Thursday, March 10, 2011

Autopsy report

I requested all my hospital records for all three births. I also requested all the records for all three babies. Including the autopsy report for Benjamin. I just wanted some answers I had surrounding all three labour, deliveries, and hospital stays. I got them last week.

So now I have all the answers I will ever have regarding Benjamin's birth and death. I have the clinical reason for his death. I have details on his body. I have everything. And yet I have less. I now know his eyes were brown (he was born with them closed). I now know he died from "fetal thrombotic vasculopathy, the thrombus in the umbilical vein, and the pulmonary thromboembolic infarction of the right lower lobe of the lung". (yes, I have googled those).

BUT the report could not figure out how 'old' he was! Going by my original due date (the one I always believed to be true) he was born at 36 weeks, 6 days. Going by my adjusted due date from an ultrasound at 10 weeks he was born at 34 weeks, 6 days. Okay. So he was either almost 35 weeks or almost 37 weeks. I can live with that discrepancy. Then when he was born based on his weight and length they concluded that the original due date was correct and he was 36w6d.

Okay, a firm answer... Not so much. Based on findings from the autopsy report his weight was consistent with 38-39 weeks. His lengths (bone lengths, crown to heel and crown to rump lengths) he was consistent with 38-40 weeks. Based on his head circumference he was 40 weeks (but my kids have big noggins, so I'm not putting much weight in that one). But then his foot length indicated 36 weeks. Okay. So going by his body sizes he was anywhere from 36-40 weeks. Okay, those can't be all that accurate, so we'll stick with the 36w6d gestational age and just assume he was going to be a big baby.

BUT then the
'placental weight' indicated 33-34 weeks gestation. WTH?? How can the placental 'age' be 33-34 weeks, but the baby be 36-40 weeks? How can they not know how old he was? And not just by a few days, or even a few weeks, but by five to seven weeks?? That's almost two months!

The report actually states "In addition, there is a discrepancy between body measurements which correspond to a later gestation of 38-39 weeks gestation, and the placental weight, which corresponds to 33-34 weeks gestation." So they state this, but give no indication if this means anything. Does this have anything to do with his death? Can the fact that he was 'older' than the placenta mean that something was wrong and his body was working too hard? Could that have somehow caused the blood clots? If I had gone for more monitoring would they have seen this 'discrepancy' and been able to do something? If they'd seen that he was measuring 5-6 weeks bigger than they believed him to be would they have intervened somehow? Could he have been saved?

See, I have less. Now I am just confused. And, I'll be honest, a tad angry. Not at anyone in particular; no one could have known that he was going to die. No one could have known that he was growing so big. Just angry though. Angry that my baby had to have an autopsy. Angry that someone else knows his body better than me. Angry that he was taken apart and put back together again. Angry that there is that small smidgen of possibility that all of this could have been avoided. Just angry.


  1. I don't know if this will help, or make things worse... but ultrasound isn't that accurate, and could not tell you those things (like placental weight, or the discrepancy between his foot and head bone lengths). As the baby gets bigger and older, the measurements and diagnosis get less and less accurate as it gets harder to see. That's why weight estimates done by ultrasound are usually off by as much as 2-3lbs in each direction. If they didn't catch IUGR early in pregnancy, then he didn't have it... and these discrepancies in his measurements may be completely normal. The only one that doesn't sound normal is the placenta one, but unfortunately there's no way to see that during pregnancy.

    I've never heard of a 'too young' placenta causing problems... only one that's "too old". I don't know that there's anything that could have been done, or seen, or prevented. :(

  2. I'm not talking about IUGR tho since he was a lot bigger than he 'should' have been. How big he was doesn't concern me. It could have been macrosomia, it could have just been he was big, it could have been that the dates were wrong, there are a lot of possible reasons for that. What concerns me, or frustrates me rather, is that the placental 'age' is so much younger than he was believed to be. The pathologist was confused and concerned about this, but gave no indication of what it could mean.