OB Case, need info

[mobey]

An Inverted uterus would have been caught on U/S I am quite sure.

I agree the cervix SHOULD be closed, however this individual had just had intercourse, with semen present one must take into consideration that semen is a powerful prostaglandin (sp), which can dilate the cervix. I will not mention the ways that contractions are stimulated during sex and preticularily orgasm.

This sounds like amniotic sac prolapse for sure, and I think all treatments were correct. This also does not mean certain death for the fetus.

If this was placenta previa, there would be a large to moderate quantity of bright red blood, and if the placenta was in fact prolapsed, it would look like bright red tissue with texture - not a smooth sac.

[Just Plain Ruff]

An Inverted uterus would have been caught on U/S I am quite sure.

I agree the cervix SHOULD be closed, however this individual had just had intercourse, with semen present one must take into consideration that semen is a powerful prostaglandin (sp), which can dilate the cervix. I will not mention the ways that contractions are stimulated during sex and preticularily orgasm.

This sounds like amniotic sac prolapse for sure, and I think all treatments were correct. This also does not mean certain death for the fetus.

If this was placenta previa, there would be a large to moderate quantity of bright red blood, and if the placenta was in fact prolapsed, it would look like bright red tissue with texture - not a smooth sac.

I just spent some time down in the ED of my client and talked to a ED Doc who also did some work in the OB department.

He said that by presentation that this was more than likely the amniotic sac and your treatment was spot on.

He said that it more than likely would signal the death of the fetus but there are a number of considerations to be taken in to account before that is the diagnosis. He didn't have time to go into all of them but he did say that if caught early enough that a skilled OB surgeon could maneuver the amniotic sac back up and possibly get it back in place. This all hinges on whether the placenta is damaged or has become detached.

He said this was a very significant emergency for the fetus but not so much for the mother. He said that he would do his damndest to save the baby but he said he would never give any type of guarantee or even allude to success until the replacement was done. He said that this is one of those pucker factor moments that happen in OB. He also said in our conversation that he has had only a handful of these events and of those he's seen, none have had positive outcomes.

But he said there's always HOPE! and if you pray, get on your knees and pray and if you don't pray maybe it's time to start in this situation.

[Dustdevil]

Pretty much what Ruffems said above.

Uterine prolapse in an otherwise healthy, nulliparous adolescent is extremely unlikely. And placenta praevia would generally present much later and with more associated symptoms.

This is almost certainly a premature delivery, but without labour. The cause may be anything from simple spontaneous AB to cervical incompetence. If it is the former, then it is an unfortunate, but otherwise normal tragedy that can be neither prevented nor fixed. If it is the latter, it will most likely happen again, so future pregnancies need to be closely monitored by an OB. Either way, the chances of survival of a 22 week foetus are abysmal. And those who do survive will almost certainly suffer from serious, disabling developmental abnormalities.

You did everything right, medically speaking. Very nice job. The only other thing I would emphasise would be the paramount importance of maintaining your composure, and imparting a calm and reassuring attitude to your patient. Getting her further adrenalised with fear or emotions cannot be helpful. And it can be difficult to strike a balance between panic and concern, and compassion and pity. Like I always say about paramedic education, there is really only one course that you will look back to on each and every patient, and that course is psychology.

[DwayneEMTP]

As Dust said, likely mid delivery without labor...

(My apologies for showing LoneStar's ex girlfriend without permission.)

Like that? Very common in livestock. In fact very often you'll hear farmers say, "Expecting that calf/lamb/foal but no bubble yet..." Cerivix dilation allows amniotic sack to prolapse (Not really sure that's the correct term for this) becoming exposed.

Dwayne

[Kaisu]

Prolapsed uterus..

picture

[island emt]

Sounds like the care provided was appropriate on this call.

On another track about this call. You have a child that is knocked up at 16 yo and still having sex with her boyfriend who if he's in collage is probably at least 18 yo.

In most places this could be considered statutory rape of a minor.

Mother natures way of reducing unneeded children.

[Dustdevil]

On another track about this call. You have a child that is knocked up at 16 yo and still having sex with her boyfriend who if he's in collage is probably at least 18 yo.

In most places this could be considered statutory rape of a minor.

Most places? Actually, 16 is the legal age of consent in "most places". Look it up.

[Just Plain Ruff]

Her boyfriend could be a child prodegy and in school at 16. Likely not but it could happen.

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[Dustdevil]

Her boyfriend could be a child prodegy and in school at 16. Likely not but it could happen.

LOL! That's true. I'm no genius, but I still graduated high school at 16, and a lot of people do. It is the norm across the world, as is the 16 year age of consent.

[Richard B the EMT]

Her boyfriend could be a child prodegy and in school at 16. Likely not but it could happen.

There are probably real Doogie Housers out there, just not with TV shows about them.