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ArticletranslatedfromoriginalDutchlanguage

The water method Intact preservation of the young deceased fetus

Dr.I.K.F.Tiemens-vanPutten,co-assistantVUH.J.LenderinkclinicalobstetricianSpaarneGasthuisDr.J.F.M.MolkenboergynaecologistSpaarneGasthuis

Whattodowiththefetusaftera(spontaneous)abortionorimmaturebirthuntilthefuneralorcremation?Wewilldescribeawayinwhichthefetusremainspresentableforlongersothattheparentscansaygoodbyetotheirchild.

Case 1 A33-yearG3P2presentedat17weeksgestationwithaIUFD.ACRLwasechoscopicallymeasuredinaccordancewith14+0weeksandHCinaccordancewith14+5weeksgestation.ItwasanundisturbedpregnancyuntilthatpointwithanormalNTmeasurement.Labourwasinducedwithmisoprostolafterpreparationwithmifepristoneat17+2weeksgestation.Thepatientindicatedthatshewantedthefetustobekeptinwaterafterthebirth.Shehopedthatbykeepingthefetusinwater,itwouldremainpresentableforlonger.Accordingtothepatient'swish,themaceratedfetuswasplacedinatransparentplasticcontainerfilledwithcoldtapwaterimmediatelyafterbirth(Fig.1).

Fig.1.Fetusintapwater

Thismadeiteasierfortheparentstolookatthefetus.Thefetuswaskeptathomeinthefridgeuntilthefuneralthefollowingday.Notable,wasthatthefetus’scolourturnedfrombrowntopinkduringthenight.Loosebitsofskinwerealsoremovedbyhand,makinghimevenmorephotogenic(Fig.2).

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Fig.2.Fetusafteranightincoldwater

Unfortunatelymorethanhalfayearlaterthepatientpresentedwithanothermissedabortion,thistimeat14+6weeks,withafetuswithaCRLof14+0weeks.Thispregnancy,too,hadbeenundisturbeduptothatpoint,andnothinguntowardhadbeenobservedatthe12-weekultrasound.

Thisfetuswasalsobornfollowinginductionwithmifepristoneandmisoprostolandplacedincoldtapwaterafterthebirth.Giventhatthisfetuswaslessmacerated,thebloodvesselswereclearlyvisibleatbirth.Afterafewhoursinthewatertheysubsided.Thisfetuswaspinkatbirthandfollowinganightinthefridgeonlybecameslightlypaler(fig3).

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Fig.3.Fetusinaccordancewith14weeksgestationincoldwater

Case 2 Thepatientwaspregnantwithmonochorionicdiamnioticgemelli.Shepresentedat16+6weeksgestationwithanIUFDofbothchildren,bothwithhydropsanddifferenceinamnioticfluid.Thepatientgavebirthvaginallyfollowinginductionwithmifepristoneandmisoprostoltotwolifelessboys.Givenourexperiencewiththepreviouspatient,theoptionofplacingthechildrenincoldwaterwasdiscussedwiththepatientandherpartner.Theywelcomedthis(fig.4).

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Fig4.Gemelliinaccordancewith16weeksgestationincoldwater

Thetwinswerelater,asisthenormintheNetherlands,laiddryinatray,afterwhichtheusualsofteninganddistortionofbothfetusesquicklyoccurred.(Fig.5).

Fig5.Gemelliafterbeingremovedfromthewater

Discussion

The(unexpected)lossofan(early)pregnancyisaneventthatmostexpectantparentsarenotpreparedfor.Thiscanhavepsychologicalconsequences,suchasdepression,posttraumaticstressdisorderoranxiety,whichcanhaveanegativeeffectonlaterpregnancies1.IntheirstudySäflandetaldescribe6qualitiesthatparentsofstillbornchildrenseekintheircareproviders2.Oneorbothparentsof31stillbornchildrenwereinterviewedtwiceabouttheirviewandexperienceontheprocessaftertheirstillbirths.Oneofthequalitiesishelpwithmeetingandsayinggoodbyetothestillbornchild.Inouropinionitmeansparentscansaygoodbyetothefetusinhis/hermostintactform.Traditionally,deceasedfetusesusedforeducationorexhibitionsareconservedinso-called'strongwater'.Acombinationofwaterwithformaldehydeorethanol.Thismethodishighlysuitedforviewingandpreservingthefetusfromallaspects.Duetotheincreasedavailabilityofprenataldiagnostics,(wanted)pregnanciesaremoreoftenterminated.Thegynaecologistwillthereforebeincreasinglydealingwithparentswhowanttosaygoodbyetotheirnewbornchild.Inthissituation

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thereisnoneedtoaddethanolorformaldehydetothewater,sincethefetuswillonlybekeptforashorttime,untilthefuneralorcremation.

Previously,afetuswasoftenplacedonacellulosemat,acardboardbasinoronacloth.Thefetuscouldthenreallynotbemovedduetoriskofdamage.Thechild’scolourwouldgetdarkerand,formostpeople,lessbeautifulandrecognizableduetosofteninganddeformation.Inmaceratedchildren,thiseffectismuchfasterandmorevisible.Wehavenowappliedthismethodofpreservingthefetusinthiswayonnumerousoccasions.Weseegoodresults,thefetusesstaypresentableformuchlongerandifthey’dliketo,theparentscantakepictures.Nomatterhowyoung,afetuscanbeverypresentable,evenwithextensivemaceration.

Thewatermethoddoesnotrequireanyspecialchangeofprocess,andisinexpensive.Itisadvisabletohavesomeclearplasticcontainerswithlidsindifferentsizesinyourdeliveryrooms,forthefetustobetakenhomein,ifsodesired.

Wehavenotbeenabletofindthiswatermethodinanyliterature.Wehopetoraiseawarenessofotherwaysoflookingafteradeceasedfetusthroughthisarticle.

Wewouldbegladtohearabouttheexperiencesothershavehadwiththewatermethod.

Conclusion Thewatermethodispotentiallyagoodwayofpreservingtheyoungfetusuntilthefuneralorcremation,anddeservesfurtherattention.

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Summary

Thisarticleintroducesthewatermethod,inwhichcoldtapwaterisusedtoshowtheyoungdeceasedfetusinitsmostoptimalformtotheparents.Theresultisthatthefetusretainsitsshapeandcolourforlongerandtheparentshavetheopportunitytosaygoodbye.

Keywords

IUFD,partusimmaturus,watermethod,spontaneousabortion,preservation,shaperetention

Authors

Dr.I.K.F.Tiemens-vanPutten,co-assistantH.J.LenderinkclinicalobstetricianSpaarneGasthuisDr.J.F.M.Molkenboer,gynaecologistSpaarneGasthuisContactdetailsI.K.F.Tiemens-vanPuttenMambo65 2152SXNieuwVennepilonatiemens@live.nl0252-685538DeclarationofconflictofinterestTheauthorsstatethatthereisno(financial)conflictofinterest.

1WeissL,FrischerL,RichmanJ.Parentaladjustmenttointrapartumanddeliveryroomloss.Theroleofahospital-basedsupportprogram.ClinPerinatol1989;16:1009-19.2SäflundK,SjögrenB,WredlingR.Theroleofcaregiversafterastillbirth:viewsandexperiencesofparents.Birth2004;31:132-7.