A disclaimer: I am not an ultrasound tech, or a perinatologist. I have experience as an OB nurse way back when (before I was a flight nurse, and before graduate anesthesia school program), in addition to PICU and adult ICU, and a smattering of other areas. I have taught OB anesthesia to CRNA students in the classroom and clinical area for about 13 years. (OB anesthesia is not the only topic I teach or practice.)
So, having said that, here is some information that might be interesting to some readers, and is (IMO), more interesting than arguing about pro life/ pro choice, and whether or not the Munoz situation is a potential elective termination of pregnancy.
The Munoz fetus is 20-21 weeks gestation as of this week (Jan 13-19), per media reports.
What the doctors (and Erick Munoz, I hope) most definitely know about the Munoz fetus (and this is just a small list of everything the docs know-they know much, much more about this fetus):
Whether the heart rate has reassuring variability beat to beat, or an abnormal pattern that indicates significant central nervous system insult (flat beat to beat variability)
How active the fetus is, or is not. Whether or not it is flexing and moving all limbs.
Whether the fetus demonstrates normal sleep cycles, indicating hormonal systems in the fetal brain are intact (or not) Usually apparent at 22-24 weeks
Whether the fetus is demonstrating normal activity that indicates an intact nervous system, such as sucking and swallowing movements, breathing movements, and startle reflex. Usually apparent at 22-24 weeks.
Head size, whether there is excess fluid around the brain, appearance of ventricles of the brain
Gender
Whether the fetus is small for gestational age (SGA), or appropriate for gestational age, or large for gestational age (LGA)
Whether the heart has 4 chambers, blood flow thru the heart, valve function
Whether there are any neural tube defects (which would have occurred before 14 weeks gestation)
Whether there are any gross abnormalities of the abdomen, such as omphalocele
Whether there is any gross abnormalities of the head, limbs, and body
Whether the placenta is appropriately sized, and where it is implanted in the uterus
Whether the amount of amniotic fluid is appropriate
Whether the umbilical cord has the appropriate configuration of blood vessels (2 arteries, 1 vein)
Biophysical profile - Wikipedia, the free encyclopedia
One of the amazing things about the internet is this thing called Youtube, lol! You can find pretty much ANYthing on YT. I often use it for teaching lots of procedures are loaded up as teaching tools. And proud parents like to upload lots of ultrasounds, and leave them set to public, which can be a learning tool for us. Here are a few 20 week ultrasounds, all of them healthy singletons (single pregnancy). Pay close attention to how active these fetuses are, and how they respond to things like the US tech nudging them to move a hand or foot out of the way, to get a better view. I looked for a startle reflex video, but couldnt find one quickly. They can use a buzzer/ vibrator device on the outside of the mothers abdomen to induce the fetus to respond to a stimuli.
20 Week Ultrasound Highlights - YouTube
Rachel's 20 week Pregnancy Ultrasound (with Sound) - It's a ..... - YouTube
4D Ultrasound 20 Weeks finding out gender - YouTube
As we all marvel at the technology that allows us to peer inside the womb, I am also reminded that very few people upload prenatal ultrasounds with catastrophic news to youtube. The Munoz fetus suffered an incredible hypoxic insult. A fetus has some protective mechanisms to ward off catastrophe from brief episodes of stress, such as brief periods of hypoxia. A fetus in its normal state is slightly more acidotic than the mother, which favors fetal hemoglobin binding oxygen more readily, but the hemoglobin is more reluctant to let go of the oxygen at the tissue level. (Refer to the oxyhemoglobin dissociation curve.)
Oxygenâhaemoglobin dissociation curve - Wikipedia, the free encyclopedia
http://www.ccmtutorials.com/rs/oxygen/page06.htm (this one is a little easier to understand, and you can search for more explanations if you want)
Fetal hemoglobin - Wikipedia, the free encyclopedia
As acidosis increases in the mother (from cardiac arrest and profound hypoxia), the fetus ALSO becomes more acidotic. Acidosis significantly impairs oxygen binding and release, that is the take home message. Add to that, a ventilation/ perfusion mismatch in the mother, from the pulmonary embolism, and the problem is magnified, EVEN with large percentages of oxygen delivered to the mother after she was discovered, and adequate expansion of the lungs with positive pressure. Factor in at least one hour of down time per the husband, and it becomes even more stunning that Marlise Munoz could achieve any degree of cardiac resuscitation, and that the fetus would also have a heartbeat. BUTthat does not mean that EITHER Marlise, OR her fetus are ok now. They both suffered a staggering hypoxic insult. Marlise is brain dead. The fetus noticed that, physiologically.
It is my opinion that the prognosis for the fetus is very likely grim, as of this week. The reason I think that, is because there has been no efforts that we know of by Erick Munoz to have a court rule to remove the ventilator, since November. I believe that there is a push now to do this before 24 weeks, before viability, because before 19 or so weeks, it was less sure what they were facing. I may be entirely wrong, but I think the timing of this lawsuit action is related to very grim news about the fetus, that has been revealed little by little over the past several weeks.
