We kick off another season of the Talkin Jazz podcast as the radio voice of the Utah Jazz joins our Dave Fox. Locke explains in detail how new ownership will take this team to the next level, and how big contracts to Rudy Gobert and Donovan Mitchell are not only a good investment, but are deals where the Jazz had no choice!
Plus the versatility of the Jazz offense this season, the many ways they can beat you, and insider info you only get from Locke including plays Head Coach Quin Snyder has installed that are already delivering!
Also Bojan Bogdanovich on his repaired wrist and the top five NBA plays of the week!
Losing a baby late in your pregnancy is devastating. Understanding why fetal demise sometimes occurs is a complex topic that continues to be studied.
Jade Elliott spoke with Dr. Jessica Page, a maternal fetal medicine specialist with Intermountain Healthcare who cares for patients with high risk pregnancies and has studied stillbirths, to discuss what we do and don’t know about stillbirths.
What is a stillbirth? How is it different from a miscarriage?
Stillbirth is defined as fetal death at or after 20 weeks of gestation. Miscarriages refer to pregnancy at 12 weeks or earlier. Early fetal losses (those between 13 and 19 weeks) are sometimes managed similarly to stillbirths.
How common are stillbirths?
Stillbirths are less common than miscarriage. In the U.S., stillbirths happen in about 6 per 1000 pregnancies. It doesn’t sound like a lot, but each loss is devastating, and it happens more often than it should. In the U.S. we continue to study the issue, learn more and work to improve.
What causes stillbirth?
It’s often hard to know the precise cause, as there can sometimes be more than one potential condition and it can be difficult to assign causality. One of the most common potential causes of stillbirth is placental insufficiency. This refers to situations in which the placenta doesn’t work well to provide the fetus with blood and oxygen. This can be due to maternal medical conditions, disruptions such as placental abruption or umbilical cord occlusion. Sometimes preterm labor prior to fetal viability (about 24 weeks) occurs and leads to stillbirth.
What tests can help determine the cause of the stillbirth and why are they important for women and their families?
Identifying a potential cause of death after a stillbirth can help families achieve emotional closure, and can help providers better manage that woman’s future pregnancies. Additionally, better identification of potential causes of death improves our ability to prevent and better understand stillbirth.
As OB providers it is important for us to deliver compassionate and clear information about what tests are most likely to identify a potential cause of death. Families often need time to consider their options and it is helpful to given them multiple chances to ask questions and process the information.
Types of exams and tests
The most useful tests for identifying a potential cause of death are fetal autopsy and placental pathology. Fetal autopsy is an exam of the baby. This can be a difficult topic for patients emotionally and it is important for providers to explain the options and high yield of this exam. The patient can spend as much time as desired with the baby prior to the exam and following the exam, and the incisions are easily hidden with normal baby clothes. This gives families the option to have funeral services or other memorials as desired. There are also options for less invasive exams which may include an external exam only or imaging with MRI. Autopsy can identify fetal anatomic abnormalities, evidence of infection or other pathologic processes leading to the death.
Placental pathology is a detailed microscopic examination of the placenta and umbilical cord. This is very useful for understanding if placental abnormalities or damage led to the stillbirth.
We also recommend genetic evaluation and testing for antiphospholipid syndrome in cases of stillbirth. If abnormal results are found, this may affect management of future pregnancies.
How do these tests help aid in research and help other women?
Understanding causes of stillbirths enables us to better identify targets for prevention of stillbirth and to characterize those pregnancies at the highest risk.
Why are stillbirths especially difficult emotionally?
Pregnancy loss at any point is difficult, but particularly as pregnancy progresses it can be emotionally devastating. It’s important to take time and space for families to grieve. Creating mementoes are helpful for many families as they navigate this grieving process.
How do labor and delivery nurses, OBs and midwives help provide comfort to mothers who experience a stillbirth?
Labor and delivery staff are experienced in all aspects of childbirth, from the joys in celebrating a new birth to comforting those who experience loss. A lot of it is meeting the patient where she and her partner are at that moment and providing the emotional support they need during their grief process. During a difficult time such as this, it’s common not to internalize all the information and details. Giving patients time and opportunity to ask questions and to acknowledge the loss of their child is especially important.
What are Cuddle Cots and how do they help families spend more time with their baby?
Many Intermountain hospitals have Cuddle Cots available, which are basically a special bassinet that provides some refrigeration for a baby who has passed away, which allows the family to spend more time with the baby they’ve lost, before rigor mortis or stiffness of the body sets in. Often they are donated by another family who has experienced a loss. We give patients as long as they want with the baby. We don’t limit that at all. Having the mementoes and support from other moms is also really helpful.
What else should women know about stillbirths?
While rare, it affects more families than you think. It’s important to recognize the role of that child in that family’s life. Just acknowledging the baby and supporting the family and listening without making judgments or commentary are what are often most helpful.
How might the COVID-19 pandemic magnify some of the feelings experienced after a stillbirth?
We find support in being around others. The pandemic has been very isolating, because we’ve reduced the interaction we have with friends and family to help protect each other from the virus. I tell patients to utilize the resources around them and those in their household. Reach out virtually to friends and family. Take it easy on yourself. Take one step at a time.
You may experience a variety of emotions from denial to anger to sadness, to depression to acceptance. If your feelings of depression and sadness are affecting your ability to function or are long-lasting, talk with your doctor. A referral for counseling or other treatment may help.
During the pandemic the numbers of support people allowed in the hospital may be limited. The hospital staff also provides experienced support. Some families may connect virtually with those not present and staff can assist.
What type of behavioral health resources are available?
Intermountain’s Angel Watch Program offers support for women experiencing pregnancy loss.
Women experiencing stillbirth can reach out to Intermountain’s Angel Watch program that offers support for women experiencing fetal demise. The program is staffed by master’s level social workers, nurses, bereavement specialists and chaplains who are available on-call to provide counseling specific to this type of loss, through in-home or virtual visits. The service is free and available to anyone, not just Intermountain patients. For more information call, 801-698-4486 or visit: https://intermountainhealthcare.org/services/women-newborn/resources/angel-watch/
To listen to the Baby Your Baby Podcast about the Angel Watch Program, click here.
Intermountain Emotional Health Relief Hotline number is 1-833-442-2211.
This free general emotional support hotline was started during the COVID-19 pandemic and can be reached seven days a week from 10 am to 10 pm. It connects callers with a trained care coordinator who can provide appropriate self-care tools, peer support, treatment options, crisis resources, and more.
Intermountain Walk-In Behavioral Health Access Centers
If depression or anxiety persists and you don’t have a mental health provider there are some walk in services available.
Intermountain LDS Hospital in Salt Lake, McKay Dee Hospital in Ogden and Dixie Regional Medical Center in St. George offer walk-in general behavioral health access centers that are open 24 hours. Check with other Intermountain behavioral health locations to see if they have urgent appointments available.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
What if you have diabetes or high blood pressure or an autoimmune disease like lupus or rheumatoid arthritis and you want to get pregnant? Or what if you become pregnant and have one of those chronic conditions?
If so, you probably have lots of questions. Jade Elliott spoke with Dr. Helen Feltovich, a maternal fetal medicine physician with Intermountain Healthcare who manages high-risk pregnancies, to discuss chronic conditions.
How common are chronic conditions among pregnant women?
The most common chronic conditions among American women are overweight/obesity (>50%), pregestational (type 1 or 2) diabetes (1-2%), high blood pressure (1-1.5%), and, less commonly, autoimmune diseases like lupus or rheumatoid arthritis.
What should women who have a chronic condition know and do before they get pregnant?
If you have a chronic condition, including obesity it’s best to get a pre-pregnancy consultation with a maternal fetal medicine specialist if you want to get pregnant. If you’re already pregnant and have a chronic condition, see a specialist as early as possible in your pregnancy, since that will lead to better outcomes for you and your baby.
How can maternal fetal medicine specialists help pregnant women who have these conditions?
Women with medical conditions that put them at increased pregnancy risks usually are managed by both high-risk pregnancy specialists and their regular obstetric provider. Every woman and every pregnancy is different. Sometimes a pregnant patient will see her high-risk obstetrician just once during a pregnancy, to design a management plan for monitoring her and her fetus. Other times she will be co-managed, which means she’ll see both her high-risk and regular provider throughout her whole pregnancy, for instance if she needs specialized tests like Doppler ultrasound or interventions like in-utero surgery.
Can chronic conditions affect your pregnancy or the baby?
Yes. It depends on the type of chronic condition. That’s why it’s so important to see a maternal fetal medicine specialist.
Why is it important to manage diabetes during pregnancy?
Having diabetes during pregnancy can lead to increased risks or complications for the mom or baby. When moms have diabetes, their babies are more likely to have a larger than normal birthweight, which can lead to delivery complications. Their babies are also at increased risk for birth defects, stillbirths, respiratory distress and low blood sugar.
For pregnant moms, most complications occur in women who have diabetes before they are pregnant. Pregnant women with diabetes are at increased risk for high blood pressure or preeclampsia, as well as preterm birth, cesarean delivery and other problems.
What are the signs of diabetes?
Excessive thirst.
Frequent urination.
Extreme hunger.
Unexplained weight loss.
Fatigue.
Irritability.
Blurred vision.
Presence of ketones in the urine (can be detected through lab tests)
What’s the difference between Type 1 and Type 2 diabetes and gestational diabetes?
They are different in terms of risk factors and onset. Type 1 or 2 diabetes is pregestational, or diabetes that exists before pregnancy. Pregnancy can complicate diabetes in these women, and outcomes are closely tied to degree of glucose control during pregnancy.
Gestational diabetes is defined as a new onset of diabetes that occurs during pregnancy. However, some women diagnosed with gestational diabetes actually have undiagnosed pre-gestational type 2 diabetes. Like type 1 and type 2 diabetes, outcomes are closely tied to the degree of glucose control. This is part of why it’s important to learn what is in your genes and understand your health before you get pregnant.
Why is it important to manage high blood pressure during pregnancy?
Complications can include:
Preeclampsia, when high blood pressure can lead to organ damage in the mother.
A stroke due to very high blood pressure.
Decreased blood flow to the placenta can lead to baby receiving less oxygen and fewer nutrients, causing low birth weight or premature birth.
Why does obesity add risk to your pregnancy?
Obesity is defined as a body mass index (BMI) over 30, and BMI over 40 in particular, poses risk to a pregnancy. Fetal complications include a higher chance of miscarriage, birth defects, abnormal fetal growth (usually overgrowth), abnormal fluid (usually too much fluid), and rarely, stillbirth. Preterm birth is more likely in obese women, either spontaneously or medically-indicated because of maternal complications such as gestational hypertension or preeclampsia, or gestational diabetes with poor glucose control.
What advice would you give to women who are obese and either want to get pregnant or are already pregnant?
A good diet and exercise plan are always key elements to a healthy pregnancy. Before pregnancy, obese women can optimize their pregnancy outcomes by losing weight to reach an ideal body weight. Obese pregnant women can also optimize outcomes by following a healthy diet and exercise plan. Although we typically associate healthy pregnancy with weight gain, depending on a patient’s BMI, it may be best for her to gain little weight.
Why is it important to manage your autoimmune disease during pregnancy?
Most of the time, women with autoimmune disorders can expect a normal pregnancy. However, some serious problems like fetal growth restriction or even stillbirth can occur, depending upon a patient’s exact diagnosis and disease control. Also, sometimes medications have to be adjusted before pregnancy if they aren’t safe for the fetus. Patients with well-controlled disease before pregnancy do best during pregnancy. So, it’s important to have a plan, ideally before pregnancy.
Are there some chronic conditions, where women actually feel better when they’re pregnant than when they’re not?
About one third of patients with autoimmune diseases report feeling better while pregnant, and one third report no change and another third feel worse or have a first episode during pregnancy. This is probably because of the natural steroid production that occurs during pregnancy.
Are there any chronic conditions where getting pregnant is not recommended?
Rarely, a high-risk obstetrician might advise against pregnancy, for instance, in women with antiphospholipid syndrome and history of recurrent blood clots, or severe pulmonary hypertension, or certain kinds of heart problems. That doesn’t happen often, but anticipating serious problems is one reason to contact your high-risk obstetrician before becoming pregnant.
Keep in mind most pregnancies and births are normal
If you have a chronic medical condition, it’s important to meet with your doctor early, ideally before you are pregnant, to develop a management plan. This helps you and your healthcare team to optimize your situation for the best possible outcome for you and your baby.
And search for high risk pregnancy or maternal fetal medicine.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
Predicting when your baby will be born and whether she’ll arrive early, on time or late has been a mystery since the time of Hippocrates, the ancient Greek physician known as the father of medicine, who developed the Hippocratic Oath, still accepted by physicians today. Medical experts in 2020 are still trying to solve the mystery to predict whether the timing of your baby’s delivery will be preterm, at term or post-term.
Jade Elliott spoke with Dr. Helen Feltovich, a maternal fetal medicine OB/Gyn and associate professor at Intermountain Healthcare who manages high-risk pregnancies to shed some light on the mystery of the possible causes of preterm birth.
What is the definition of preterm birth?
Babies born at 37 weeks or later are considered at term. For babies born before 37 weeks, the earlier they are born, the more likely they are to have health issues. So, we categorize preemies into these general categories.
Babies born between:
34-37 weeks are considered late preterm
34 or 32 weeks are considered early preterm
26-28 weeks are considered very early preterm
Does preterm birth just happen on its own or are there reasons why it would be recommended for a mom to give birth before 37 weeks?
Preterm birth can be either medically-indicated (because continuing pregnancy is not safe for the mother, baby or both) or spontaneous (labor happens on its own). Currently, at least 2/3 of preterm births are spontaneous, and, while we do know some factors increase the risk of preterm birth, most preterm births actually have no biological explanation. Unfortunately, by the time labor is happening, we have no therapies at all that can stop it.
Why is it so difficult for physicians to predict preterm birth?
While physicians have various ways to try to guess at when a baby will deliver, like how long or dilated the cervix is, none of these work well, even during labor itself, to predict when a baby will be born. Preterm birth is particularly vexing to OB/Gyn caregivers because of its potentially serious health consequences to the newborn.
What are some of the challenges in preventing preterm birth?
Preventing preterm birth is even more challenging because we have only two basic approaches, that have been around since about the 1950-1960s and they both have limits in their effectiveness. One of these approaches is progesterone (hormone) supplementation, which although it’s been tried in various formulations and doses, prevents preterm delivery less than half of the time.
The other approach is mechanical support of the cervix by cerclage (basically stitching a purse-string around the cervix), which prevents preterm birth less than half of the time.
Although these therapies don’t work all the time, they certainly work some of the time in the right patients. So, it’s very important to see a high-risk pregnancy specialist, ideally before pregnancy, to discuss which approaches might be appropriate for the next pregnancy.
This lack of overall progress seems astonishing, but it’s because preterm birth is so complex, and there are so many factors that come into play, and so many different pathways.
What are some of the possible risk factors that may lead to preterm birth?
Studies show the two strongest risk factors for preterm birth are:
History of PTB, and
Short cervix during your current pregnancy
Other risk factors include:
Infection or inflammation
(There are many different types of infections or causes of “sterile” or non-infectious inflammation. Some studies have shown that COVID-19 increases the risk of preterm birth).
Smoking or substance abuse during pregnancy
Short time between pregnancies (less than 18 months)
Expecting multiples, twins, triplets, etc. 50 percent of twins come early.
Vaginal bleeding
Abnormal shape of the uterus
Maternal and fetal stress (probable, difficult to measure/prove)
What about stress – how does that have an impact?
Stress is a very difficult thing to measure, because there is physiological stress, psychological stress, and a combination of the two and they do all kinds of things in a person’s body. That said, it is becoming increasingly clear that social determinants of health that are associated with both physiological and psychological stressors (like education, income level, ancestry, race or ethnicity, access to healthcare, social support, etc. can change preterm birth risk.
The COVID-19 pandemic is highlighting this, because in some countries (like the Netherlands), the rate of preterm birth has decreased among higher income women, thought perhaps due to less stress because of working from home, etc, while in the U.S. (where we do not have widespread governmental support for income maintenance, or universal healthcare), the CDC data suggests an increased risk of preterm birth. This is an extremely complex issue, which affects an extremely complex and multifactorial outcome (preterm birth), but this pandemic is showing us new ways to look at potential contributors to and solutions for preterm birth.
What kinds of symptoms of preterm labor should a woman call her doctor about?
Call your obstetric provider right away if you notice any of these signs or symptoms:
Change in type of vaginal discharge (watery, mucus, or bloody)
Increase in amount of discharge
Pelvic or lower abdominal pressure
Constant low, dull backache
Mild abdominal cramps, with or without diarrhea
Regular or frequent contractions or uterine tightening, often painless
Ruptured membranes (your water breaks with a gush or a trickle of fluid)
See a specialist if you have a history of preterm birth or complications in your pregnancy
If you have had a preterm birth in the past, it’s important to see a high-risk pregnancy specialist, ideally before you become pregnant, to discuss your particular situation and the types of strategies to decrease your risk of recurrent preterm birth.
What does the future look like for preventing preterm birth?
We need to think about preterm birth not as a diagnosis, but rather one possible outcome of a variety of different causes and processes. We need to follow the successful path of our cancer colleagues.
Before the 1950s, “cancer” was considered a singular diagnosis, and treated similarly with surgery, chemotherapy and radiation, no matter where or how it occurred in the body. But today, through the use of imaging biomarkers like those identified with PET or CT scanning combined with fluid biomarkers found in blood or urine or the tumor itself, we understand that there are thousands of different types of cancers, and the approach to treating them should be individualized to a specific tumor in a specific patient at a specific point in time.
This involves understanding the internal (for example, genetic) and external (for example, environmental stressors) environment of a person. This is called precision (or personalized) medicine, and it’s why now the previously unthinkable has become true – some cancers are curable!
Could understanding a patient’s genetics and environmental factors help doctors determine what might help prevent preterm birth in a certain patient?
This is where we are slowly starting to go with preterm birth.
One of our maternal fetal medicine doctors at Intermountain, Dr. Sean Esplin, recently led a nationwide study looking at an imaging biomarker (length of cervix measured by ultrasound) and fluid biomarker (presence of fetal fibronectin in the vagina) related to preterm birth. More than 9000 women were evaluated, and the study showed that even the combination of these two biomarkers did not effectively predict preterm birth.
However, more importantly, it told us we need more, and better, imaging and fluid biomarkers to direct their therapies. What will happen from further investigations is we will have many more biomarkers so we can develop new therapies and target them to a particular person in a particular pregnancy. When we are able to do that, we will undoubtedly have the same sort of success as our oncology colleagues – and the previously unthinkable will happen – a cure!
Decades ago, nobody thought cancer would actually be curable, but today we know that several cancers are actually curable, or at least can be managed as chronic diseases. This is where we can go with the problem of preterm birth!
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
