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Aborted Abortion

Aborted Abortion.

 

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Aborted Abortion

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(Photo courtesy of http://www.ehow.com/how_2335892_manage-preeclampsia.html)

Few months ago, one baby was referred to my service because the mother was having a life-threatening, severe pre-eclampsia (if I’m not mistaken, her BP was >180/100 and can’t be controlled), on the verge of having seizure. Baby had to be delivered prematurely because she was already not faring well. Baby then was born at 28 weeks, 815 grams. She was able to survive and was discharged after nearly 2 months in the hospital.

When baby was 3 months old, she was supposed to have her injectable hormonal contraceptive but she missed it because the obstetrician was out of town at that time she had her post-natal visit. Then when baby was 5 months old, mother found out that she is 1-month pregnant again. She was very confused and alarmed because she cannot forget her traumatic experience with her first baby, when she almost had seizure due to the very high blood pressure.

On her 2nd month of gestation on the 2nd baby, she came and talked to me in a soft whisper. She was asking my opinion on her plan to have abortion. I was shocked. But at one point, I got her point, her fear of possibly dying while being pregnant again, especially that her first-born is just 5 months old. I really could sense her confusion. Do I blame her to be afraid? No. The thing she fears is a reality and not just a make-believe. I told her, personally, I would not advice abortion as it is a crime. I tried to talk to her, told her the chances of severe hypertension related with pregnancy decreases on the next pregnancies.

Gladly, she took my and her obstetrician’s advice not to go on with her plan. Now, she jokingly blames her obstetrician for being absent during that prenatal check-up that’s why she got pregnant too soon. She gave birth via a repeat cesarean section. This time, she was able to do the Unang Yakap and she was so grateful that she was able to do this at least to one of her kids. Immediately, she had ligation – she and her husband decided on this before the delivery.

Can you blame them for deciding to have ligation? My take? It was their choice. They were well aware of what the consequences of pregnancy to her health, their kids, their family. It was a well-informed, intelligent choice!

 

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The Filipino Adolescents 2012

The Filipino Adolescents 2012.

 

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The Filipino Adolescents 2012

(Photo courtesy of http://reynthology.blogspot.com/2012/06/pinoy-teen-smokers-on-rise.html)

A woman recently gained attention after she performed cesarean section on her OWN SELF, delivering her own baby. As of this time we don’t know what drove her to do this. Did she use anesthesia, what kind and how, to avoid pain; or did she do it without any anesthetics at all? What drove her to do this when the baby is term and she could just have waited to labour? She sew herself with a regular needle and thread.

I remember another case of abortion that I came across with, though not as violent as that top story. She was in her early 20s, student. She was impregnated by her boyfriend; they’re unmarried. She looked frail, like someone who’s so meek enough to who raise her point when they’d argue. She seemed like she’ll say yes to everything.

At about 28 weeks, her boyfriend told her to take they need to do something about the pregnancy. They bought some abortifacient from the witches selling “pamparegla” (menstruation regulating substance/concoctions) outside Quiapo Church. (Yes, that iconic church that seems not to do anything about those witches around her, and allowing them to bastardize her with their merchandize, even on a Sunday). She took in 5 tablets of the drug, and inserted another 10 tablets into her vagina. Presto, preterm labor instantly.

She delivered to a 28 weeks preterm baby boy, who eventually needed mechanical ventilator to breath. They cannot afford surfactant so it was not given to the baby.

I talked to the mother of the baby as well as her mother about the incident.

First, I asked her why she committed that act. She blankly said, her boyfriend told her to do it.

Second, I asked her if she knew that taking the drug and inserting them as well to her vagina will cause labor pains, she just said “no.”

Then I told her, “are you aware that what you did is a form of killing?” She just said “no.”

My next question was “do you know that what you did is a crime?” Again, blankly, she said “no.”

Lastly, I told her, “did you know that I can call a police right now and have you arrested for what you did to your baby?” That was the only time she seemed to have realized the gravity of her crime, and so was her mother, and they broke down.

It is overwhelming and alarming that young people nowadays are not abreast with the different things they are doing. Only after the crime as been consummated will they come to realize that such an act was criminal.  What have you there… bullying classmates until the victim falls in a manhole and die, joking about holding/pointing a gun to a playmate and then accidentally shoot and kill him, daredevil stunts with a bike or skateboard just because they saw it was cool on youtube videos and then they get the worse fracture an orthopedics would almost object attending to, and many more.

Adolescence is a time of big confusion during a person’s life; they’re no longer kids, but they’re not yet adults. Hormones are raging making them ambivalent or confused, seeking identity or roles to portray, explore their sexuality, among other else. Peer influence is strong enough thus the high probability to form gangs during this age.

Parents have the biggest responsibility to guide their children until they can become totally independent and live on their own. It’s not the teachers at school, nor the religious at church. But how could the parents attend to all of their children’s needs when there are too many of them? Guidance and proper education can also fill in the void these adolescents quest.

A very matter of fact education that these teens need these days is age-appropriate sex education. This does not teach students to foreplay and have orgasm. Rather, sexuality education that will teach them about their body parts, how it functions, how pregnancy occurs, what are the sequela of being pregnant, responsible parenthood, contraceptives, sexually transmitted infections (STIs), etc. With the advent of information technology, a person can easily access these information, but without guidance, they will not understand it clearly. Still guidance is what these young people need so as to avoid unwanted “excursions.”

A study done has already shown that sexuality education has significantly delayed the first sexual intercourse among teenagers, lesser incidence of STIs, lesser incidence of early pregnancy and increased use of contraceptives.

Another sad facts that have plagued the young people recently are: (1) Philippines has been ranked no. 1 having the most number of teenage pregnancies in Asia, (2) increasing incidence since 1984 of HIV/AIDS among the 15-24 age bracket (2282/9669 or 23.6% cummulative incidence as of May 2012, http://www.doh.gov.ph/sites/default/files/NEC_HIV_May-AIDSreg2012.pdf), and (3) the very high incidence of smoking among the Filipino teenagers. These must have caught the attention of those in the palace.

Will you just be startled there?

 

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Beinte-Cinco: Quatro

Beinte-Cinco: Quatro.

 

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Beinte-Cinco: Quatro

For the past few days, I have been plagued by extremely premature babies for the first time, all 25 weeks gestational age, with different stories embracing each…

UNO…

Parents are well-to-do. They have a business, requiring husband to be out of town. Allegedly, the current pregnancy is not of the husband’s… Mother came in to the labor room, in active phase of labor, meaning, baby is already about to come out. Based on limited data gathered by my resident, mother is about 25 weeks pregnant, had been having diarrhea few hours prior to abdominal pain.

Baby was born, I immediately provided his needs – intubation, mechanical ventilator support, umbilical vascular catheterization. Despite full support, baby’s oxygenation status was never better. Chest x-ray showed collapsed lungs due to sequelae of prematurity. Husband is out of town, the mother’s companions are her employees, who cannot help me with legalities and decision-making.

Then the obstetrician revealed, (as she has the rapport with the mother), that the mother attempted to abort the baby by ingesting some abortifacient. About six hours from birth, the father arrived, but even if he wanted to be aggressive, the baby couldn’t respond anymore to treatment. They then signed a DO NOT RESUSCITATION order. Baby expired after about 12 hours from birth.

DOS…

Both parents are young and unemployed. Mother is 18 years old, father is 22. She came in too to the hospital because of abdominal pain. When at the emergency room, baby’s head was already presenting so she was rushed to the delivery room. I was called in after the baby was delivered so I rushed like an ambulance driver to the hospital. Baby’s urgent needs were provided and then I talked to the father about baby’s condition, what he needs. Unfortunately, even after he has called all possible resources, he wasn’t able to provide the medication baby badly needed.

Baby was only relying on the mechanical ventilatory support. However on the 30th hour of life, he started showing signs of deterioration. His mechanical ventilatory settings were unusually high that eventually led to rupture of both lungs (just as when I left the hospital). I had to rush back to possibly rescue baby. His x-ray revealed rupture of both lungs, with air escaping out but still within chest cavity, thus compressing both the lungs, and the heart. If this were not addressed, baby will die in a few minutes..

I called in a pediatric surgeon to insert tube to drain the air, while I only deed a rescue needle thoracentesis. Alas, after our attempts to rescue baby, he didn’t make it. He expired at about 38 hours from birth.

TRES…

I was informed that there is a pregnant mother, on her 28th week gestational age, for control of labor, but if she will deliver, I will attend to the baby. At least, the baby was older this time (and so I thought)… I instructed then the NICU staff to prepare equipment that baby will need upon delivery. Only two hours after the referral, the phone rang again, calling me now to the delivery room as the baby’s head was already almost out. At least this time, I was already able to have dinner.

I rushed to the hospital and in less than 10 minutes, baby came out. But baby wasn’t looking normal, he was deformed. His head and face were deformed, the abdomen was as large as the head (normally, for a preterm, the head is larger, abdomen and chest are almost the same in diameter), the feet are compressed, looking like club foot. When I was asked what the gender of baby was, I couldn’t commit whether baby is a boy or girl. It seemed like there are scrotal sacs, but empty (which is expected at this gestational age), there was a protrusion that is hard to discern if its penis or clitoris. (In cases where genitalia is ambiguous, we are not obliged to assign a gender until we were able to document it by chromosome (DNA) analysis, so as to avoid mistake in gender assignment). Baby’s skin were also showing red spots highly suggestive that baby has congenital infection, probably german measles or cytomegalovirus. The large abdomen suggests that liver or kidney is enlarged. Whether it is a tumor or a reaction to maternal infection during the course of pregnancy, I could not be certain. Physical assessment also revealed that baby is only 25 weeks, and not 28 weeks as thought of by the mother.

Upon birth also, heart beat was already less than normal, and he was already gasping (an ominous sign of arrest). I already knew that resuscitative efforts in this kind of situation will be otiose. So, I immediately called in the grandmother (as the husband is abroad) and explained how futile resuscitating baby is. We provided comfort care, had baby baptized, and waited for baby to expire.

In retrospect, I learned that at 5 months gestational age, baby’s ultrasound revealed that there was polyhydramnios (excessive amount of amniotic fluid). The placenta was large too, heavier than the baby, also substantiating my suspicion that mother had a lethal form of asymptomatic infection that grossly affected the baby.

After 58 minutes from birth, baby expired.

QUATRO…

It was a Sunday, it was supposed to be lazy day, rest day for me, but for some crazy reason, the world does not want me to fully enjoy my rest days, this day included. I was called in for emergency cesarean delivery at a hospital for the birth of yet again 25 weeks old baby. Baby had to be delivered as the hand is already coming out of the vagina.

Upon arrival at the hospital, the obstetrician and her assistant was already operating on the mother so I barely had time to prepare. Baby came out in few minutes and needed resuscitation as he was not spontaneously crying and breathing. We had to provide bag-mask ventilation but the equipment was dysfunctional. Also, many equipment that baby needs is not available in that hospital so I had to immediately transfer baby to a higher center. The baby is the 2nd child, the 1st child being 13 years old already and parents want the baby to live. What am I to do but to stress myself thus? (evil-grin) 

The ambulance and I rushed to the other hospital in convoy. Again, his needs were provided. This time, I or perhaps the baby was lucky because the father was able to provide that much needed surfactant. Also, the baby’s lungs are not that collapsed compared to the other ones I previously mentioned.

It seemed that the mother has uterine infection as the bag of waters broke one day before she had labor pains. Usually infections at this week of gestation is lethal/deadly to the premature baby.

The baby is currently stable at present, although still requiring mechanical ventilatory support.

 

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Dilemma…

Dilemma….

 
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Posted by on June 10, 2012 in Abortion, neonates, Pregnancy

 

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