RSS

Tag Archives: reproductive health

Why Single Women, And Yes, Nuns, Ought To Take Contraceptive Hormones

Image

Birth Control Pills (Image courtesy of © iStockPhoto / Ceneri)

When I once said that nuns and single women who do not intend to get pregnant would benefit from taking contraceptive pills, one anti-RH Bill reacted saying “that is hysterical!” I didn’t think HYSTERICAL was even the appropriate word to say, even if she wanted to express disgust based on her knackered beliefs.

Let us put it that a woman has her first menstruation (called menarche) at age 15 years of age, and menopauses at 45 years of age. Granting she has a regular monthly menstrual cycle, that would make her mens 12 times a year. If she will have 30 years of reproductive age, then that would mean, she will have 360 menses in her lifetime. (Although realistically, nowadays, some girls already start menstruating at 9 years of age. To give you an idea when to expect the girl will mens for the first time, note at how old she is when her breasts start to enlarge — termed medically as thelarche. Approximately two years after that, she will now start her menstruation.)

During a woman’s menstruation, there is interplay between estrogen and progesterone. During the first day until day 14 of a woman’s menstrual cycle, ESTROGEN predominates especially on the day just before ovulation. The latter is responsible to prepare the uterus for an incoming pregnancy as well as ovulation in concert with other hormones; it’s level declines once the ovary has released an ovum. Once ovulation occurs, the corpus luteum (the cells surrounding the ovum in the ovary) release PROGESTERONE. The latter on the other hand ensures that the reproductive organs are optimum for a pregnancy to proceed.

PREGNANCY AND ITS EFFECT ON ESTROGEN ELEVATION

I have emphasized in my other blogs the role of progesterone as the hormone responsible for keeping the pregnancy intact. While estrogen may still be produced during pregnancy (as estriol), its potency is a lot weaker than the estrogen produced during non-pregnancy state (estradiol).

If woman gets pregnant for 9 months, the effect of progesterone is greater than the effect of estrogen. Even if estrogen is also produced during pregnancy as estriol, its effect to other organs such as ovary and uterus is dampened to nil. Thus, in cases where the woman is able to carry her pregnancy to full term, that would save her 9 months from the potent effects of estradiol to her body. If she will exclusively breastfeed (no breastmilk substitute whatsoever is given to the baby) after giving birth as well, this will have the effect of LACTATION-INDUCED AMENORRHEA (woman’s menstrual cycle remain arrested as effect of exclusively breastfeeding her baby) for about 6 months. Thus, one pregnancy will save the woman at least 15 months free from effects of elevated estrogen (estradiol) level. If in her lifetime, a woman will bear 4 children, all of which were term pregnancies, then she will have a total of (15 x 4) 60 menstruation free months in her lifetime. This means, she is on the advantage of 300 months exposure only, compared to women who never got pregnant, who are exposed to the potent effects of estradiol for 360 months.

EFFECT OF UNOPPOSED ESTROGEN ELEVATION

What effect does estrogen have to a woman? Most commonly discussed effects of unopposed estrogen elevation would range from benign (leiomyoma, or myoma of the uterus) to malignant such as cancer of the uterus, ovary, and breast, among other else.

Cancer

It has been established that most cancers are mainly genetic (meaning, inheritance of cancer genes from either side of the parents). But aside from the genes for expression of cancers, there are also genes for cancer suppression that comes along with its inheritance. Whichever of these genes predominates, that is  what is manifested clinically or physically or biochemically or physiologically by the person involved. If a person has breast cancer gene, and the gene for its suppression is muted or ineffective, then the person will have breast cancer manifestations. On the other hand, if the person has breast cancer genes, but his cancer suppression genes are enhanced and working effectively, then the person will not show signs of breast cancer, but still at risk and will readily convert once those cancer suppression genes are skewed. (Confused? hahaha). These cancer suppression/expression genes are regulated by the environmental factors to which the person is exposed to. In the case of breast cancer, one environmental factor is elevated estrogen (estradiol) level.

Estrogen naturally exists in 3 forms in women. The ovary produces (1) estradiol, the most potent form of estrogen, and this is the form usually seen elevated among nonpregnant women during the reproductive age group. This is believed to be the most potent of the three forms. Another form of estrogen is produced during pregnancy is (2) estriol; this has been noted to be the a lot weaker in comparison to potency of estradiol. Another form of estrogen is found among menopausal women, (3) estrone. During the reproductive age group, estrogen is produced by complex enzymatic process at the ovary. Postmenopausally, estrone is converted peripherally at the liver, adrenal glands, breast and fat tissues.

If a person has inherited the breast cancer genes, and keeps on being exposed to elevated estradiol, then she can develop breast cancer, especially if her breast tissue also has the hormone receptors for estrogen. These receptors will bind with the circulating estrogen and thus bring about the genesis of cancer. Between non-pregnant woman (who has 360 times of exposure) and a woman who got pregnant for four times (who only has 300 times of exposure), it is the former who is more susceptible. This only goes to show that even if the woman never took exogenous sources of estrogen (such as oral contraceptive pills), they can still have breast cancer. (I previously blogged a colleague who was single and died at the age of 42 from breast cancer. She too was not taking contraceptive pills — The Pain She Should Never Have.

DO CONTRACEPTIVES OFFER ANTI-CANCER BENEFIT TO WOMEN?

Contraceptive pills contain synthetic progesterone alone or in combination with estrogen. Among its many benefits, the effect in focus is its role in suppressing ovulation. With a sustained elevated level of progesterone from religious intake of contraceptive pills or injectable hormones, this suppresses elevation of estradiol (which leads to ovulation). With lesser if not complete non-exposure of the reproductive organs to estradiol, nothing will stimulate the cancer expression genes and therefore no cancer formation. Of course this is NOT always absolute and there are always exceptions, but these exceptions are often minimal compared to those who will benefit from the treatment.

A meta-analysis on the effect of oral contraceptive pills among women who had genetic mutations (BRCA1/2) for expression of ovarian cancers have shown that oral contraceptives reduce the risk for ovarian cancers, proportional to the length of use. The same meta-analysis also stated that OC formulations used before 1975 were associated with a significant increased risk of breast cancer (SRR: 1.47; 95% 1.06, 2.04), but no evidence of a significant association was found with use of more recent formulations (SRR: 1.17; 95% 0.74, 1.86). (highlights were mine). (Reference: Oral contraceptive use and breast or ovarian cancer risk in BRCA1/2 carriers: A meta-analysis.S. Iodice, M. Barile, N. Rotmensz, I. Feroce, B. Bonanni, P. Radice, L. Bernard, P. Maisonneuve, S. Gandini. European Journal of CancerVolume 46, Issue 12August 2010Pages 2275-2284).

Do women ought to take contraceptive pills, even if they are not married? 

 
Leave a comment

Posted by on September 22, 2012 in Breast Cancer, RHBill

 

Tags: , , , , , ,

How Pro-Life Are You?

How Pro-Life Are You?.

 
Leave a comment

Posted by on July 12, 2012 in Abortion, RHBill

 

Tags: , , , , ,

How Pro-Life Are You?

Your stance as a PRO-LIFE is definitely distinguishably palpable and admirable. You fight with all your might for the welfare of the UNBORNS, and would prevent any factors that will harm them, right from the very point that LIFE begins. You ardently believe that life begins the moment the sperm fertilizes the ovum. Yes, so does the many (including us) agree with you on that, even if the definition indeed of when life exactly begins remain still to be controversial, even among those regarded as experts in that particular field of discipline.

But just how admirable your being a prolife is, that’s the same magnitude how disgusting you are spreading lies. You label contraceptives abortifacients. All experts, those who think rationally than you do, agree that contraceptives prevent fertilization to take place. If no fertilization happens, then there’s no life that forms. (You must agree with this as you emphatically annunciate it to be so). When there is no life formed, there is nothing to abort. Thus, how can a contraceptive act as abortifacient? You’re no experts in that field let alone have sufficient medical background, yet you act and talk superior than them. You are challenged to file a class suit against the manufacturers of these contraceptives. Yes, you can do that, with the billions you amass every mass. But why don’t you? Those that you are saying are of course LIES; you, who are so righteous, judgmental perverts and experts of morality, know that lying is an act of sin. Or doesn’t it matter anymore if you are committing an act of sin as long as you convince your clout to believe your lies?

BUT… until what extent of their lives will you fight for? Just until they’re born? What about afterwards?

Image

(Photo courtesy of http://lover-caring.blogspot.com/2010_08_01_archive.html)

Image

(Photo courtesy of http://sforiginal.blogspot.com/2010/02/baby-thrown-into-garbage-bin-and-burnt.html)

Image

(Photo courtesy of http://cura-personalis.blogspot.com/2010/12/why-help-street-children.html)

Image

(Photo courtesy of https://abandonedchildren.wordpress.com/)

(Photo courtesy of http://yvettetan.com/2012/07/07/child-labor-the-cbcps-latest-argument-against-the-rh-bill/)

Unplanned pregnancies are so rampant they comprise >50% of the total pregnancies. What do they end up with? Abortion, dumping of live borns at garbage bins or sewers and then left to die, street children, and then children being forced to join the labor force. Is this what you envisioned their life would become, after all your valiant efforts to fight for their welfare whilst in pregnancy? Shouldn’t being a pro-life also entails ensuring that their offsprings will have a good quality of life after birth?

EMPOWERMENT vs. CONTROL

During the time of Jesus, he said “give them fish, and they will live for a day. Teach them how to fish, and they can live a lifetime.” Since then, Jesus has encouraged EMPOWERMENT for his followers to survive. But how does empowerment apply?

Empowerment is:

  • When a family has free will and varied options on how to plan their family. Consequently because they were able to plan, without restriction,
  1. parents are able to provide for the family; parents don’t have to work overseas in order to augment family income, thus parents also performs their supervisory role over their children; parents are able to save for their retirement, and do not end up as nannies of their grandchildren
  2. children are able to receive all vaccines and thus fare better against these vaccine-preventable diseases; they do not contribute to under-five mortality burden; grow up as healthy individuals and thus a healthy society in return
  3. children are able to go to school instead of being forced into child labor; receive good education that will prepare them as they enter the labor force during adulthood.

Control is…

  • when you blind your followers and limit their options. Consequently, the options you have provided fail more than succeed.
  • impose your belief, whether rational or not, to others who do not necessarily share your views
  • when your followers keep on feeling indebted to you; when they always seek and rely on your approval;
  • when you use your position and blackmail your followers with abomination, excommunication and eternal damnation
  • when you label those who adapts a modern evidence-based, legal, ethically sound practices as terrorists, insurgents, filibusters, demons, just so you can get what you want
  • when you extend your duties and powers beyond pastoral and shepherding to governing.
  • when you suppress truth from surfacing and impose what was “traditionally” accepted truth as infallible.

My religion classes way back then taught me that one of the gifts of the holy spirit to us humans is FREEDOM and FREE WILL. Clearly, this is being contradicted, oppressed by some who thinks their power is limitless.

 

 
11 Comments

Posted by on July 12, 2012 in Abortion, RHBill

 

Tags: , , , , ,

The Filipino Adolescents 2012

The Filipino Adolescents 2012.

 

Tags: , , , , , , , , , ,

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?

 

Tags: , , , , , , , , ,

CBCP: Science Facts on the RH Bills (In Plain Language) — DEBUNKED!

CBCP: Science Facts on the RH Bills (In Plain Language) — DEBUNKED!.

 
Leave a comment

Posted by on July 5, 2012 in RHBill

 

Tags: , , , ,

The IFs of RH Bill

If you were male, will you be credible enough to speak in behalf of women regarding their reproductive health?

If you were male, who never had the experience menstruating, having dysmenorrhea, having been pregnant, and having endured the pains of labor and giving birth, how authoritative are you to talk about menstruation, dysmenorrhea, pregnancy, labor and birth pains? How authoritative are you to deny the existence of these gender problems and impose what you personally experience over them?

image

(Photo courtesy of http://people.tribe.net/fae4bdef-9835-4871-a784-577e6ff32ea6/photos/2dc025f5-078e-4aa4-8804-621d70eaa35d)

If you were a single female, never married, never had sex, would you be in a position to tell women how they should space out their child’s birth, to know what contraceptive method is suited for all women? If I were you, I’d rather worry about unopposed estrogen effect for not getting pregnant at all – uterine myoma, breast cancer, etc.

If you don’t have a family of your own, NO wife that wakes up early to cook food, prepare kids and husband to go to school/work, do household chores while attending to younger children, attend to kids and husband when they get back home, rest only when she sleeps, how can you tell them to only observe natural family planning method that requires them to take time to monitor and record their cervical mucus, body temperature, just to know when they are fertile or not?

If you’re not a physician, who has no background in interpreting clinical trials and/or researches, and whose only medical background is the product inserts of some medications and your unguided readings from websites, how can you be knowledgeable to tell others that contraceptives are not listed as essential medicines, that they are absolutely cancerous?

If you have crude understanding of woman’s menstrual cycle, who do not understand that progesterone, a hormone whose effect is to prevent ovulation & to make the uterus and cervix unfavorable for a pregnancy to occur SIMULTANEOUSLY, how can you insist that hormonal contraceptives (pills, injectables) will allow pregnancy to occur and abort them at the same time?

If you’re a single male, with a vow of celibacy, yet you molest child/women because you can’t rule your own libido, or have sex with your male employees, or have a child outside of marriage, are you now credible to speak of abstinence as the only morally acceptable family planning method, and sex should only be viewed as a tool for procreation?

If you’re single, unmarried, vowed for celibacy, why will you prevent couples from having sex apart from procreation when it is already established that regular sexual activity decreases their risk from cardiovascular diseases, prostate cancer and improves immune system?

If you have no family to raise, if you rely on donations for your own sustenance, why will I believe you talking about responsible parenthood?

If your only credential is the religion you uphold, who are you to shove your religious beliefs to others who believe otherwise? Is that how Christ, the man you profess, wants you to act?

If you are rich, can afford to financially sustain 84 children, can afford to have queridas y queridos, can afford your wife’s birthing in expensive hospitals, why should you deny lowly people access to health care?

——-

Do not confine your children to your own learning, for they were born in another time. – Chinese Proverb

 
1 Comment

Posted by on June 24, 2012 in Pregnancy, RHBill

 

Tags: , , ,

For Your Entertainment

For Your Entertainment.

 
Leave a comment

Posted by on June 9, 2012 in Pregnancy, RHBill, Sex Education

 

Tags: , ,

For Your Entertainment

Here is this woman, a lay missionary for the Catholic church, NEVER MARRIED, NEVER HAD A CHILD, and shall I presume NEVER HAD SEX; (Okay, let’s make it sound righteous, VIRGIN) and yet speaks with chutzpah and effrontery regarding women’s reproductive health. I knew for sure it will be a dangerous move to engage her, and I got what I deserved?…

@drclinton: once and for all, NFP is not possible for all women (ex, irregular menses) & NFP has high failure rate

@nirvadel: once and for all, my pretty dear. they are such a special segment.we are talking about state funding to make it a default

@drclinton: why not? We pay taxes, govt gives back. And why would CBCP who doesnt pay taxes dictate where taxes should go?

@nirvadel: i am talking to you as a private citizen.i’m not a bishop nor do i ever hope to be.exactly bec our taxes need to be used WELL.

@drclinton: you cannot insist abstinence coz sex has health benefits. Why deprive couple the benefit?

@nirvadel: excuse me,NFP is not a starvation diet.it is a carefully synced method to coincide with d woman’s cycle.they have sex,believe me

@drclinton: FYI, reproductive health is not textbook description. Since you’re not a physician stop pretending to know whats best for women! do you fervently believe that all women has regular menstrual cycle, amenable to natural FP?

@nirvadel: if they knew just what their other options are, i believe they would.

@drclinton: who in the family should decide what family planning method they should opt?

@nirvadel: informed couples.and seriously the gov’t should have a bias for ones that are constitutional.unconstitutional nga ang AFP e

@drclinton: tigas ng ulo mo, the bill provides options, but other people are intelligent enough to know AFP is best for them. Ipagbawal mo?

@nirvadel:hindi pinagbabawal.it is already available now.pls refer to my tweets that say injectibles are FREE,NOW in brgy health centers

@drclinton:Who told u it is available in ALL health centers? Umakyat ka sa bundok ng Cordilleras at nagsurvey ka? Nagcensus ka sa Mindanao?

(Do I already sound pissed off here?)

@nirvadel: it is a default, believe me. it is being pushed down the throats of poor women na maraming anak.after they give birth literally pinapahiya sila & asked “to stop having kids”.my sister, a doctor told me this. pero poor lang ha, mind you. they don’t do that to rich mothers

@drclinton:default? That is a serious allegation miss. Make sure you have your basis before you accuse.

@nirvadel: oh, boy, do i mean to be serious.it already is a default now.

@drclinton: what made you say UNCONSTITUTIONAL ang AFP? Miriam Santiago is constitutional expert, author of RHBill in senate.

@nirvadel:oh gawd. don’t get me started with that woman.AFPs are abortifacients.igoogle mo, pls. consti states protection of the unborn

@drclinton: I am a doctor. We in the medical field know that google is the last website to search for medical facts. Dont teach me!

@nirvadel: then that pits you against other doctors who do not believe AFPs should be for all.so as a doctor you know what abortifacients r

(Then when I wanted to retweet her message regarding the bill as unconstitutional, I couldn’t so I took a screen capture of it)

@drclinton: dear, kahit dinelete mo na ang tweet mo, napicturan ko na! Eto o…pic.twitter.com/K0fehqoq

@nirvadel:i’m actually do hoping you guys retweet me. seriously do it pa.

@drclinton:naawa ako sa u, wont RT u coz u r being laughed at.

@nirvadel: mutual feelings then.as a doctor you know what abortifacients are.then you know why they are unconstitutional

@drclinton: I had enough test dose of you, and yeah, you’re not at par. Sorry I have to end this convo. It’s a waste of time. Thanks though.

@nirvadel:sorry din kasi i don’t believe you’re even a doctor really.you head out when we discuss abortifacients.good luck on the practice

@drclinton: pwes, papatulan kita. Explain to me the menstrual cycle and explain where NFP works! Di ako doctor? Pwes, explain by your own words and dont copy or post any link.

@nirvadel: as you also know,every woman’s cycle is different.nfp is taking advantage of knowing her most fertile periods.(do i get a prize?)

@drclinton:Dear @senmiriam , this @nirvadel is claiming that AFPs are unconstitutional, therefore you #RHBill is also unconstitutional. How dare you?

@nirvadel:sigh..magsumbong ka kahit kanino. it’s unconstitutional@senmiriam. oh, i really dare.@senmiriam

I always base my discussions on contraceptive pills and other family planning method on menstrual cycle, as I deem it necessary for all women to understand this before even embarking on any contraceptive method they chose. It is a basic concept that should have been taught during school age years to make women understand their body and their potentials in child bearing. Unfortunately, sexuality education is still a big no in this country hence this opportunity to educate women about their body is gravely MISSED.

How could even a woman, who isn’t married talk expertly about married life, sex life? How could even a woman who has never been pregnant and given birth talk with authority what is best for women and child birth? How could she ever speak for married women when she hasn’t experienced these at all?

Others may ask, who am I to talk about pregnancy, childbirth, abortion, when I am a male after all? Yes, it’s true that I am a male, never been married and certainly never experienced getting pregnant nor giving birth. But I am a lowly pediatrician and neonatologist who gets called upon when problematic pregnancies are about to be terminated. Most of the babies I take care of are products of high-risk pregnancies — women who are walking time-bombs, what with their systolic blood pressures shooting over 200 or diastolic blood pressure to over 100; women whose placenta separated prematurely even before baby was born due to very high blood pressure, women bleeding, women having seizure from very high blood pressure; bottom line: COMPLICATED PREGNANCIES. Whilst I take care of the babies and not the mothers, I do appreciate the significant role of mothers in rearing these sick babies. Because, what will happen to these babies when their mothers die from giving birth?

And you thought, the twitter war between Mo Twister vs Troy Montero/Aubrey Miles was more entertaining huh?

At the end of the day, I finally drew the moral lesson: never engage these dimwits.

 
Leave a comment

Posted by on June 9, 2012 in Pregnancy, RHBill, Uncategorized

 

Tags: , , ,

In The Nick of Time

Yesterday I was consulting patients when at 2:00 pm, I received a referral from a hospital where I will be attending to the delivery of a term baby via cesarean section. The procedure was scheduled at 4 pm. Since I don’t have a long queue of patients, I was taking time my time to attend to my outpatients. At 2:45 pm however, with 3 remaining patients, my phone rang again and the caller is the same hospital. I thought the CS was being rescheduled but it was a new referral. A mom who is on her 9th pregnancy, but this would be the 6th live baby, was admitted due to very high blood pressure at 220/120. She was being scheduled for emergency cesarean section. I asked what time, the resident said NOW! I asked for the indication and  the resident replied there was a sudden drop of blood pressure from 220/120 to 160/90. It was alarming indeed! With the three remaining patients I haven’t attended to yet, shall I ask them to come back tomorrow or will I finish my consultation before I proceed to the hospital? I decided to consult them all, anyway, they were all for an oral vaccine. I was really telling sorry I had to rush them, but they do understand that I am no regular pediatrician, and they also won’t prefer to come back the next day, so all was well.

I drove as fast as I could to reach the hospital on time. Upon arrival at the parking area, I saw the obstetrician handing her key to the guard so the latter could do the parking for her. I also did the same and ran towards the NICU. I first checked the equipment if they were all prepared and in less than 5 minutes, I was notified that the operation has began. (The NICU is adjacent to the operating room). I then went to the operating room and just as I finished gloving, the baby came out. The baby was limp, no spontaneous breathing, and was bluish in color. The obstetrician immediately cut the cord so I could attend to him. On the resuscitation table, after the initial procedure of drying the baby, wiping off the amniotic fluid, the baby was not reacting. So after clearing the mouth of any secretions, removing the wet towel and covering the baby with a newer one, I immediately did bag-mask ventilation.

Image

Bag-mask ventilation. (Image credit: http://odlarmed.com/wp-content/uploads/2009/02/laerdal_als_baby_rescuer_cpr.jpg)

After few seconds, baby started to grimace, breath regularly, and his color improved. Heart rate was at a normal rate and baby began to cry. I heard then the OB gave a sigh or relief. I give credit to the obstetrician for delivering the baby as fast as possible.

When the baby already seemed alright, I immediately latched her onto the mother. While baby was on mother’s chest, I went to inspect the placenta as the obstetrician noted abruption. I noticed that on the uterine side of the placenta, it was black all over. This means that the placenta completely separated from the uterus prematurely, the black indicates blood has already clotted. (This explains why the blood pressure of the mother suddenly dropped from 220/120 to 160/90 even if the medications for controlling her blood pressure was just started). What is the implication of this? In cases of abruptio placenta (or placental abruption), the blood supply to the baby decreases depending on the placental surface that separated. The more placental surface separates, the more decreased blood flow. If this remains unmanaged, it may go to the extent where baby will become completely devoid of blood flow, loss blood volume and suffer shock. If this will still remain uncorrected, it can lead to the baby’s demise. In the case of this particular baby, the placenta completely separated, meaning, no blood flow was already going to the baby. That’s why when the baby came out, he was bluish, limp, not breathing spontaneously, and heart beat was very slow, almost towards death. The ventilation process that I provided (as illustrated above) reversed this process that’s why baby came back crying.

Image

(Image credit: http://www.moondragon.org/obgyn/pregnancy/placentaabruption.html)

In less than 5 minutes that the baby was on his mother’s chest, I noticed that he was again turning pale to bluish and breathing was getting slow. I immediately took baby to the NICU for further care. After stabilizing him, I took his blood gas and showed a mixed acidosis, and the pH was at 6.9! (A pH below 7 usually is not compatible to life as the cellular enzymes and proteins already begin to coagulate). Glad thing it was reversed immediately.

ABRUPTIO PLACENTA is one of the very serious complications of pregnancy. Depending on how immediate the action is, the baby will eventually turn out normal (if the baby was delivered immediately upon detection of subtle signs, such as a sudden drop of blood pressure on a hypertensive mother at the time of evaluation or presentation), or dead (when the action was delayed, probably due to delay in recognition of symptoms, or no health care provider was able to assess the condition, such as in remote, rural areas, or when the patient is poor enough to afford a physician/hospital). The most common frank manifestation is vaginal bleeding in relation to abdominal pain and/or labor. Subtle sign may be the sudden drop of a blood pressure in a mother who was hypertensive during the course of pregnancy. Management of course would be immediate delivery of the baby or else the baby will die. For mothers who are hypertensive, let it be known and remembered that this elevated blood pressure is able to direct blood flow to the baby. Since it is not also good for the mother to be having a very high blood pressure, as it may also cause sudden rupture of blood vessel in the brain causing stroke, they are usually admitted for it to be controlled to a satisfactory level. The control is done gradually hence the titration of the anti-hypertensive drugs. If the blood pressure immediately drops, this will cause minimal to nil blood flow to the baby, and the baby will suffer shock, and eventual death.

This is one complication of pregnancy that we are wary of as babies often are the ones who suffer the complication, from ending normal, premature, with cerebral palsy, or dead. My baby was indeed premature at 32 weeks. This is facet of the reproductive health of the mother. If the bill get’s passed and enacted, health care providers may be able to reach pregnant mothers in the remote areas, those who cannot afford private obstetrician care. Once the health care provider is able to assess a mother at risk, then they can be referred to a higher institution capable of taking care of such cases. Luckily, my patient’s family can afford private physician’s attendance. But what of those poor mothers?

 

Tags: , , , , ,