I consider all miscarriages to be a loss of life and patients go through great pain regardless of the length of gestation but clearly the most significant loss are those patients who have made it through the end of the pregnancy only to lose the baby in the last few weeks. These patients are usually and most likely incorrectly told that this was an accident, this is something that won't repeat itself and many are actually told it was because the cord was wrapped around the body or the neck – which actually occurs in about only twenty five percent of all pregnancies. If this was such a serious condition there would be a much higher rate of stillbirths.
Well, this is the time and the opportunity to get a complete workup. The workups consist of a course of in depth immunological work up as well as a thrombophilic workup looking for blood clotting issues. Clearly there are many expert centers that do an excellent job in ruling out almost all of the causes of stillbirths but usually the immunological component is never worked up in detail. These are the patients who usually end up at my practice. It is important to understand that a defect in the early development of the placenta, many times caused by an attempt that the immune system to reject the placenta, is what eventually leads to these full term stillbirths. At my practice, we do a thorough workup for these immunological causes and the good news is that when they are found, almost always we can successfully treat and we can prevent the recurrence of these terrible tragedies.