I’m a specialist screening/fetal medicine midwife

[FMMidwife]

Obviously I can’t comment specifically on peoples individual pregnancies or plans of care, and there is a really informative and brilliant AMA below by a midwife. But if anyone had any questions about this specialist area I’d be happy to answer.

Background.... trained in economically deprived area, but have been working in a very middle class (and therefore older mothers, and therefore more issues with abnormalities) area for 11 years. Primarily worked in triage, birth centre and home birth before specialising two years ago.

@HJWT I wouldn’t know enough to comment on your individual case, sorry

@gubbsywubbsy I’m sorry you’ve felt people haven’t been honest with you. Obviously I don’t know the individual details of your case but ime our doctors are much more likely to give a guarded prognosis than vice versa.

@Poppiesway1, nobody has asked me for my qualifications, I just started a thread.

I had a baby with Edwards Syndrome when I was 29. How unusual is this? Just reading that the women you see are usually over 40?

Hi there, what does tachiachardic mean. I am sure I have spelled that wrong. Sorry. On my 1st labour they kept saying she is a little bit tachiacardic. I didn't know if they meant me or the baby. It was a natural birth and she was a big baby almost 10lbs. I have always wondered! Thanks

Tachycardic = fast heart rate. Can be a sign of distress.

How would severe toxoplasmosis infection of a foetus be missed at 12 week scan- just too young of a foetus? My apologies if this is out of your remit.

My baby died after a massive acute fetomaternal haemorrhage. How long do you think the timeframe is from when the bleed begins (the blood loss was over 90%) to when there is irreversible brain damage/no quality of life for the baby if he/she were to survive? Do you also have views on what causes the spontaneous cases - I wonder if the placenta structure can be faulty and that makes it more susceptible but would be interested to hear your thoughts (a full post mortem was unable to find out the cause in my case). Do you also think there could be a link between a FTM and another pregnancy with IUGR?

Hi @FMMidwife my understanding was NiPT was only available privately apart from in the trial area in north east/ central London. Do the NHS offer it elsewhere?

Thank you op. Really interesting thread.

I've got to say, I'm a little startled to hear you talk about terminations that you don't think are the right choice. What happened to a woman being the best judge of what she can cope with and what is right for her?

I've recent read that the age of the father can make abnormalities more likely as well as the mother, so if the mother was 40 and father say 55 would there, in your experience, be more risk than if both were 40? Hope that makes sense

I often hear from the forced birthers stories about 'miracle' babies where a fatal foetal abnormality was diagnosed but after deliver the baby was absolutely fine.

I am always surprised as my impression was that the technology and scans were so good now that this would be highly unlikely ?

Do you come across this scenario v often ?

@Boyo7 it’s very unusual. Edward’s occurs around 1:2-3000 pregnancies. It’s more common when older but we don’t have exact figures given the rarity. I’m very sorry.

@Moomoo1975 it means fast heart rate. In babies it can be a red flag for infection or distress.

You seem to have some very strong opinions about the difficult decisions people make, which I find a little disappointing for a professional working in this area. Women need support in situations not judgement.

@YouJustDoYou difficult one. Toxo is devastatingly fast. I have seen babies who look entirely normal on scan and then ten days later they have no discernible brain structures. It would probably be difficult to see at 12 weeks initially at least it doesn’t affect the things they can see at 12 weeks (head shape, limb formation, heart rate etc).

With low pappA babies do you see much problems? Like the low birth weight ect?

Thanks very much for your reply.

If you have gestational diabetes in a first pregnancy is it almost inevitable in the second? Are the risks higher in a second GD pregnancy because the mother is inevitably older?

@CmdrCressidaDuck I support women through very difficult decisions, whatever they decide. I may have my private opinions, because I am a human, but I never judge or think negatively of women because they choose TOP. It’s an emotionally tough job and without my right to a private opinion I would burn out.

@MyGreyCat I am so sorry that happened. I don’t deal with acute emergencies in my current role but if the rate of blood loss is fast then it’s only a few minutes before baby is compromised. In terms of percentage of blood loss, I am not sure. Certainly it would seem intuitive that placental implantation issues could cause IUGR in one pregnancy and abruption in another

@Passthecherrycoke we do it on the NHS for women whose combined test gives a high result. Quite a few trusts are now.

@happycamper11 I have heard that too but not sure of the numbers. I haven’t noticed it per se in my work.

@parkrunhun I think with this it is hearts that can differ from the prognosis.... we are seeing quite a few TOFs and HLHS survive now. But no, generally a guarded prognosis will be given and is correct. I have not seen any miracles.