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Monthly Archives: May 2012

Swollen Misfortune

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Posted by on May 31, 2012 in neonates, Pregnancy, Specific Disorders

 

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Swollen Misfortune

Few weeks ago, someone sent me an SMS seeking an appointment. She is a first-time pregnant woman who wants to discuss the results of her second ultrasound findings. She told me her baby was found out to have hydrops and she wants to hear my opinion. Well, that was kinda flattering, but the person she really needed to see is a perinatologist (an obstetrician who subspecialized on very problematic pregnancies, and this pregnancy is one example). Nevertheless, being a neonatologist myself, I may also be able to give her my piece, though on a limited span.

I saw her after few days, together with her mother, and before they sat, she handed me the ultrasound findings. It’s true, the baby was visualized to be hydropic (generalized swelling) on ultrasound. As I shifted my eyes from the ultrasound result to her face, she was already on the verge of tears. You can see there the longing to hear a different opinion, that perhaps the ultrasound result was erroneous, that the baby will still become normal eventually. But I am not someone who will nurture that false hopes she was brewing. I told her that a single ultrasound finding is not definitive. The baby has to be serially monitored and the best person to do this better be a perinatologist. She heeded and went straight to the perinatologist immediately after we ended our conversation.

Few days ago, while attending to the delivery of a baby whose placenta separated totally from the uterus, I was notified that the mother with a hydropic baby was scheduled for cesarean delivery at seven in the evening of the same day. I asked why the preterm termination of pregnancy, the resident reckoned the mother already began to have abdominal cramps (labor pains). This was the 26th week of pregnancy (panic mode alerted! Baby is extremely premature). If baby was premature, then there’s not much problem; if hydropic, there’s not much problem. But if you combine both prematurity and hydrops, that’s too much of a trouble. I almost swallowed my testicles that rushed up my throat upon hearing the news of imminent delivery later in the day.

The operation commenced. Upon opening the uterus, the amniotic fluid was so voluminous. This must be stretching the uterus beyond limits that prompted it to contract and expel the baby. After almost four liters of amniotic fluid was siphoned, the baby was next. The baby’s feet was first to be delivered. It looks big for a 26 weeks old baby, more like that of a 34 weeks. Then the body followed. There was almost difficulty of delivering the baby as the abdomen was too distended and tense, and so was the head. The skin was so taut from abdomen to the face, his lips were almost like a fish mouth in appearance. Generally, the baby looks like a victim of drowning. She was gasping for air. I immediately intubated her to assist her breathing as her chest will have difficulty in rising.

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I took picture of the baby and showed it to the mother as I can’t let baby have skin-to-skin contact with the mother, while the nurse rushed baby to the incubator at the adjacent nursery. I provided mechanical ventilatory support but the baby wasn’t improving much. I showed baby after attending to her immediate needs to her lola. I asked them to provide surfactant that may help baby get better, but they were reluctant as they think it is an extraordinary measure anymore to do heroic measures. They were already resigned that the baby will not make it; and if ever, will grow up impaired.

Maybe I was wrong to ever ask them to procure some medicine, or they were right all along not to continue providing baby’s needs. I did some work-ups to help me identify the probable cause of baby’s hydrops. Hydrops is usually called by a problematic baby’s heart. Because of it’s inability to pump blood well, the fluid gets retained and thus explains why the baby’s entire body swells, including body cavities damming up with fluids. Another most common cause of hydrops is anemia of severe degree. Because of anemia, the body lacks adequate oxygen delivery. Baby’s heart now have to work more than double time to cope up with the body’s demand (just like in a congestive heart failure), and likewise ending up generally swollen. For this particular baby, her blood work-up showed a very, marked anemia. I wish I could do further test and identify what could be the cause of the anemia but then I was limited. I could transfuse blood to reverse the condition, it could have been easy. But there was a major road block. Parents are Jehovah’s Witnesses. (Oh, I was doomed.., nothing further).

Five hours from birth, baby’s condition still never improved. Her heart already showed declining function… The heartbeat and oxygen saturation keeps on falling… her color started to turn darker… I asked them if they have some practice of baptizing baby or a minor before death, they said it was up to them to pray for the baby. I respected their religious view. Six hours from birth, baby finally succumbed.

 
 

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Early Marriages, Adolescents and Young Pregnancies

Early Marriages, Adolescents and Young Pregnancies.

 

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Early Marriages, Adolescents and Young Pregnancies

(These are curated tweets by WHO during the World Health Assembly 65 at Geneva Switzerland, dated May 25, 2012)

  • In 2008, mothers aged 15-19 years gave birth to 16m babies, representing 11% of all births worldwide.
  • About 95% of births in 2008 by mothers aged 15-19 years occurred in low- and middle-income countries.
  • Progresss has been made: worldwide, the adolescent birth rate has declined from 60 per 1000 in 1990 to 48 per 1000 in 2007.
  • Discrepancy between regions in adolescent birth rates is wide, eg 5 per 1000 women in eastern Asia to 121 per 1000 in sub-Saharan Africa.
  • What contributes to adolescent pregnancy? Most people initiate sexual activity between 15 and 19 years of age.
  • In poorer countries, sexual activity for girls is often initiated in marriage, or due to coercion, frequently with older men.
  • Rates of use of contraception by adolescents are often low, hence adolescent girls may become pregnant.
  • Early marriage also contributes to adolescent pregnancy. Worldwide, 60m+ women aged 20-24 years were married before age 18.
  • Gender norms can also contribute to adolescent pregnancy; eg social norms that condone violence against women, girls put them at risk
  • Not knowing much about sex, family planning contributes to early pregnancy. Effective sexuality education is lacking in many countries.
  • Education in general is important: the more years of schooling, the fewer early pregnancies.
  • All couples should have access to safe, effective, affordable, acceptable methods of family planning.
  • Women have the right to access appropriate health-care services that enable them to go safely through pregnancy and childbirth.
  • Many countries have laws that prohibit adolescents from accessing sexual and reproductive health services without parental, spousal consent.
  • What are the consequences of early pregnancy? A first pregnancy at an early age is risky. It can lead to disease and death.
  • Early, unwanted pregnancies can lead to induced abortion which can lead to severe health risks, death when carried out in unsafe conditions.
  • Up to 65% of women with obstetric fistula develped this during adolescence, with dire consequences for their lives.
  • Adolescent pregnancy is dangerous for the child. The younger the mother, the higher the risk of stillbirth and death of the infant.
  • Social consequences of adolescent pregnancy can be severe: school drop out, lack of subsequent income, violence against unmarried girls…
  • How can too-early pregnancies be prevented in developing countries? WHO has issued 6 recommendations.
  • 1) Reducing marriage prior to age 18; 2) Reducing pregnancy before the age of 20 years.
  • 3) Increase the use of contraception by adolescents at risk of unwanted pregnancy
  • 4) Reducing coerced sex among adolescents
  • 5) Reducing unsafe abortion among adolescents to prevent too-early pregnancies.
  • 6) Increasing the use of skilled antenatal, childbirth, postnatal care among adolescents to prevent too-early pregnancies.

For complete copy on the report of the WHO Secretariat on Early Marriages, Adolescents and Young Pregnancies, please feel free to read this article http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_13-en.pdf

 

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Dateline to Impeachment

Dateline to Impeachment.

 
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Posted by on May 24, 2012 in Personal

 

Dateline to Impeachment

My poor recall of this part of Philippine History…

Few years ago… GMA was proud to be this…

August 2009:

Former Pres. Corazon Aquino succumbed to colon cancer. During her funeral march, several people have been calling out for Sen. Noynoy Aquino to run as President in the next year’s election.

October 2009:

Sen Noynoy Aquino took some time to reflect whether to accept people’s encouragement.

November 2009:

Sen. Noynoy Aquino filed his certificate of candidacy as President of the Republic of the Philippines under the Liberal Party.

May 2010:

Noynoy Aquino emerged as a popular president with a landslide victory (redundant?).

June 2010:

President Noynoy Aquino announces the creation of TRUTH Commission that shall be responsible for the investigation of misdeeds of the past administration.

(Then I dont remember the dates that followed)

Supreme Court junks the Truth Commission.

Ombudsman Merciditas Gutierrez was impeached.

(BIR and DOJ joint committee conducting investigation on Electoral Sabotage – according to Sec DeLima)

June 2011

PNoy delivered his 2nd SONA. GMA didnt attend the SONA, instead went to her hometown on the same day to inspect. Later in the day she was admitted at St. Lukes Hospital due to nape pains and hypertension? Then GMA attended Sen Miriam’s Wedding.

But during the recessional… look at GMA at the upper left corner of the photo: (Yes, no neck brace!)

As days passed by, GMA was diagnosed to have some bone spurs in her neck. She required wearing neck braces and underwent neck surgery.

Few days after GMA’s admission at St. Luke’s Hospital, this picture was released…

The neck surgery of GMA had complication, either and endocrine problem with calcium imbalance or infection. It was the former later that was the main consideration.

Series of scams have been coming out.

PCSO scandal broke out. Allegedly, a bishop sought a vehicle as a gift from GMA.

PCSO Charity fund was channeled through other purposes, was that about 700M?

PAGCOR 300M also went… where?

Anomalous purchase of helicopters by the PNP where Mike Arroyo’s name was dragged.

One of the Ampatuans testified vs GMA about election rigging in his region during 2007.

Mikey Arroyo and wife slapped with tax evasion charges by BIR.

November 25, 2011: 

GMA lawyers prepared a fake medical abstract (based on personal observations of the lawyers, not the doctors) and asks her doctors to sign it, but they refused.
Then GMA’s lawyers petitioned SC to have TRO of the WLO so that GMA can fly and go abroad for treatment because she has apparently a life-death condition.
SC by virtue of 8 justices (all GMA appointees, including CJ Corona) grants the TRO, GMA able to pay 2M bond beyond 5pm, after office hours of SC cashier.
Then GMA entourage headed to airport, staged a drama. They were given VIP access but they instead went to public gate (remember how GMA wants VIP treatment before, when asked to remove shoes at airport and was to be whisked, she asked the guard, “kailangan pa bang gawin to?” irritatedly)

Leila deLima enforced that they not be allowed to leave the country.
Reactions poured out on why did the DOJ secretary defy the SC ruling.
On the other hand, why did the SC hastily issued TRO without hearing govt side.
GMA headed to St Lukes.
On a friday, SC en banc session was held, COMELEC-DOJ joint panel filed Electoral Sabotage vs GMA, Ampatuan, Bodal and Abalos. Pasay RTC Judge Jesus Mupas issued warrant of arrest for everyone.
Saturday, GMA had her booking (finger printing, mugshots taken by the police at SLH).
Tuesday:oral arguments for the SC granting TRO vs WLO
Friday: GMA doctors testified in court; claimed GMA condition getting much better, can go home anytime. GMA’s lawyers motioning that doctors need not testify, now wants a motion for house arrest instead of hospital arrest.
Another photo of GMA after the foiled exodus…
GMA dont want doctors to testify in public because GMA wants her condition in private.
Prosecution moves for GMA transfer to a detention cell.
GMA got transferred to Veterans Memorial Hospital.
December 2011:
House of Congress by virtue of 188 congressmen, filed impeachment complaint against Renato Corona.
Addendum:
PNoy owned 2% of the shares of Hacienda Luisita, but sold his share before his presidential election. (This I recall from Winnie Monsod’s videos).
(Please feel free to correct me with the chronology of these events by posting your comments, or insert details that I have forgotten to include. Very much appreciated).
 
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Posted by on May 24, 2012 in Uncategorized

 

My Blue Baby

Gestational HypertensionHealth Insurance

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Posted by on May 19, 2012 in Uncategorized

 

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