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Miscarriage at 21 weeks - did I receive the proper medical care?

  In 1995, I was diagnosed with cervical dysplasia (Ibelieve it was grade III) and my doctor removed a portion of my cervix during a leep procedure.  For the next two years, I had to go for check-ups - once every three months for
  the first year and then once every six months for the second year.  In January of this year, I became pregnant and was thrilled.  I am 35 years old and it happened without planning per se.  I experience bleeding starting at about 2 weeks after conception while I still did not realize I was pregnant.  At seven weeks I went to see an OB/GYN (not the same one that did the surgery on my cervix), but informed him of my history during the ultrasound exam.  For the next six weeks I continued to experience bleeding off and on and phoned my doctor and/or his partners several times.  Each time I did, I told whomever called me back about my history and inquired whether this bleeding was due to an incompetent cervix, as I was told when I had the surgery would probably be the case if I ever became pregnant.  At 13 weeks, I experienced a sudden gush of blood and went to the emergency room.  They obtained a fetal heartbeat and sent me home without ultrasound.  Later that afternoon, I insisted that my physician see me so as to get a better diagnosis (it was one of his partners that saw me in the ER).
  He told me that they did not know why I was bleeding.  Once again, I enquired to incompetent cervix due to my history and I was told that was probably not the problem.  For the next seven weeks I did not experience any bleeding whatsoever.  However, eight weeks after I had the heavy bleeding episode, I was having frontal lower abdominal pain along with lower back pain.  I phoned my physician's office, one of his partners returned my call, and I was told to take Ibuprofen and that there was no need to be seen.  Four days later, I went for my 5 month check up.  My husband and I learned we were having a son and were very, very thrilled to say the least.  While my doctor was doing the ultrasound, however, he commented that he could not see the baby's head and that "he was down lower than we normally see them at this stage."  Two days later and very suddenly, I went into labor and was admitted into the emergency room at a hospital that my doctor did not practice at - not before contacting my doctor's answering service where I was told it would be 45 minutes before someone could get back with me.  I had no other choice but to go to an alternate facility due to its proximity.  The physician that delivered our son told me there was nothing that could be done because the amniotic sac was drooping into my vagina.  She punctured it, induced labor , and 12 hours later I delivered my son, dead.   Her lack of empathy was one thing (she was obviously irritated that I was so upset because she was on call and another woman down the hall was having a "live baby.")   She appeared as if she had been disturbed from washing her car or some other menial activity....hair askew and a stained shirt.  After she punctured the sac, my husband arrived and phoned my physician.  An active argument ensued between the physician that was on call and one of my physician's partners that was on call.  Evidently, the decision was made to let him die inside of me and wait for delivery to occur due to the drugs that were administered to do so.  The treatment I received at this hospital was nothing short of horrible.  Thirty-six hours afterwards, they determined that I was not emotionally stable to leave and informed me that they felt I should go to get "some help."  I was told it was a "yuppie type facility" for people that were having emotional difficulties, so I signed the form.  Unfortunately, that is not what it was at all.  It was the psychiatric ward.  It is important to note that I have never been treated and/or diagnosed with psychiatric problems.  My husband signed me out the following day, against medical advice, and I left.  Since all of this occurred, I have consulted with the OB/GYN that I saw for years after I went home to be with my family.  He did not feel that I received the proper care from the very beginning and appologized for the profession.  He felt that I should have been referred immediately to a perinatologist once it was known that I was pregnant, considering my history.  I have also consulted with another GYN that did not feel I received the proper treatment considering my history and I have an appointment scheduled in the immediate future to speak with another physician, a perinatologist.  It is now five weeks and to say I haven't recovered emotionally doesn't even begin to express the absolute, unadultered grief that I feel constantly.  Besides the feelings of inadequacy, I have chest pain and have lost 20 pounds because I am constantly sick to my stomach.  Ergo, my question is this:  After practically chaining myself to my doctor's door (considering my history), were the right steps taken from the very beginning by the many physicians I encountered during this orderal in order to save my baby's life?  This has profoundly and fundamentally altered my entire existence forever and I am in need of answers.
  Thank you,
  Bonnie T.
Dear Bonnie T:
You have had a very upsetting experience. There is no way that anyone can assess the quality of medical care that you received without access to medical records. Some generalizations can be offered:
approximately 25% of patients experience bleeding in early pregnancy and one-half of this group miscarry.
the cause of bleeding in the first half of pregnancy and the cause of stillbirth is often mysterious by prenatal testing. An autopsy is the best way to determine cause, and even here, many questions remain unanswered
incompetent cervix is not associated with gushes of bleeding, labor, or any need for induction.
patients who have a history of emotional illness are more likely to have a recurrence following pregnancy.
The consultation with the perinatologist will be most helpful if all of your medical records (physician and hosptial) are available.
This information is provided for general purposes only and is not a medical consultation. If you have specific questions, please contact your physician.
Keywords: miscarriage.

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