9/365 - The empty gestational sac

Evacuated a failed pregnancy, which was showing an empty gestational sac from ultrasound scan prior to procedure. However, check out the fetus lying in it with well formed crown rump length! Don't you think it is amazing how a few cells come together can produce human being like us?

We are wonderfully and fearfully made :)

9/365 - The empty gestational sac

The cause of death

It was a missed miscarriage of a 15-weeker with the fetal parameters at only 12 weeks size, showing either an arrest or shrinkage. Note how its cord tightly entangled around the neck, multiple times till the blood supply was depleted. Hence the fetal demise.

Babies are gift from God

A Para 2 was referred to Specialist Antenatal Clinic at 24 weeks of gestation for fetal ascites. She was otherwise well. Transabdominal ultrasound scan revealed a singleton baby with parameters corresponded to date, but gross fetal ascites present. She was suggested to consult fetomaternal specialist in tertiary hospital with referral letter attached. However, she preferred to seek opinion from private sector first and isn't keen to follow up with us again.

Barely 3 weeks from her visit, I tried to call to review her well being. Successful only after a few attempts, she denied who she was initially. I got to know that she had aborted the baby, even before fetomaternal specialist consultation. Was a tad disappointed.

The baby deserves a chance to live, or at least further fetal well being assessment.

The killer embolus

We'd lost another mother lately, a Gravida 7 in mid thirties, expecting her fourth child with anterior placenta praevia type 4. An emergency caesarean section was performed for bleeding praevia at 35 weeks gestation. She collapsed on table shortly after baby was delivered.

She went under general anaesthesia. First noted a drop in end tidal volume followed by circulatory collapse with cyanosis, then DIVC with bleeding from multiple orifices. CPR of more than 2 hours commenced but couldn't beat her death to massive pulmonary embolism, evidenced by the clips recorded by anaesthetist.

Subcostal view, with liver shadow on left upper corner.

1) Foreign body, the embolus in right atrium

2) Enlarging embolus, behaving malignant.

3) Multiple emboli, flopping up and down.

Infraclavicle view, atria on the right and ventricles on the left.

4) Persistent emboli, prior to pulseless electrical activity. Right atrium and ventricle dilatation seen.

5) Acute right heart failure, note some emboli had gone out of atrium.

6) Dislodge of main bulk of emboli, with some small ones still visualized in right atrium.

Pregnancy posts 10 times higher risk of embolism compared to normal population. To undergo a caesarean section increases the risk up to 20%. It was tragic to have lost a mother who was previously so well to massive emboli. Her little daughter remained not cuddled.

If love is as a sweet flower,

then my mother is that sweet flower of love.

Twin!

Dragged myself for locum today. Can't content the happiness picking up a twin pregnancy from a patient who complained of nausea for the past 2 days but did 3 self-done-UPTs which returned negative for the same period of time.


It's a DCDA twin pregnancy!

Hooray! (Although they aren't mine...)

Ectopic pregnancy

A negligence that costed too high a price to pay.

It's a sad world

I am a lil moody today. One of the contributing factors, is none other than the baby I delivered 2 weeks ago.

She was the first born, delivered via vaccum assisted delivery after a poorly traced CTG for 20 minutes. She was borned flat with an extreme cord pH of 6.799. I couldn't find any reason for early intervention prior to that as her heart was beating reactive throughout.

Today, she is planned for discharge. The paediatrician had counselled her parent for high risk of being a cerebral palsy due to the fact of being severe hypoxic ischaemic with recurrent seizure.

I have probably brought one more cerebral palsy to the world.

God bless the child, and grant the parents strength to persevere through. Emmanuel.

Unwanted or wanted?

Taken 1/12/2011 at 1449H, OT of Bintulu Hospital

It was a caesarean section for breech presentation on an Indonesian lady. The baby cried vigorously loud upon delivery, with a sad facies as if he knew he would leave his mother soon after he was out from the womb.

Yes, he was planned to be sold for adoption since he was in-utero. Post-operatively, I stood by him to mourn a little, and to whisper a lil prayer hoping that he will grow up well.

Recently I came to know a couple who had just adopted a newborn. Oh they love the baby and give him the best they can offer! They are overjoyed with the presence of the little one.

Come to think about the abandoned baby, maybe the adoption is for good. He will probably grow up better in the well-to-do-family, who treasure his presence because they really want a child, not because of another unplanned pregnancy.

Teenage pregnancy is a norm in Sarawak, whereby majority of the babies will be adopted at birth. So as to the babies bornt to single mothers or the unmarried.

Would you prefer to be bred by your own biological mother? Or an adopted family who can probably offer you better living, education etc.?

I would still choose the former.