Recent PostsSwollen MisfortuneEarly Marriages, Adolescents and
via 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.
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.
(These are curated tweets by WHO during the World Health Assembly 65 at Geneva Switzerland, dated May 25, 2012)
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
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: