RSS

Monthly Archives: May 2017

prenatal care

(pic: http://www.camelliawomenshealth.com/Prenatal-Care)

The importance of prenatal visits can never be underemphasized. It is a must that all pregnant mothers, regardless of social and economic strata, should receive adequate prenatal care for a successful outcome of the pregnancy.

I was once called to attend to a baby who was born premature at 36 weeks via emergency cesarean section due to uncontrolled maternal hypertension. The baby was having uncontrolled seizure despite the fact that the baby was already seen by a neurologist and on anti-convulsant. I requested some laboratory tests and results revealed that he has low sodium levels (hyponatremia) at a level that can trigger seizures.

Going back to the mother’s prenatal course, she didnt know she was pregnant then because of irregular menstrual cycle. There was a certain period when she noticed that she was having bipedal edema (swelling of both lower extremities). She was self-medicating with furosemide, to no avail. She consulted a nephrologist who noted that she too was having elevated blood pressure. Unknown to both of them, she was pregnant and this was not at all investigated. The mother too was a bit plump and she never noted abdominal enlargement until few days prior to delivery when the abdomen was already large enough to disregard. Furosemide was continued. Abdominal ultrasound revealed a singleton pregnancy. Because of the uncontrolled blood pressure, baby had to be delivered thus.

The mother’s prolonged intake of furosemide, a loop diuretic, lead her to have electrolyte imbalance, particularly sodium. This was reflected to the baby who also had low sodium levels at a level that could trigger seizure. Had she known she was pregnant, and had she been receiving prenatal care, this could have not happened to her baby. The effect of the seizure to the baby’s brain is another story.

 
Leave a comment

Posted by on May 22, 2017 in neonates, Pregnancy

 

When Life Ends Unexpectedly…

Yesterday, 20th of March, was the birthday of one of my god children. A few years ago, that day was very tragic because while the grandfather was grilling some hotdogs for the celebrator, he suddenly collapsed. I was four floors down in my apartment unit, just arrived from work and just took off my shoes when I heard a soft voice, almost a whimper, calling me. “Doc… Doc… nagcollapse si papa” were the words that I heard. Immediately I ran upstairs and checked his pulses. I could not say he has no pulses. That would be the last thing every family members wants to hear. I told them we need to go to the hospital. Gladly, the son-in-law was around, and he drives well, really really well.

The relatives were saying we bring uncle to this secondary hospital but I argued and told them he cannot be cared for properly there as there is no ICU set-up there. Inside the vehicle, I tried my very best still to do chest compressions but I could not do it the proper way with the correct pressure because he was on my lap while I was compressing him; we were at the back seat. Still I tried and persevered. Traffic leading to the hospital was hell, but gladly, I was with the best race driver in Baguio. And thankfully, the vehicles cooperated with the emergency signal and honking he sounded.

We rushed to my alma mater and gladly upon reaching the emergency room, every personnel needed to do cardiopulmonary resuscitation was already there, there was no need to page for a resident. Vitals were 0. After few minutes of trying to revive him, defibrillation, his vitals were back but still comatose. He was transferred to the ICU. Later on, when the other family members arrived, I learned that he already had previous heart operations and heart attacks. Sadly, after few days, when he perhaps bid goodbye to everyone in the household, he left…

 
Leave a comment

Posted by on May 21, 2017 in Personal