#placenta percreta babies

[hipernikao]

La imagen de la izquierda es propia y la de la derecha es de una puerta-

🚨 **A Critical Diagnosis Often Missed Until Delivery: Placenta Percreta Involving the Bladder** 🚨

Placenta percreta is a life-threatening condition where the placenta invades beyond the uterine wall, sometimes extending into the bladder. Shockingly, most cases are only identified at the time of delivery. While you'd think bladder invasion might be apparent through symptoms like hematuria, only 25% of these cases actually present gross hematuria.

Unlike the more familiar painless third-trimester hemorrhage associated with placenta previa, bleeding from placenta percreta tends to be painful due to its invasive nature. Mothers with this condition often have a history of constant dull lower abdominal pain throughout their pregnancy.

For multiparous women with a previous cesarean delivery who present with placenta previa, especially if hematuria is detected, clinicians should seriously consider the potential for bladder invasion. Prompt investigation is crucial and can be life-saving.

🔬 **Diagnostic Tools at Your Disposal:**

1. **Ultrasound:** Grayscale ultrasound can reveal initially a low-lying uterine sac with a thin myometrium. In later stages, look for placental lacunae, irregular borders between the bladder and myometrium, and Doppler ultrasonography showing turbulent blood flow.

2. **MRI:** Provides detailed imaging and is invaluable for complex cases.

3. **Cystoscopy:** Useful for direct visualization when there's a suspicion of bladder invasion.

Early detection and appropriate planning can significantly improve outcomes for both mother and baby. If your patient fits the clinical profile, don't hesitate to conduct a thorough evaluation.

🚼 **Stay vigilant and proactive. The difference you make could be life-changing.**

#PlacentaPercreta #Obstetrics #MaternalHealth #MedicalImaging #HealthcareProfessionals

[mcatmemoranda]

I started my internal medicine rotation today. I still have imposter syndrome and I feel dumb and I'm afraid of looking dumb. I am starting on the floors. Then there's telemetry and ambulatory.

Anyway, telemetry is the unit where pts are monitored constantly.

From Wikipedia:

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.

Telemetry is used for patients (biotelemetry) who are at risk of abnormal heart activity, generally in a coronary care unit. Telemetry specialists are sometimes used to monitor many patients with a hospital. Such patients are outfitted with measuring, recording and transmitting devices. A data log can be useful in diagnosis of the patient's condition by doctors. An alerting function can alert nurses if the patient is suffering from an acute (or dangerous) condition.

T&S = Type and Screen; it's when you determine the pt's blood type. There was a pt whose Hb was 5. He was very weak as well. Since his Hb was so low, he needed a T&S so he could get a blood transfusion. I always forget what normal levels are, so:

The normal range for hemoglobin is: For men, 13.5 to 17.5 grams per deciliter. For women, 12.0 to 15.5 grams per deciliter.

The type and screen determines (T&S) both the ABO-Rh of the patient and screens for the presence of the most commonly found unexpected antibodies. ABO-RH testing (the “Type”): The patient's blood cells are mixed with serum known to have antibodies against A and against B to determine blood type. The patient’s blood cells are also treated with anti-D antibodies to determine Rh. Antibody Screen (the “Screen”): The purpose of this test (also known as the indirect Coombs test) is to detect the presence of the most common antibodies in the patient’s serum. Essentially, the patient’s serum is mixed with red cells of known antigenic composition. The incidence of a serious hemolytic reaction after transfusion of an ABO-Rh compatible transfusion with a negative screen is less than 1%. Crossmatching (NOT part of a type and screen) where actual donor cells are mixed with the recipient’s serum reduces the risk of a serious hemolytic reaction to essentially zero.

We had a presentation on placenta previa. Notes I took:

Risk factors: C-section, uterine fibroids, multiparity, increased maternal age, smoking. Greatest risk factor is previous placenta previa. Abdominal US is done first. Then a transvaginal US. US is done between 16 and 20 weeks. Placenta previa often resolves spontaneously. Trophotropism = placenta migrates away from internal cervical os. The later you see it, the less likely it will resolve. It’s painless vaginal bleeding. But it can be painful, so just because there is painful bleeding doesn't mean you can rule out placenta previa. Dx with US (first do abdominal, then transvaginal). If placenta is less than 2 cm from the internal cervical os, then it's called "low lying placenta." I remember from the US course we had in the summer, there was a video about all of this. Have to find it and post later. A full bladder makes it look like placenta previa, so you should have the pt urinate first. Vasa previa = placenta over internal os.* Velamentous umbilical cord = cord not protected by Wharton’s jelly. Hemorrhage can necessitate post partum hysterectomy. Preterm delivery and anemia can occur in the baby. Placenta accreta and percreta can occur. No digital vaginal exam should be done; no sex or heavy lifting should be done. Just monitor pt. Give corticosteroids if less than 37 weeks 48 hrs before delivery. Get vitals including pulse ox. If shocky, give fluids with bore IV (20 gauge), blood transfusion

*In vasa previa, membranes that contain blood vessels connecting the umbilical cord and placenta lie across or near the opening of the cervix—the entrance to the birth canal. Vasa previa may cause massive bleeding in the fetus and mother when the membranes around the fetus rupture, usually just before labor starts. To confirm the diagnosis, doctors insert an ultrasound device into the vagina to check for blood vessels over or near the opening of the cervix. If a woman has vasa previa, doctors check the fetus's heart rate frequently after 28 weeks of pregnancy to determine whether the fetus is in distress. Cesarean delivery is required and is often done at 34 to 37 weeks or, if problems develop, even earlier.

A velamentous umbilical cord is characterized by membranous umbilical vessels at the placental insertion site; the remainder of the cord is usually normal. Membranous vessels can also arise as aberrant branches of a marginally inserted umbilical cord or they can connect lobes of a bilobed placenta or the placenta and a succenturiate lobe. Because of the lack of protection from Wharton’s jelly, these vessels are prone to compression and rupture, especially when they are located in the membranes covering the cervical os (ie, vasa previa).

There was a 4th year student who showed us how to do blood draws. They're pretty easy, but I failed to get the vein when I tried it. Use the 25 gauge needle because it's smaller and hurts less. Recall that the larger the gauge number, the smaller the needle. So a 25 gauge needle is smaller than a 20 gauge needle. He said for a large bore IV, you would want to use a larger, 20 gauge needle.

AMA = Against Medical Advice.

"Med rec" = medical reconciliation; this is when you call the pt's pharmacy to get a record of their medications. You need to get the drug names, the doses, the number of times a day the drugs were prescribed, and whether the pt picked up the prescriptions. I did this for one pt today.

[spencersarc]

As I write this my last two babies are taking their afternoon nap,  something that I know along with sleepy snuggles and cuddles in bed,  will too soon be outgrown!

August 2107 – Day One

I am so emotional about my last two babies becoming toddlers.

When I found out that we were having twins for the second time I was so distraught. I knew how much hard work the first two were. Now my babies have grown Oh boy I wasn’t wrong it’s so much hard work but I’m so in love with them. Im so sad that during their newborn phase I was so poorly and could barely look after them.

September 2017 – Month 2

September 2107 – Month One

These two little surprises were definitely our last ones when we found out there were going to be two again. although it does make me sad that I wont have a newborn in my arms again. (until you know the next generation come along!) The decision of having more was taken away from me because of the emergency  hysterectomy. It feels a little bit more final than actually just saying your done!

The past year has been so long but has gone so fast.

October 2017 Month Two

We have been on many adventures not all good adventures either!

There are times throughout the last year that I’ve wanted to throw in the towel of being mum and head to Fiji. I have struggled so much with being outnumbered.

November 2017 – Month Three

I’ve been up and down health wise, we’ve had jealously from the big two and faced lots of tantrums and stroppy behaviour.

But were all learning to be a big family of 6! I know that’s quite small for some but I’m an only child so that huge to me!

December 2017 – Month Four

A letter to you my last babies

A year ago I was put to sleep not knowing if I would ever meet you.  I was so scared that I was going to leave your brother and sister without a mum. yet I didn’t stop to think about you two! I feel so guilty that I was so selfish thinking I didn’t care if you two lived I just had to come out of the other side for my other babies.

January 2018 Month Five

But you know when I got through the other side I was so in love with you both.

So happy to be alive and so ready to cuddle you both!

I wanted to feed you myself but didn’t realise how poorly I was going to become!

I want to say how sorry I am that not only was I too poorly to breast feed you but on most occasions I was too poorly to even hold you for a bottle. When I did find the strength I threw up all over you Mason as well as the bed, your daddy’s shoes & trousers and the nurse!

February 2018 Month Six

When I was eventually fixed and we were allowed to come home there wasn’t much time for us to bond alone as I couldn’t lift you for ages so there was always someone here.

I can’t believe that was a year ago! and now look at us!

I am so much more confident being your parent than I was with your brother and sister!

Confident in things like what you need, how your developing, changes in routine etc.

What I’m still not good at is not getting stressed at everyone as everyone needs me all once! Im not good at being one step ahead of you both! You are always ready for your bottle before I have it made.

March 2018 Month Seven

I’m not good at dealing with your screaming Mason I wish you could tell me what you want as I fear I will be deaf before you can talk. You squeal is so high-pitched and loud!

I feel sometimes that maybe I don’t have enough time for all of you!

It’s a good job we have nanny sue around to help us and give mummy a break from time to time!

April 2018 Month Eight

I just want you to know even though I am shouty and often upset you have made me such a better mummy! Its bloody hard work being outnumbered by an army you made yourself.

I want you to know that I’m going to try over the next year to make our home such an amazing place.

It will get better I know it will!

May 2018 Month Nine

I know there will be moments that will be testing but we will get through them together!

I’m so proud of you both!

Mason you curly hair and cheeky smile is so warming! You are like no-one we know grandma thinks you have a bit of an Italian side to you. Your amazing tanned skin.

Jessica you are the cutest little girl. Just looking at you brings a smile to my face. – You are so much like you big sister was!

June 2018 Month Ten

Just recently you seemed to have noticed each other and started playing together.

Not like Jake & Melody who used to cuddle one another!

July 2018 Month Eleven

You both seem to have your own independence. which I’m hoping as you grow is a good thing!

Thank-you both for coming into our life! Making our family complete!

Happy 1st Birthday!

August 2018 Month Twelve

Here is to another year of adventures!

Mummy x

And Just like that They turned One – An emotional Letter To My Last Babies As I write this my last two babies are taking their afternoon nap,  something that I know along with sleepy snuggles and cuddles in bed,  will too soon be outgrown!

[sunrisediagnostic]

Why Sonography is Necessary During Pregnancy?

 Sonography is necessary during different stages of pregnancy. During the second trimester of the pregnancy; between 18 to 20 weeks an ultrasound determines that things are moving ahead as they should. When you decide to have a sonography, we suggest you connect with Sunrise Diagnostic team because, it is one of the best sonography center in Pune. We are sure you would recommend it for full body health checkups to your friends and family.

Apart from the fact that a sonography offers patients those special moments of the first picture of the baby, the ultrasound or sonography has some important diagnostic functions. They provide critical information of the mother and the health of the baby.

Sonography is utilized to analyze and monitor the developing fetus, the uterus and placenta. This is necessary to ensure the normal development of fetus and placenta.

Basically, ultrasound imaging is utilized to assess development during pregnancy in the following manner:

Confirm the pregnancy

1.     Gestational Age:

40 weeks gestation is considered as normal pregnancy but, in medical terms it’s considered from 37 to 41 weeks. Why is it important to verify the gestational age of a developing fetus? The baby’s growth is compared with well established growth charts. This is to ensure if the baby is growing normally. Gestational age is arrived at after noting the dates informed by the mother about her last menstrual period so that the due date can be confirmed. This way the doctor ensures that the baby isn’t delivered way to early or too late.

2.     Issues with the placenta:

During pregnancy the placenta’s position in the uterus is significant for the health of the baby and the mother. An ultrasound can identify the following issues:

Vasa Previa:

It is a condition where the baby’s blood vessels run near the cervix. Due to this, vessels might get raptured in case the mother’s membrane raptures. In case of vasa previa the patient has to hospitalized during the pregnancy and in case of a cesarean section.

Placenta Previa:

When the placenta lies usually low in the uterus, either it’s next to or covers the cervix, it is referred as placenta previa. It’s common to have the placenta lying close to the opening of the cervix in the early stages of the pregnancy. It can also move up the uterine wall as the baby grows.

But if it’s low at the time of labor then it’s a bit troublesome since it can lead to catastrophic bleeding that can injure the mother and the baby too. How will an ultrasound help?

It will determine if the situation needs a cesarean section delivery.

Placenta Percreta:

In this condition the placenta is grown through the uterine wall.

Placenta Accreta:

The blood vessels and other placenta parts grow deep into the uterine wall. This causes problem as the placenta has to detach from the uterine wall after the child is born. While in placenta accrete, part or all the placenta has a grip on it.

This can be a problem because the placenta normally detaches from the uterine wall after childbirth. With placenta accreta, part or all of the placenta remains firmly attached. This can cause severe blood loss after delivery.

Placenta Increta:

In this condition the placenta invades the uterus muscles.

3. Keeping a check on the congenital anomalies:

Most parents wish to ensure that the baby is healthy and has no genetic problems or genetic issues. They can choose to terminate the pregnancy if they know about it. Alternatively, they can be prepared for the difficulties that they need to face.

4. Multiple pregnancies:

If the pregnancy includes multiple babies, it carries some risks and must be monitored regularly. One such complication can be twin to twin transfusion.

5. Monitor Fetal Growth:

When the baby’s growth is slow as compared to the norms then it indicates problems with the placenta or health of the baby. Early intervention is always better in all cases.

6. Monitor Fetal Position

It is important to know the placement and position of the baby as it affects the method of delivery.

7. Monitor the Level of Amniotic Fluid:

Fetus produces amniotic fluid; its either too much or too little fluid that indicates pregnancy problems that require early intervention.

Other tests can be done easily when its preceded and guided by an ultrasound.

What are the different types of ultrasounds?

Transvaginal ultrasound is done through the vagina. A thin transducer shaped is put into the vagina. You might feel a bit of a pressure while doing it but causes no pain. This takes 20 minutes and your bladder has to be full during this procedure.

3-D ultrasound takes many pictures at once. It takes 3-D image that has immense clarity. This type of ultrasound is used to ensure that the baby’s organs are developing and growing normally. It also keeps a check on the problems in the uterus and abnormalities in the baby’s face.

4- D ultrasound is like the 3-D ultrasound and pictures the baby’s movement on a video.

Fetal echocardiography uses sound waves to keep a check on the heart of your baby while developing. Fetal echo finds out the health defects even before birth of the baby.

We believe that your curiosity has been satiated after reading this blog post. Visit our website: www.sunrisediagnosis.com  and blog: www.sunrisediagnosis.com/blog  to know more about different diagnostic and imaging tests. Infact, Sunrise Diagnostic has the best health checkup packages in Pune. Be rest assured that you are in safe hands because, we are one of the best diagnostic center in Pune.

Sunrise Diagnostic Centre

Address:- Ground Floor, Shop No. 2, Business Hub Building Opp. Mirch Masala Hotel , Near Vandevi Mandir Karve Road,Karvenagar, Kothrud, Pune, Maharashtra 411038

Phone:  090285 66644 , 9028801188 , 9028566611

[crimsonpublishersreproductiveblr]

Practical Tips to Ensure Patient Safety while Managing Cases of Placenta Praevia_Crimson Publishers

Practical Tips to Ensure Patient Safety while Managing Cases of Placenta Praevia by Lynda M Khouzam in Perceptions in Reproductive Medicine_Crimson Publishers

Background

On many occasions Obstetrician encounter problems or difficulties while managing cases of placenta praevia or while performing caesarean section for placenta praevia. At times, patients loose large amount of blood leading to shock. Excessive and unanticipated blood loss pose the risk of severe maternal morbidity or mortality.

Following are practical tips for managing cases of placenta praevia.

A-Antenatal Woman Diagnosed to Have Placenta Praevia, who is not Bleeding

a. Admit the patient and follow standard protocol of conservative management in antenatal ward.

b. Arrange minimum two units of blood. Ask relatives to donate blood.

c. Do not perform per vaginal and frequent per abdominal examination.

d. Let everyone including nursing staff know about the admitted case, so that anyone can start the zero-hour management, in case patient starts bleeding at any odd hour.

e. Do not change or shift the bed of the patient. Keep the bed close to passage for prompt transfer on stretcher.

f. Allow one female relative with the patient all the time. Write emergency contact number of the patient’s first degree relative on the case sheet front page back side.

g. Take provisional consent for Obstetric hysterectomy, internal iliac ligation, massive blood transfusion and admission to intensive care unit before shifting patient to operation theatre. Additional consents may be obtained during surgery as and when it is needed depending upon intra-operative findings and some unanticipated complication.

h. Plan termination of pregnancy by appropriate method at the completion of 36/37 weeks. There is no advantage of conservative management after completed 37 weeks.

i. Rule out placental invasion by ultra-sonography by senior sonologists. Resident must accompany the patient when patient is shifted for sonography or to operation theatre on stretcher.

j. Reconfirm the blood and component availability before posting the case for surgery k. Confirm the availability of responsible relative of the patient at the time of surgery.

l. Post the placenta praevia caesarean section during routine morning OT, when whole team is available for help. Considering the unanticipated intra operative problems, never post elective placenta praevia caesarean section at night time.

m. Arrange/confirm the availability of two faculty members/obstetrician during surgery.

B-Antenatal Woman Diagnosed to have Placenta Praevia, who is Bleeding

a. Secure two IV line, use No 16/18 vein flow, collect adequate cross matching sample, start Ringers Lactate iv solution.

b. Arrange two units of PCV and four FFP.

c. Arrange/confirm the availability of two faculty members/ Obstetrician during surgery.

d. Mobilize adequate manpower(Residents and Interns). e. Shift patient to operation theatre after taking high risk consent.

f. After opening the abdomen, inspect for evidence of abnormal vascularity of the uterus, especially lower uterine segment. See if there is any evidence of increta and percreta, bladder involvement, prominent vessels in broad ligament.

g. Do not be in hurry to give incision on lower segment without proper inspection of the uterus. Do not blindly believe USG findings regarding invasion. Call for help when needed before opening the uterus.

h. Perform surgery/caesarean as per clinical and ultrasonographic evaluation of the case.

i. If there is evidence of increta or percreta, perform classical caesarean section avoiding extension of vertical incision in lower uterine segment, deliver the baby, do not disturb the placenta, apply temporary haemostatic clamps to both cornua and isthmus. Plan internal iliac artery ligation followed by obstetric hysterectomy.

j. Call surgeon, if bladder invasion is anticipated or seen on inspection before opening the uterus.

k. Inform anesthesiologists about the surgical plan or anticipated blood loss and operation time so that they make necessary arrangement at their end.

l. If there is un-anticipated bleeding from lower uterine segment, then ask second assistant to apply good aortic compression, so as to control placental site bleeding till further preparations/planning for surgery is done. Apply good aortic compression using fist of the hand, so that there is disappearance of femoral pulsation.

m. Do not fiddle with the placenta, if you feel that it is adherent. Attempts of manual separation of adherent placenta can result into profuse torrential bleeding resulting into hypovolemic shock and even cardiac arrest within very short time.

n. If placenta is seen posterior and adherent, inspect the posterior surface of the uterus externally by exteriorization. Judge the extent of invasion and plan further actions accordingly.

It is extremely important to anticipate the complications and thus make necessary arrangements before posting the cases (elective as well as emergency) of placenta praevia for surgery.

Be prepared to deal with adherent placenta or placental site bleeding. Make sure that the operating surgeon/surgeons are well versed with the procedures like internal iliac ligation, aortic compression and obstetric hysterectomy.

For more open access journals in Crimson Publishers please click on link: https://crimsonpublishers.com/aboutus.php

For more articles in Journal of Reproductive Health please click on below link https://crimsonpublishers.com/prm/

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[happyhealthyfitmomma]

One of my friends from high school had her third child at 23 weeks and suffered from placenta percreta. It almost killed her and little Oakley. They have both had countless surgeries and are still fighting for Oak's life. He just turned 8 months old yet can't drink from a bottle, sit up, learn to crawl, play, or do anything other babies his age can do because of what he is going through. If any of my followers can send prayers, help donate, or share this post further, it would be greatly appreciated! She can't work right now, has to drive more than 3 hours to the Children's hospital in Birmingham, and her husband takes care of their two daughters while living off of a military veteran disability check. They need all the help they can get!

[sps06]

Best Hospital in Punjab | SPS Hospitals Ludhiana

SPS Hospitals Ludhiana Punjab is counted as one of the Best Hospital in Punjab. Scar On Uterus, Can Be Scar On Life Motherhood and placenta….. Too deeply attached?Mrs Sukhvir Kaur, 29 year old, resident of Ludhiana, mother of a 5 year old, pregnant with her second child with history of previous Cesarean, referred to SPS hospitals by a local nursing home. She presented in emergency with severe bleeding and premature labor pains. The patient was admitted under department of obstetrics and gynaecology and investigated thoroughly where her MRI showed placenta invading the uterine wall and bladder and was diagnosed as placenta praevia with percreta.Dr. Venus Bansal, Senior Consultant Obs and Gynae, with her Team including Dr. Harkiran Kalsi, Dr. Jagriti Bajaj, Dr. Jaspreet Ghuman (Residents) syncronised the involvement of different modalities of the medical sciences for a good outcome of the patient. It was a huge task ahead as these patients can bleed to death on operation table. The interventional radiologist was called to access the main blood vessels that supplied the uterus (Internal Iliac artery catheterisation) to block it in case the need arise. Blood bank was alerted for preparation of blood and blood products for massive blood transfusion. During the surgery, baby was taken out by non conventional Classical Cesarean method and despite all the prophylactic measures DEADLY placenta started to bleed. A very difficult and crucial decision of Cesarean Hysterectomy (removal of the uterus) which was life saving was taken and with great caution successfully completed. She recovered very well within 48 hours and was happily sitting with her baby for kangaroo mother care. Placenta is the first part to develop for the nourishment of a developing baby. Sometimes the placenta forms abnormally, where it can be life threatening. Such conditions are Placenta Accreta, Percreta, Increta where placenta grows too deeply into the mothers womb and may be extended to the urinary bladder and near by structures. Generally it occurs in patients with previous surgeries on the uterus like cesarean sections, myomectomy (removal of fibroids), cleaning of the uterus for abortions. Dr Venus Bansal told that this case is published to Highlight the issue of increasing number of Cesarean on Demand / request by patient and low threshold for normal delivery leading to increasing the number of SCARRED UTERUS. Moreover, repeated abortions for unwanted pregnancy is also a reason for uterine scarring. Contraception is encouraged rather than termination of unwanted pregnancy. These are the reasons for increase in the number of cases of placenta praevia and accreta. It is traumatic experience, where patient undergoes surgery for placenta accreta /increta / percreta and knows the risk of loosing her life by bleeding out to death on operation table itself, and as an intervention it might becomes necessary to take out the uterus itself or leave the placenta inside.”Dr Naresh (Senior Anaesthetist) told that these cases can be managed only in higher centres with state of art operation theatre, ICU, interventional radiologist, pediatrician, urosurgeon, blood bank and highly trained staff. Dr Bakshi, head of the department of Radiology also commented that incidence of placenta praevia with invasions is increasing as compared to past.Scar on uterus can become a scar on life. Visit us here ! SPS Hospitals Ludhiana

[instapicsil2]

Cindy Lopez, 28, grimaces in pain after the premature birth of her third daughter. She required lifesaving surgery after her C-section delivery to address complications she developed during her pregnancy, including placenta percreta, in which the placenta grows through the uterine wall and can attach to other organs. In the second picture Lopez peeks in on her new baby, Aria Victoria Orta, born at 32 weeks. Lopez came every day from home to visit and breastfeed her for the six weeks Aria spent in the neonatal intensive care unit. During my career as a photojournalist I have documented maternal mortality across the developing world but for my most recent @natgeo story, ‘Giving Life Can Still Be Deadly,’ I spent several months focusing on this issue at home in the U.S. and in Somaliland. The U.S. is one of only two developed countries where the rate of women dying from pregnancy has gotten worse since 1990. The rate of maternal deaths remains stubbornly high in the United States: about 14 deaths for every 100,000 live births. Black mothers are particularly at risk. Better basic care could help, as it has in the developing world. https://ift.tt/2BiyxT0

[medicine-in-reality-blog]

Emotion - Part I

Mothers in Medicine takes many approaches to the voice and the overall feeling of every post, which is, of course, a result of having so many contributors. That is one aspect that makes this such an interesting source for women in medicine: it has so much variety. There are many fun posts where mothers talk about their kids and share funny stories that make you laugh, but there are also the ones that speak to the truth about this profession with family and how physically and emotionally demanding they can be. I find that to be extremely important in medicine, because people like to talk about the good, but there is also so much bad that people neglect to discuss. One post that really touched me is called “I Forgot to Worry About That!” by MonkeyJoe. In this post, she explains that she is pregnant with her fourth baby, but how this one will be different from all the others: she has a placenta percreta. She explains that a placenta percreta means that her placenta invaded through the myometrium and serosa as well as the surrounding structures and organs. This makes delivery extremely risky for both her and her baby. By having this diagnosis, she will have a C-section followed with a complete hysterectomy where the major concern is massive blood loss (potential hemorrhage), damage to her surrounding organs, and the possibility of death. That’s just for the mother. The baby will have to be delivered preterm which puts the baby at risk for many diseases as well. I found this post to be compelling and a very emotional read. I admire the fact that she posted this and was able to get support from other mothers who have gone through similar complications in the comment section; comments that say “good luck!!! 2 of my 3 pregnancies were high risk . . .” may not seem like much, but there’s a specific type of comfort that comes with knowing you’re not alone.

[oovitus]

I forgot to worry about that!

Hi! So excited to join this sisterhood. I am a pediatric hospitalist at a mid-sized children’s hospital. I am blessed with 3 amazing children and a supportive, talented husband who is thankfully not in medicine but rather works during normal human hours.

I am pregnant with my fourth child. I have had 3 normal, healthy pregnancies and delivered 3 healthy, full term babies. I was apprehensively hoping for the same this time around. No such luck; at my routine anatomy scan, I was suspected to have placenta accreta. For those of you who don’t remember from medical school, here’s a crash course. Normally the placenta adheres loosely to the uterine wall, and is able to detach easily following delivery. With placenta accreta, the placenta adheres to the uterus pathologically. It invades inward, doesn’t separate spontaneously after delivery, and can cause massive hemorrhage if manual separation is attempted. Most patients who have placenta accreta require a life-saving hysterectomy. There are 3 subtypes: in a standard accreta, the placenta simply attaches too deeply to the uterine wall; in placenta increta, it invades into the myometrium; and in placenta percreta, it invades through the myometrium and serosa, and occasionally into surrounding structures and organs (most commonly the bladder, but any organ in the vicinity is potentially at risk).

I immediately transferred care to the placenta accreta referral center in the nearest big city. Within 2 weeks I had an appointment and within 2 minutes of meeting my MFM she told me I was a “hot mess.” I have placenta percreta. Go big or go home. (I think I want to go home.)

People comment on how “well I’m taking it.” How “strong” and “resilient” I am. “You look great; you don’t even seem worried,” people tell me. I don’t seem worried? That’s cool. Because I am worried. I’m worried about a lot of things. In fact, here is a list of things I’m worried about.

The very complicated cesarean delivery, complete with a hysterectomy. I will be on the table for about 6 hours, and there will be various surgical teams parading in and out of the OR.

Intraoperative blood loss, with potential for massive hemorrhage. I will almost certainly require multiple blood transfusions, and if things go particularly badly “massive transfusion protocol” will be initiated, which puts me at risk for complications including fluid shifts, electrolyte derangements, DIC and ARDS, to name a few.

Damage to surrounding structures, including but not limited to my genitourinary tract. That placenta is freaking close to my bladder, people.

Let’s just put this out there: death. There is in fact a 7% mortality rate for cases like mine. Even in the major centers, even if the operative teams are prepared.

Oh, and the baby. In order to reduce the risk of these complications, the baby will need to be delivered preterm. And not late-preterm. Preterm preterm. Like a preterm baby who is at risk for sepsis, IVH, chronic lung disease, NEC, and all the other preemie ailments.

And the more minor things too. That pesky surgical incision that will extend vertically from my pubis up to my xiphoid. Recovering from this surgery, which will render me essentially nonfunctional at home. The possibility that breastfeeding may not go well, and may not be possible at all. The fear that this pregnancy may become even more complicated, and I may need to deliver even earlier than planned. The fact that I don’t have enough paid time off, and I will need to take unpaid leave for several weeks, something that I’m not sure we can handle financially. The loss of my fertility, completely and forever.

But life goes on. Thankfully the baby is fine and the pregnancy is otherwise healthy, so there’s not much to do between now and delivery. So I get dressed, get in my car, and go to work. I take care of sick patients, supervise residents, and teach medical students. And on nights in the hospital when things are slow I work on my mandatory compliance modules. Every year we are obligated to do like 40 of them. They range from mildly clinically interesting (preventing central line infections, reporting suspected child abuse) to stiffly corporate (anti-kickback statutes, reminders not to commit fraud) to downright irrelevant and time-wasting.

One night on call I had some free time so I decided to bang out a few modules. I was up to “Preventing Operating Room Fires.” Groan. This one was not only completely irrelevant (I wasn’t even allowed in the ORs! Not even to, say, do an LP on a sedated child!) but it was an 18-minute-long video. As I started watching the video, I froze. I realized that even though I wasn’t allowed in the OR as a doctor, I was about to be in one as a patient. And I slowly but suddenly wondered: WHAT IF THERE IS A FIRE IN THE OR??? THIS COULD TOTALLYHAPPEN TO ME! And it dawned on me, that with all the things I was worrying about – the massive blood transfusions, the damage to my genitourinary tract, the 7% mortality rate, the preemie baby – there could ALSO be an OR fire and I FORGOT TO WORRY ABOUT THAT! How could I forget to worry about something that had a nonzero chance of happening and could have devastating consequences? I didn’t sleep for the next 3 nights.

I remember my last night on call before delivering my youngest child. I was 38 weeks along and healthy. One of the patients I admitted was a 4-month-old infant. She had had corrective surgery to repair anorectal atresia with a rectovestibular fistula and needed to be monitored post-op. As I took the history from her parents and discovered that they did not know about this condition until after she was born, I remember having a similar realization: I had been worrying about all the usual things – prematurity, infection, birth hypoxia. But anorectal atresia with rectovestibular fistula? I had completely forgotten to worry about that!

Worry is a funny thing. Psychologists postulate that worry is beneficial insofar as it helps people do the things they need to do to keep themselves safe. Studies have shown that people who worry about skin cancer are more vigilant about applying sunscreen than those who don’t. But I already transferred to the regional center and am compliant with my prenatal care, all the things I need to do to optimize my chances for a good medical outcome. At this point most psychologists would agree that worrying won’t do me any good. It doesn’t help anything. But that doesn’t stop me.

A few friends jokingly suggested that I focus all my energy on worrying about that potential OR fire and not bother worrying about anything else. It’s not a terrible idea.

I forgot to worry about that! published first on

[yes-dal456]

What I Wanted To Say To The Pregnant Woman Bashing Her Bed Rest But Didn’t

Not too long ago, as I was sitting down to take a late night Yin Yoga class, a pregnant woman rolled out her mat and sat down right next to me.

At first I was thinking how wonderful it was that she was taking this time to relax and enjoy the beautiful shape of her pregnant body ― but this changed when she began to speak.

The yoga Instructor asked her how far along she was. She smiled and said “I’m 19 weeks today” and then she said this:

“My f*****g doctor put me on bed rest and it’s bulls**t, so I came here to get out of the house!”

I felt myself start to hyperventilate.

She then said:

“He told me that I could go into labor at any minute and I should sit in my bed for as many hours of the day as possible and always have someone available to drive me to the hospital, but I refuse to do that.”

I now felt myself tense up and start to sweat.

You see ― I hemorrhaged and almost died at 17 weeks (and again at 19 and 21 weeks) pregnant because of placenta percreta and I was on strict bed rest from 17 weeks on.

I could have died and left behind my three beautiful little boys, as well as lost my tiny daughter growing in my womb at the time, and the order to remain in my bed was the only thing that prevented any of things from happening.

Every time I rolled over I would feel the blood gushing out of me, along with the hope of surviving and carrying my pregnancy to term.

This is how I lived ― constantly having IVs deliver me transfused blood in a hospital bed, from 17 weeks until I reached 23 weeks gestation and until I experienced my final hemorrhage, one that required an emergency caesarian ― accompanied by the surgeon separating my placenta from both my bowels and bladder because it attached to them after it grew through my uterus.

And to top if off, I also required a hysterectomy and over 30 units of blood to remain alive.

This was nothing compared to what my daughter had to go through.

She was born at 23 weeks gestation ― at just one pound and four ounces (575 grams) and was not even as long as a ruler.

My daughter fought to say alive while enduring countless intravenous lines in her veins and near her heart, X-rays, infections, medications, procedures, pain and more. Because of her extremely premature birth, she needed to remain in the Neonatal Intensive Care Unit (NICU) for 121 days.

While I had experienced a terrible and life threatening ordeal, it was not even comparable to what my precious baby has to endure, so I take pregnancy-induced bed rest very seriously!

I want to be the first person to acknowledge that my experience forever changed the way I view many things and that most other people (thankfully!) will not have to experience what I did, so they simply cannot comprehend that magnitude and dangers of a premature birth.

I will also acknowledge that many women are pushed into a state of disbelief and denial when they are prescribed pregnancy-induced bed rest. I fell victim to this as well. I did not want to believe that anything bad could happen to me or my growing baby. I already had three successful and full-term pregnancies prior to my fourth and last and everything always turned out well.

Could it be that this woman was in denial?

Maybe she just did not know anyone who had an extremely premature baby and watched it suffer or gain angel wings?

Maybe she was not properly educated on the dangers both her and her baby may face if she in fact went into labor “at any minute” as her doctor warned her could happen?

Maybe she didn’t use Google to research the plethora of things that could happen to her baby if she delivered him/her early?

Maybe.

That is what I would like to think, at least.

I also want to admit that women who experiences a life-threatening pregnancy and/or a premature birth are known to suffer from a type Post Traumatic Stress Disorder (PTSD) that is just now being studied and understood.

I suffered from this.

While it took me over a year to realize why certain sights and smells would put me into a bad mood or how certain songs popular at the time of my pregnancy and delivery would play on the radio and I would start to sweat or breathe fast- I eventually realized that I had a mild version of PTSD ― although it didn’t always seem mild.

This is why I started going to Yin Yoga two years ago. I wanted and needed a way and a place that did not remind me of the high-risk pregnancy unit or the NICU. I wanted and needed a place where I could just be calm and listen to my body and myself.

For two years this Yin Yoga class helped me more than I can explain.

Having four children does not leave a lot of time to exercise and reflect.

I needed to do much of my healing on my own time and on my own terms, and my Yin class was my safe place- until this night.

So what I wanted to say to this woman was:

· You should listen to your doctor’s orders and stay in your bed as much as humanly possible because each day your baby can stay inside your womb gives him/her a better chance at survival.

· 19 weeks is too early to deliver and there is no chance that your baby will survive before 22/23 weeks gestation.

· “In babies born preterm, the chance of survival at less than 23 weeks is close to zero, while at 23 weeks it is 15%, at 24 weeks 55% and at 25 weeks about 80%.” (latest statistic from tommys.org)

· Babies born as micro preemies (before 26 weeks gestation like my daughter) are at an extremely high risk for Anemia, Apnea, Chronic Lung Disease, Septic Infections, Intraventricular hemorrhage (IVH), Jaundice, Necrotizing enterocolitis (NEC- a deadly disease in only premature babies where the intestines die off), Patent ductus arteriosus (PDA- a hole near the heart that hasn’t closed yet), Respiratory Distress Syndrome (RDS- inability to breath unassisted for a long time requiring ventilation), Retinopathy of Prematurity (ROP- a disease that affects the baby’s eyesight) and many other diseases that are unique to premature babies.

· My daughter was born at 23 weeks gestation after six weeks of bed rest and I can honestly say that she would not be alive if she were born any earlier.

· Pregnancy-induced bed rest is TEMPORARY.

· The most it can last is 41 weeks, if you’re lucky.

· You want your bed rest to last at least 37 weeks.

· I understand that it’s frustrating being forced to sit in a bed while everyone lives their lives around you, but you must understand that it is for the good of your baby and it will end with a precious reward.

Actually there are a lot of other things I wanted to say to her that I simply cannot write about here ― but you get the point!

Although I wanted to say all of those things, I said nothing.

I froze.

I was dealing with all of the emotions I once felt as they all came flooding back into my memory and it took a lot of breathing to just focus on remaining calm.

I did not know this woman and I did not want to give her advice that she did not ask for, although she may have needed. If I were prepared to hear what she said, then I may have been in a better state of mind to offer advice.

She stopped discussing her pregnancy as soon as we said our three “Oms” and I was able to complete my Yin class. Once it was over, I ran out the door to my car and sat there for a while trying to process what I heard and how I reacted.

You see- although my daughter is now doing well despite her extremely premature birth and the Chronic Lung Disease it left her with- I still feel like I could have done more to remain pregnant longer.

That is my issue.

I still wish I were more educated about the dangers of placenta precreta caused by my three previous caesarian sections, before I agreed to have them.

That is my issue.

What I came to realize, and must remind myself often, is that we each have fears and regrets that we carry with us everywhere, including yoga classes.

We just need to live our lives and treat others and ourselves as best as we can and we should think about our words before they leave our bodies.

I decided that if I see her at another Yin class, I will gently approach her at the end and introduce myself as someone who has been in her shoes and see if she opens up.

In hindsight, where everything seems to come to light but is usually too late, I believe that she may have been angrily announcing her bed rest to the group because she had not had time to accept it yet and she may have even been looking for someone to listen.

She might have been scared.

I wish I was in the place to listen the first time but I was not.

If I see her again, I will be.

For more information on pregnancy induced bed rest, premature births and to purchase my book “From Hope to Joy: A Memoir of a Mother’s Determination and Her Micro Preemie’s Struggle to Beat the Odds” about my journey with prematurity and my daughter’s success, please visit my website at www.micropreemie.net.

Tweets by JenniferDegl

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from http://ift.tt/2mDg4r7 from Blogger http://ift.tt/2lMSv1F

[spencersarc]

Did you know in April @hfa.ukchapter run a 30 day challenge over on their Facebook page. To raise awareness of the rare pregnancy condition. Placenta accreta, increta, percreta. This is me. A week after surgery after having my babies. At the time I didn’t think about future implications. I just hoped that I got through the surgery. Now I’m going through the menopause. Who knew at 38 I’d be feeling like an old lady. I know it affects people at different times but I just never thought it would affect me just yet. . #placentapercreta #placentaaccreta #pregnancycomplications #csection #cersarianhysterectomy #hysterectomy #menopause #lifeafterpercreta #lifeafteraccreta #survivor @nhsmillion (at Jessop Hospital) https://www.instagram.com/spencersarc.mummy/p/BvzIvOFlJ9H/?utm_source=ig_tumblr_share&igshid=l7o7oq3h2tfa

[imreviewblog]

What I Wanted To Say To The Pregnant Woman Bashing Her Bed Rest But Didn’t

Not too long ago, as I was sitting down to take a late night Yin Yoga class, a pregnant woman rolled out her mat and sat down right next to me.

At first I was thinking how wonderful it was that she was taking this time to relax and enjoy the beautiful shape of her pregnant body ― but this changed when she began to speak.

The yoga Instructor asked her how far along she was. She smiled and said “I’m 19 weeks today” and then she said this:

“My f*****g doctor put me on bed rest and it’s bulls**t, so I came here to get out of the house!”

I felt myself start to hyperventilate.

She then said:

“He told me that I could go into labor at any minute and I should sit in my bed for as many hours of the day as possible and always have someone available to drive me to the hospital, but I refuse to do that.”

I now felt myself tense up and start to sweat.

You see ― I hemorrhaged and almost died at 17 weeks (and again at 19 and 21 weeks) pregnant because of placenta percreta and I was on strict bed rest from 17 weeks on.

I could have died and left behind my three beautiful little boys, as well as lost my tiny daughter growing in my womb at the time, and the order to remain in my bed was the only thing that prevented any of things from happening.

Every time I rolled over I would feel the blood gushing out of me, along with the hope of surviving and carrying my pregnancy to term.

This is how I lived ― constantly having IVs deliver me transfused blood in a hospital bed, from 17 weeks until I reached 23 weeks gestation and until I experienced my final hemorrhage, one that required an emergency caesarian ― accompanied by the surgeon separating my placenta from both my bowels and bladder because it attached to them after it grew through my uterus.

And to top if off, I also required a hysterectomy and over 30 units of blood to remain alive.

This was nothing compared to what my daughter had to go through.

She was born at 23 weeks gestation ― at just one pound and four ounces (575 grams) and was not even as long as a ruler.

My daughter fought to say alive while enduring countless intravenous lines in her veins and near her heart, X-rays, infections, medications, procedures, pain and more. Because of her extremely premature birth, she needed to remain in the Neonatal Intensive Care Unit (NICU) for 121 days.

While I had experienced a terrible and life threatening ordeal, it was not even comparable to what my precious baby has to endure, so I take pregnancy-induced bed rest very seriously!

I want to be the first person to acknowledge that my experience forever changed the way I view many things and that most other people (thankfully!) will not have to experience what I did, so they simply cannot comprehend that magnitude and dangers of a premature birth.

I will also acknowledge that many women are pushed into a state of disbelief and denial when they are prescribed pregnancy-induced bed rest. I fell victim to this as well. I did not want to believe that anything bad could happen to me or my growing baby. I already had three successful and full-term pregnancies prior to my fourth and last and everything always turned out well.

Could it be that this woman was in denial?

Maybe she just did not know anyone who had an extremely premature baby and watched it suffer or gain angel wings?

Maybe she was not properly educated on the dangers both her and her baby may face if she in fact went into labor “at any minute” as her doctor warned her could happen?

Maybe she didn’t use Google to research the plethora of things that could happen to her baby if she delivered him/her early?

Maybe.

That is what I would like to think, at least.

I also want to admit that women who experiences a life-threatening pregnancy and/or a premature birth are known to suffer from a type Post Traumatic Stress Disorder (PTSD) that is just now being studied and understood.

I suffered from this.

While it took me over a year to realize why certain sights and smells would put me into a bad mood or how certain songs popular at the time of my pregnancy and delivery would play on the radio and I would start to sweat or breathe fast- I eventually realized that I had a mild version of PTSD ― although it didn’t always seem mild.

This is why I started going to Yin Yoga two years ago. I wanted and needed a way and a place that did not remind me of the high-risk pregnancy unit or the NICU. I wanted and needed a place where I could just be calm and listen to my body and myself.

For two years this Yin Yoga class helped me more than I can explain.

Having four children does not leave a lot of time to exercise and reflect.

I needed to do much of my healing on my own time and on my own terms, and my Yin class was my safe place- until this night.

So what I wanted to say to this woman was:

· You should listen to your doctor’s orders and stay in your bed as much as humanly possible because each day your baby can stay inside your womb gives him/her a better chance at survival.

· 19 weeks is too early to deliver and there is no chance that your baby will survive before 22/23 weeks gestation.

· “In babies born preterm, the chance of survival at less than 23 weeks is close to zero, while at 23 weeks it is 15%, at 24 weeks 55% and at 25 weeks about 80%.” (latest statistic from tommys.org)

· Babies born as micro preemies (before 26 weeks gestation like my daughter) are at an extremely high risk for Anemia, Apnea, Chronic Lung Disease, Septic Infections, Intraventricular hemorrhage (IVH), Jaundice, Necrotizing enterocolitis (NEC- a deadly disease in only premature babies where the intestines die off), Patent ductus arteriosus (PDA- a hole near the heart that hasn’t closed yet), Respiratory Distress Syndrome (RDS- inability to breath unassisted for a long time requiring ventilation), Retinopathy of Prematurity (ROP- a disease that affects the baby’s eyesight) and many other diseases that are unique to premature babies.

· My daughter was born at 23 weeks gestation after six weeks of bed rest and I can honestly say that she would not be alive if she were born any earlier.

· Pregnancy-induced bed rest is TEMPORARY.

· The most it can last is 41 weeks, if you’re lucky.

· You want your bed rest to last at least 37 weeks.

· I understand that it’s frustrating being forced to sit in a bed while everyone lives their lives around you, but you must understand that it is for the good of your baby and it will end with a precious reward.

Actually there are a lot of other things I wanted to say to her that I simply cannot write about here ― but you get the point!

Although I wanted to say all of those things, I said nothing.

I froze.

I was dealing with all of the emotions I once felt as they all came flooding back into my memory and it took a lot of breathing to just focus on remaining calm.

I did not know this woman and I did not want to give her advice that she did not ask for, although she may have needed. If I were prepared to hear what she said, then I may have been in a better state of mind to offer advice.

She stopped discussing her pregnancy as soon as we said our three “Oms” and I was able to complete my Yin class. Once it was over, I ran out the door to my car and sat there for a while trying to process what I heard and how I reacted.

You see- although my daughter is now doing well despite her extremely premature birth and the Chronic Lung Disease it left her with- I still feel like I could have done more to remain pregnant longer.

That is my issue.

I still wish I were more educated about the dangers of placenta precreta caused by my three previous caesarian sections, before I agreed to have them.

That is my issue.

What I came to realize, and must remind myself often, is that we each have fears and regrets that we carry with us everywhere, including yoga classes.

We just need to live our lives and treat others and ourselves as best as we can and we should think about our words before they leave our bodies.

I decided that if I see her at another Yin class, I will gently approach her at the end and introduce myself as someone who has been in her shoes and see if she opens up.

In hindsight, where everything seems to come to light but is usually too late, I believe that she may have been angrily announcing her bed rest to the group because she had not had time to accept it yet and she may have even been looking for someone to listen.

She might have been scared.

I wish I was in the place to listen the first time but I was not.

If I see her again, I will be.

For more information on pregnancy induced bed rest, premature births and to purchase my book “From Hope to Joy: A Memoir of a Mother’s Determination and Her Micro Preemie’s Struggle to Beat the Odds” about my journey with prematurity and my daughter’s success, please visit my website at www.micropreemie.net.

Tweets by JenniferDegl

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from Healthy Living - The Huffington Post http://huff.to/2lrjA85

[oovitus]

I forgot to worry about that!

Hi! So excited to join this sisterhood. I am a pediatric hospitalist at a mid-sized children’s hospital. I am blessed with 3 amazing children and a supportive, talented husband who is thankfully not in medicine but rather works during normal human hours.

I am pregnant with my fourth child. I have had 3 normal, healthy pregnancies and delivered 3 healthy, full term babies. I was apprehensively hoping for the same this time around. No such luck; at my routine anatomy scan, I was suspected to have placenta accreta. For those of you who don’t remember from medical school, here’s a crash course. Normally the placenta adheres loosely to the uterine wall, and is able to detach easily following delivery. With placenta accreta, the placenta adheres to the uterus pathologically. It invades inward, doesn’t separate spontaneously after delivery, and can cause massive hemorrhage if manual separation is attempted. Most patients who have placenta accreta require a life-saving hysterectomy. There are 3 subtypes: in a standard accreta, the placenta simply attaches too deeply to the uterine wall; in placenta increta, it invades into the myometrium; and in placenta percreta, it invades through the myometrium and serosa, and occasionally into surrounding structures and organs (most commonly the bladder, but any organ in the vicinity is potentially at risk).

I immediately transferred care to the placenta accreta referral center in the nearest big city. Within 2 weeks I had an appointment and within 2 minutes of meeting my MFM she told me I was a “hot mess.” I have placenta percreta. Go big or go home. (I think I want to go home.)

People comment on how “well I’m taking it.” How “strong” and “resilient” I am. “You look great; you don’t even seem worried,” people tell me. I don’t seem worried? That’s cool. Because I am worried. I’m worried about a lot of things. In fact, here is a list of things I’m worried about.

The very complicated cesarean delivery, complete with a hysterectomy. I will be on the table for about 6 hours, and there will be various surgical teams parading in and out of the OR.

Intraoperative blood loss, with potential for massive hemorrhage. I will almost certainly require multiple blood transfusions, and if things go particularly badly “massive transfusion protocol” will be initiated, which puts me at risk for complications including fluid shifts, electrolyte derangements, DIC and ARDS, to name a few.

Damage to surrounding structures, including but not limited to my genitourinary tract. That placenta is freaking close to my bladder, people.

Let’s just put this out there: death. There is in fact a 7% mortality rate for cases like mine. Even in the major centers, even if the operative teams are prepared.

Oh, and the baby. In order to reduce the risk of these complications, the baby will need to be delivered preterm. And not late-preterm. Preterm preterm. Like a preterm baby who is at risk for sepsis, IVH, chronic lung disease, NEC, and all the other preemie ailments.

And the more minor things too. That pesky surgical incision that will extend vertically from my pubis up to my xiphoid. Recovering from this surgery, which will render me essentially nonfunctional at home. The possibility that breastfeeding may not go well, and may not be possible at all. The fear that this pregnancy may become even more complicated, and I may need to deliver even earlier than planned. The fact that I don’t have enough paid time off, and I will need to take unpaid leave for several weeks, something that I’m not sure we can handle financially. The loss of my fertility, completely and forever.

But life goes on. Thankfully the baby is fine and the pregnancy is otherwise healthy, so there’s not much to do between now and delivery. So I get dressed, get in my car, and go to work. I take care of sick patients, supervise residents, and teach medical students. And on nights in the hospital when things are slow I work on my mandatory compliance modules. Every year we are obligated to do like 40 of them. They range from mildly clinically interesting (preventing central line infections, reporting suspected child abuse) to stiffly corporate (anti-kickback statutes, reminders not to commit fraud) to downright irrelevant and time-wasting.

One night on call I had some free time so I decided to bang out a few modules. I was up to “Preventing Operating Room Fires.” Groan. This one was not only completely irrelevant (I wasn’t even allowed in the ORs! Not even to, say, do an LP on a sedated child!) but it was an 18-minute-long video. As I started watching the video, I froze. I realized that even though I wasn’t allowed in the OR as a doctor, I was about to be in one as a patient. And I slowly but suddenly wondered: WHAT IF THERE IS A FIRE IN THE OR??? THIS COULD TOTALLYHAPPEN TO ME! And it dawned on me, that with all the things I was worrying about – the massive blood transfusions, the damage to my genitourinary tract, the 7% mortality rate, the preemie baby – there could ALSO be an OR fire and I FORGOT TO WORRY ABOUT THAT! How could I forget to worry about something that had a nonzero chance of happening and could have devastating consequences? I didn’t sleep for the next 3 nights.

I remember my last night on call before delivering my youngest child. I was 38 weeks along and healthy. One of the patients I admitted was a 4-month-old infant. She had had corrective surgery to repair anorectal atresia with a rectovestibular fistula and needed to be monitored post-op. As I took the history from her parents and discovered that they did not know about this condition until after she was born, I remember having a similar realization: I had been worrying about all the usual things – prematurity, infection, birth hypoxia. But anorectal atresia with rectovestibular fistula? I had completely forgotten to worry about that!

Worry is a funny thing. Psychologists postulate that worry is beneficial insofar as it helps people do the things they need to do to keep themselves safe. Studies have shown that people who worry about skin cancer are more vigilant about applying sunscreen than those who don’t. But I already transferred to the regional center and am compliant with my prenatal care, all the things I need to do to optimize my chances for a good medical outcome. At this point most psychologists would agree that worrying won’t do me any good. It doesn’t help anything. But that doesn’t stop me.

A few friends jokingly suggested that I focus all my energy on worrying about that potential OR fire and not bother worrying about anything else. It’s not a terrible idea.

I forgot to worry about that! published first on https://storeseapharmacy.tumblr.com