TX - pregnant wife unresponsive on life support, husband hopes to fulfill her wishes

[dh109977]

From the link above, what does this mean:

"It also appears that there are further abnormalities, including a possible heart problem, that cannot be specifically determined due to the immobile nature of Mrs. Munoz's deceased body."

I was thinking along the lines of when I went for my ultrasounds they would make me change positions if the baby didn't cooperate. Since she can't change positions maybe they can't see some things. But not sure.

 

[DeeMarie]

I don't really understand why he would say that, why he claims he doesn't know the condition of his baby. Does he not want to know or is the hospital refusing to tell him? Or does he know but doesn't want to discuss it publicly?

Is he allowed to see his (dead) wife? And if so, is he visiting her or is he keeping away?

They are probably keeping him away.

Texas does not honor his marriage with his wife by disregarding their end of life wishes by keeping her on life support against her will.

- why would they care about letting him see his wife?

Marlise Munoz is just an state-run incubator to a fetus that is now deformed.

The fetus, Mr. and Mrs. Munoz, and her loved ones are all made to suffer because of Texas.

The movie 'Coma' comes to mind..

 

[liljim]

i dont agree with this position, just stating it;

unless the fetus is absolutely not viable i dont think this news should change the mind of anyone who previously thought that this baby should be saved at all costs.

 

[DeeMarie]

Who knows what the state of Texas is going to do?????? I live here & I sure can't tell you because what the state does, doesn't always make sense.

I will repeat what I said in an earlier post. I do respect this judge, no matter his decision, for assigning this case to himself rather than pawning it off on another judge. Regardless of any decision, it is going to result in a firestorm in spite of the condition of the baby. At least the judge is man enough to take the heat himself instead of giving it to someone else to take the fall.

Is Texas going to enforce Marlise Munoz to a full pregnancy with a fetus that has hydrocephalus?

This is a political hot potato and I don't think anyone wants to touch it.

What is going to happen to her? She and her fetus are going to lay in the hospital bed with tubes, machines, drugs, needles -etc and nothing is being done...everyone suffers.

 

[DeeMarie]

i dont agree with this position, just stating it;

unless the fetus is absolutely not viable i dont think this news should change the mind of anyone who previously thought that this baby should be saved at all costs.

With hydrocephalus? Have you looked up what it is?
Here is an image:
http://www.nydailynews.com/life-style/health/family-unable-afford-medical-treatment-daughter-hydrocephalus-article-1.1315053

A fetus feels pain at 20 weeks. The fetus is suffering right now and feels pain due to its deformity.

I believe that Texas is now guilty of child abuse.

 

[K_Z]

From the link above, what does this mean:

"It also appears that there are further abnormalities, including a possible heart problem, that cannot be specifically determined due to the immobile nature of Mrs. Munoz's deceased body."

Most likely, the fetus has akinesia, too, complicating imaging--meaning the fetus is not moving, flexing, etc. Fairly common when there are clusters of major deformities, along with lack of variability in the fetal heart rate.

One really can't look at each of these fetal abnormalities in isolation; the likelihood is that they are part of a cluster of major, and very severe multisystem defects, probably incompatible with life outside the womb, regardless of the number of weeks of gestation. There may be a temptation by some to simplify these conditions and claim that they are somehow minor or correctable. Everybody knows somebody with a shunt, or someone with a clubfoot, or someone that had neonatal heart surgery, but that is not an accurate example what this particular combination of abnormalities signals. This kind of a cluster of abnormalities is truly devastating. There is really no way to frame this situation as even remotely hopeful, IMO. If this is what the attorneys are saying, the actual medical diagnostic information that is known is probably much, much worse, IMO. And the fetus is almost certainly IUGR (intrauterine growth retardation)on top of everything else, IMO.

There are certainly other imaging they can do, but the question is risk vs benefit. The gadolinium in an MRI, for example, could be fatal to the fetus.

On the other hand, most radiology service providers consider gadolinium-based contrast agents for MRI (eg, gadopentetate, gadodiamide, gadolinium DPTA, gadoterate meglumine) to be relatively or absolutely contraindicated during pregnancy; these paramagnetic agents are not recommended by the Food and Drug Administration because they cross the placenta and their long-term effects are unknown.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479713/

Lower limb deformities can be associated with genitourinary tract deformities, ambiguous genitalia, and anorectal deformities as well. Lower limb deformities are associated with a number of medications, and are more rare than upper limb deformities. Truly a devastating set of circumstances.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279100/

Prenatal diagnosis of limb abnormalities: role of fetal ultrasonography

 

[liljim]

im well aware of hydrocephalus yes, and i think that since it is treatable and not necessarily a death sentence that if someone previously held that this child should be saved at all costs then they should still feel that same way if they dont want to be considered a hypocrite.

 

[dh109977]

im well aware of hydrocephalus yes, and i think that since it is treatable and not necessarily a death sentence that if someone previously held that this child should be saved at all costs then they should still feel that same way if they dont want to be considered a hypocrite.

Im missing your point? People who were hoping for the best can't change their minds?

Did I want this baby saved? Yes. Do I want the best for this baby now knowing the extent of the disabilities? Yes. Does that mean I am a hyprocrite?

 

[Linda7NJ]

Very very sad. My thought are with the family. How horrifying for them.


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[liljim]

Im missing your point? People who were hoping for the best can't change their minds?

Did I want this baby saved? Yes. Do I want the best for this baby now knowing the extent of the disabilities? Yes. Does that mean I am a hyprocrite?

i dont think im allowed to reply directly so i will speak in abstract;

if someone previously felt that given the circumstances in this case the fetus deserved every chance at life including overriding the wishes of the dead mother and her living family members, and since none of the new information is proof that this baby could not possibly be carried to term, then in my opinion that person should also believe that this fetus is still entitled to every possible chance at life.

 

[Only4Justice]

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 couldn’t find one quickly. They can use a buzzer/ vibrator device on the outside of the mother’s 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.)

Oxygen–haemoglobin 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. BUT—that 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.

:tyou:

Thank you K_Z, for this post! I am pro-life in most cases; but without any medical knowledge/background at all, in following this case, I have held on to the feeling that the baby "fetus" (to me, it's a baby), should have been allowed to die when his/her mama did.

We may be now at 19-21 weeks, but if nature had taken its course, the baby would have died when the mother did. That's the truth.

God Bless all those Involved.

 

[Linda7NJ]

Im missing your point? People who were hoping for the best can't change their minds?



Did I want this baby saved? Yes. Do I want the best for this baby now knowing the extent of the disabilities? Yes. Does that mean I am a hyprocrite?

Do you still want this fetus saved?
If not, why?
Severe disabilities means... now it's somehow okay to put an end to this families suffering??
Are there clear cut disabilities where it's acceptable to terminated life support? What are they? Where is the line?
I'm so confused by other people's opinions.





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[jjenny]

They are probably keeping him away.

Texas does not honor his marriage with his wife by disregarding their end of life wishes by keeping her on life support against her will.

- why would they care about letting him see his wife?

Marlise Munoz is just an state-run incubator to a fetus that is now deformed.

The fetus, Mr. and Mrs. Munoz, and her loved ones are all made to suffer because of Texas.

The movie 'Coma' comes to mind..

That's absolutely false. From what has been reported, he is not being kept away.

 

[dh109977]

i dont think im allowed to reply directly so i will speak in abstract;

if someone previously felt that given the circumstances in this case the fetus deserved every chance at life including overriding the wishes of the dead mother and her living family members, and since none of the new information is proof that this baby could not possibly be carried to term, then in my opinion that person should also believe that this fetus is still entitled to every possible chance at life.

I wanted the baby to pull through. Now I want this baby not to suffer. While I am stuck on what I mean by that. I am afraid if they turn the life support off the mother the baby will suffocate. I am afraid if the baby is delivered early or full term it is gonna suffer. I still want a miracle to happen because I can't wrap my brain around how this is gonna all happen. What I am getting at is if this baby is gonna pass I want it the easiest way for the baby. maybe I don't know what I am trying to say. I am torn

 

[jjenny]

Do you still want this fetus saved?
If not, why?
Severe disabilities means... now it's somehow okay to put an end to this families suffering??
Are there clear cut disabilities where it's acceptable to terminated life support? What are they? Where is the line?
I'm so confused by other people's opinions.





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If mother was alive, and found out fetus had abnormalities, she could chose to terminate the pregnancy or to continue on. So I guess the line is what one sees fit.

 

[jjenny]

:tyou:

Thank you K_Z, for this post! I am pro-life in most cases; but without any medical knowledge/background at all, in following this case, I have held on to the feeling that the baby "fetus" (to me, it's a baby), should have been allowed to die when his/her mama did.

We may be now at 19-21 weeks, but if nature had taken its course, the baby would have died when the mother did. That's the truth.

God Bless all those Involved.

A lot of people would die if we simply allowed nature to take its course. For instance, if someone needs a heart transplant. We don't take an approach that we should just allow nature take its course.

 

[liljim]

I wanted the baby to pull through. Now I want this baby not to suffer. While I am stuck on what I mean by that. I am afraid if they turn the life support off the mother the baby will suffocate. I am afraid if the baby is delivered early or full term it is gonna suffer. I still want a miracle to happen because I can't wrap my brain around how this is gonna all happen. What I am getting at is if this baby is gonna pass I want it the easiest way for the baby. maybe I don't know what I am trying to say. I am torn

this is a great and reasonable response, thank you for being civil.

 

[Linda7NJ]

If mother was alive, and found out fetus had abnormalities, she could chose to terminate the pregnancy or to continue on. So I guess the line is what one sees fit.

Apparently, not in Texas...for the brain dead or their family of origin or the spouse.
Under the current law, I believe she will continue to remain a womb hooked up and forced to continue on...and on.



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[dh109977]

this is a great and reasonable response, thank you for being civil.

It still makes so much more sense in my head. I just can't put it into words. Thank you for understanding. I don't want to be a hyprocrite. I can't believe this case has hit me so hard. I was praying so hard for this baby. Now I am sitting here fighting back the tears.

 

[jjenny]

Apparently, not in Texas...for the brain dead or their family of origin or the spouse.
Under the current law, I believe she will continue to remain a womb hooked up and forced to continue on...and on.



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We will find out on Friday.