對於計畫懷孕而喜獲麟兒的婦女來說,胎兒無疑是上天給的美好禮物,有時天不從人願,常在沒有預警下失去了腹中的小生命,這種無情的打擊造成孕婦及家人的傷痛。
懷孕中胚胎或胎兒沒有生命跡象,三個月前稱為流產,週數達三個月之後的流產稱為死胎或是胎死腹中,也有些學者定義20週以後為死胎。
媽媽通常是因為感覺不到胎動或者是在例行性產檢以超音波檢查的狀態下發現。有些死胎發生早在第一孕期,有些發生在接近臨盆甚至在待產中,顯示死胎發生的原因其實是非常多樣的。
發生的原因大致上可以分為與母體、胎兒或與胎盤有關。
與母體有關的原因如母親本身身體的疾病像是高血壓與糖尿病,感染、內分泌、免疫性疾病,與胎兒有關的原因如染色體、基因異常,發育不良,與胎盤有關的原因如病變或是血流不足,臍帶打結或扭轉等,但是約¼的死胎找不出原因。
其他的危險因子像是抽煙、酗酒、吸毒、肥胖與母親年齡等都被認為與死胎的發生有關係
死胎的發生對任何母親來說都是ㄧ件悲傷的事情,以醫生的立場除了安慰母親之外是需要找出最有可能的原因避免下次再發生類似的憾事 。另外如產後憂鬱症其實在這些傷心的母親身上也很可能會發生,家人也需要多注意。
印象中照片為紐西蘭的 Wakatipu 湖。是毛利傳說裡,被勇士殺死的巨人留下的跳動心臟。願傷心過的媽媽們保持勇氣與希望。
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For expecting mothers, babies are gifts from the God. However, some babies are lost unexpectedly, causing grievances for the mother and her families.
Babies that are spontaneously lost during the first trimester are called miscarriages, and those lost after the first trimester are called stillbirths. Although in some countries stillbirths are defined as fetal loss after 20 weeks.
Stillbirths are usually discovered mothers who don't feel fetal movements or incidentally during regular pregnancy ultrasound surveillances. Some still births occur early in 2nd trimester, whilst some occur towards the end of the pregnancy, suggesting different underlying mechanisms.
Causes of stillbirths can be classified as mother, fetus or placenta related. Examples of causes relating to the mother include diabetes and hypertension (or eclampsia), infection and autoimmunity; relating to the fetus include abnormal chromosomes, fetal growth retardation; relating to the placenta include blood flow insufficiency or twisted umbilical cord. Although about in 25% of cases no cause can be found.
Factors like smoking, alcohol and illicit drug, obesity and Mother's advanced age use are related to increased risk of fetal loss.
It is one of the saddest things to see a Mother who lost her child. From an obstetrician's point of view, identifying the cause may help to prevent recurrences of such tragedy. Carers' support and vigilance for mothers who lost their babies is important as postpartum depression can unfortunately also occur.
(Picture is taken at Lake Wakatipu, which from the Maori Legend it is the remaining beating heart of the Giant Matau, who was slain by a warrior to rescue his beloved girl. Hope mums keep hope and courage.)
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