Why Texas Fetus Might Have Had 'Abnormalities' Before Mother Was Brain Dead

Fetal abnormalities appear to be genetic rather than caused by embolism.

ByABC News
January 23, 2014, 1:15 PM

Jan. 24, 2014— -- Lawyers representing a pregnant Texas woman on life support against her family’s wishes said that the fetus she is carrying is “distinctly abnormal,” but medical experts said this may be the result of a genetic condition that was present before the mother’s health deteriorated.

The family of Marlise Munoz, a 33-year-old paramedic who was 14 weeks pregnant when a suspected pulmonary embolism left her brain dead two months ago, is suing John Peter Smith Hospital in Fort Worth because doctors there told the family a Texas law forbade it from withdrawing life support until the fetus’s birth or a miscarriage occurs.

The fetus has hydrocephalus, or water on the brain, a possible heart condition, and “lower extremities that deformed to the extent that the gender cannot be determined,” lawyers representing Munoz’s husband announced Wednesday evening.

"Quite sadly, this information is not surprising due to the fact that the fetus, after being deprived of oxygen for an indeterminate length of time, is gestating within a dead and deteriorating body, as a horrified family looks on in absolute anguish, distress and sadness," the attorneys told the Associated Press.

Dr. Vincenzo Berghella, a maternal-fetal medicine specialist at Thomas Jefferson University in Philadelphia who has not treated Munoz, said the fetal abnormalities the family described appear to be genetic rather than caused by the mother’s pulmonary embolism or time on life support.

“All those things – the brain, the head, the heart, the legs – should have actually all been formed by 11 or 12 weeks,” said Berghella, a member of the American Congress of Obstetricians and Gynecologists . “You cannot really get a congenital, structural heart defect after 12 weeks.”

Berghella said he can’t think of a genetic syndrome that includes all this fetus’s problems, and it will be hard to know its prognosis until a diagnosis can be made. This can be done through further ultrasounds and an amniocentesis, he said. The most serious issue seems to be the hydrocephalus.

Dr. Jennifer Ashton, a senior medical contributor for ABC News and practicing ob/gyn, said the lack of oxygen to the fetus during the mother’s suspected pulmonary embolism could have been harmful to the fetus, but they wouldn’t necessarily have caused the heart and brain abnormalities the lawyers described.

“The majority of organ development occurs in the first trimester, but from 14 weeks on, a lack of oxygen to the developing fetus is obviously a significant problem,” said Ashton, who has not treated Munoz but has treated pregnant patients on life support. “But the severity of these physical anomalies suggest the possibility of an underlying chromosomal abnormality in addition. It is very possible that if this is the case, the two factors taken together could result in a situation that is incompatible with survival.”

The family filed its suit against the hospital on Jan. 14 in Tarrant County District Court. Two days later, the judge recused herself from hearing the case, which has since been transferred to Judge R. H. Wallace’s 96th District Court.

Read about how Christmas was Munoz's favorite holiday and a confusing time for her family.

According to the family’s motion, another state law may trump the law that forbids the hospital from withdrawing life support. The Texas Health and Safety Code defines death as the "irreversible cessation of the person's spontaneous respiratory and circulatory functions," the motion reads. Since Munoz has lost all brain stem activity, this law could apply to her, it says.

Munoz's husband, Erick, "vehemently" opposes continued life support, and would like to bury his wife, the motion states. The hospital has interpreted the law in a way that "makes no sense and amounts to nothing more than the cruel and obscene mutilation of a deceased body against the expressed will of the deceased and her family," it reads.

The family hopes that the judge orders the hospital to remove Munoz from life support, and that he finds that the law keeping her on it is unconstitutional.

Because John Peter Smith Hospital is a local public hospital, the Tarrant County District Attorney's office will represent it. On behalf of the hospital, the office filed its response to the suit, in which it denied all allegations.