinary way.
Vasa praevia is a rare complication of pregnancy, that happens about one in every two and a half thousand pregnancies. Within it the vessels from the - either the umbilical cord or from the placenta, lie across the opening to the womb, and obviously when labour starts these vessels can be pinched off, causing oxygen starvation for the baby, and could lead to brain damage, or they can rupture if there's no intervention - if they haven't been detected, these vessels can rupture, and once they rupture the babies effectively bleed to death, if there's, if it hasn't been detected before.
So otherwise healthy babies would die during delivery?
Yes. These babies are perfectly normal. These pregnancies are perfectly normal, healthy babies, and then, if it hasn't been detected with scans beforehand, the, these babies' lives are at risk. These, 96% of the babies who are not detected are lost. They do - they die.
Why was this never detected before you went to deliver?
It - the vasa praevia wasn't detected because it's not the standard of care within the UK to scan routinely for vasa praevia. There are very few places within the UK where they actually do scan for vasa praevia, and at the moment it's not - it's not routinely done. There are women, categories of women who are more at risk of developing the condition, but they still don't even scan these women.
She had been booked for an induction. The condition was discovered when staff broke her waters and suddenly there was a lot of blood. She had an emergency caesarean, which was frightening, but it all happened so quickly there was no time to ask questions. The baby needed resuscitation immediately after birth and there were concerns for a long time that she might have brain damage. (She is now five and developing normally). See also 'When something is wrong with the baby'.
Her waters were broken during an induction, and suddenly there was a lot of blood. Staff...
Her waters were broken during an induction, and suddenly there was a lot of blood. Staff...
So when, when they said to you, "Look, we've got to go to theatre", what was your, what kind of state were you in at that point?
I think when you have, when you're told that you have to go to theatre, and you know there's something wrong, you can, you - you sense there's something wrong anyway, by the, by the faces of the people, the medical staff who are round about you, who are obviously trying to keep you calm and reassure you, and, but it's still very frightening, because again you've lost control, and you don't know what's going to happen to this much longed-for baby. So it is very frightening, and you've got all these questions that you want to ask, but there isn't really time to ask anything. It's just got to - you've got to get in and they can get that baby out as quickly as possible, get them delivered as quickly as possible. So very frightened, very frightened, and very concerned about what the outcome for the baby would be. But again you've just got to put your trust in thenmpeople that do this day in and day out, that's why they're there so.
Did they explain to you what they thought might be going on?
Not at that point, no. They didn't - at that, at the moment that the vessels ruptured and I had to get to theatre, for the emergency section, they didn't have time to explain things. All they were able to tell you was that there was severe bleeding, a lot of bleeding, and the baby had to be delivered quickly. And they were going to get you to theatre, and you would be sedated, you'd be under a general anaesthetic and have surgery, but that was it. It was very quick. It was within five or six minutes, and that was you [laughs]. You didn't know anything about it, and the surgery went ahead, so until I came round, no, I didn't know anything else, anyway. So I didn't get a chance to ask any questions at that point.
The baby needed resuscitation immediately after birth and there were concerns she might have...
The baby needed resuscitation immediately after birth and there were concerns she might have...
How did you feel when, when they told you that that was a possibility?
It's, it's very shocking to think that this was a perfectly healthy baby, and a perfectly normal pregnancy, and that there's going to be something - there could be something wrong with your baby, and that there's a possibility of something like cerebral palsy developing and everything. My husband and I both knew that whatever happened we would still love her, because she was the most wanted baby, so we would still love her whatever happened, but it still, that still doesn't make it any less devastating news, to think that there could be problems ahead for her, and more battles for her, so it's, it's very hard.
Because vasa praevia is very rare, this mother was very concerned that other women and health professionals should be better informed about it. She devotes considerable time to raising awareness. The International Vasa Praevia Foundation and UK Vasa Praevia awareness websites can provide more information.
Last reviewed May 2017.
Last updated August 2010.
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