FROM THE FRONT LINE Losing the Future.

As ob.gyns. we tend to deal with death more frequently than most other physicians. Since most of these deaths we encounter occur in the first trimester of pregnancy, however, we may not give them the importance they deserve.

Psychologists tell us that the bonding of a woman (and her partner) to a baby may occur even before implantation takes place. Three recent incidents have shown me how strong preconceptional and prenatal bonding can be.

A dear friend of mine has been infertile for several years. After an in vitro fertilization cycle she was told over the phone by a medical assistant that her pregnancy test was positive. The next day her physician called to inform her that the test had somehow been misread and she was not pregnant. She was totally devastated. She is an executive who is very committed to her position but was not able to work for several days after learning the news.

Several months ago I removed a tubal pregnancy from a patient. On her follow-up exam she asked me several questions about the fetus, including the sex. This made me realize that to her this pregnancy was more than just a swelling in her fallopian tube.

Another unfortunate situation occurred when one of my patients had an ultrasound examination in her 12th week of pregnancy for a routine follow-up of a large ovarian cyst. She was told that although the cyst was shrinking, fetal heart tones no longer existed. It took much of my time over the next several days, both before and after her uterine evacuation, to help her and her husband begin to deal with their grief.

There are no magic words to comfort someone who is grieving. Unfortunately, ...