OBSTETRIC NIGHTMARE

Two weeks ago, a lady walks into the consultation room. Heavy set lady in her late thirties, well dressed. On looking at her card, i see she is on follow up for Gestation Diabetes Melitus(Diabetes that develops during pregnancy). On closer scrutiny she is at around 37 weeks. Patient reports feeling exhausted and she just wants the baby out. she is tired! (Well, for those who have been pregnant,  this feeling is not too uncommon, sometimes you just want it over...) Since she had been seen earlier she is wielding an ultrasound scan to check on the general well being of the baby. Quick scan through the report shows a Live fetus, at around 38weeks with a perfect biophysical score of 8/8. I reassure her and tell her i will give her one week, so that we can at least buy time so that the baby reaches 38weeks then we can induce labor. the lady says that she is tired and she doesn't feel the baby moving as well as before. I reassure her and say we have a perfect score so to keep a fetal kick chart and if less than 10 in twelve hours, she should come to labor ward immediately.

Exactly a week later, she returns. this time I can tell she has really reached the end of the road. I do a quick examination on her. I ask her how her week was, she says she hasn't felt her baby kick in two days! The first alarm bells go off in my head! I do a quick examination, unfortunately I don't auscultate a fetal heart. She is heavy set, a huge fat padding over the anterior abdominal wall so i give myself hope that maybe just maybe that is causing the difficulty in perception of the fetal heart. I ask two of my colleagues to try with no luck. I tell her with the steadiest voice that I can muster that we need to do an urgent scan to determine how the baby is doing. Deep down, I feel a dark and empty pit slowly creeping in my tummy.

We do a quick scan that reveals that we have fetal demise! have you ever felt like a ton of bricks has landed on your face, back and head all at the same time? Am faced with the difficult task of breaking the news to the mother. I pull myself together and tell her in gentle tones what has happened, there's no way to sugar coat the issue, it is as it is.... She goes stark quiet for a second or two, then the floods begin, and I feel so helpless......then the shock sets in and anger rears its ugly head! She wails out loud, "My baby was fine one week ago, You should have delivered me then..."............ WHAT??

Should we have delivered her then and risk respiratory distress syndrome? We had a perfect score of 8/8...
She also waited two days with absolutely no perception of fetal movements and she didn't come earlier.
What to do, who to blame, where to go from there?

Dark abyss, an absolute nightmare!