OOPS THIS PREGNANCY LOST ITS WAY-ECTOPIC PREGNANCY

BY DR EMORUWA OPEYEMI

ectopic pregnancy

 

I fell pregnant in February of 2005 – I had my first positive pregnancy test on the 10.2.05 to which myself and my partner were ecstatic. On Saturday I started to show a brown discharge but thought this was nothing to be worried about. On Sunday I began with left sided pain from 11am which continued and worsened throughout the day and into the night. At 10pm I started with diarrhoea and thought the pain was connected to that and so I went to bed! By 6am on Monday 14th I was in a lot of pain and rang the NHS helpline – I was told to get to my doctors within the next 2 hours which is what I did. When I went to the toilet first thing I began to pass dark blood and clots and thought I was having a miscarriage. I saw my GP on Monday 14th at about 8.15am. I told him that I was 6 weeks pg and that I was now experiencing severe pain in my left side and I told him I was loosing blood. He gave me an internal examination and pressed on my tummy – this caused excruciating pain. He told me that my cervix was closed and to go home but go back and see him the next day. He said I should take paracetamol for the pain. I went back on Tuesday 15th by which time my abdomen was swollen – it hurt to pass water – I had constant diarrhoea – I could not sit down without being in pain and I was having difficulty breathing. Again he gave me an internal and told me I was not miscarrying as my cervix was still tightly shut – in fact he told me that I had a healthy baby! I asked him to send me to hospital as I thought something was seriously wrong – he rang the EPU and I was given an appointment for Wednesday 17th at 2.15. I struggled home, still bleeding, still in pain, and feeling absolutely terrible – although there was a glimmer of hope after being told I still had a baby. By the evening of the 16th I could not lay down on my back as it affected by breathing, when I say it affected my breathing what I mean is I could not breath. I went to bed sitting up hoping that everything was going to be ok. I had asked my GP earlier this day whether he thought I was having an ectopic and he said NO – I can feel that your uterus is swollen indicating that the baby is in there! – I had very little sleep this night and got out of bed around 6am – the stabbing pains in my lungs and abdomen was too much to take – I truly got out of bed feeling that this was going to be the day I died, I was grey sweaty and now could only inhale if I bent over or got on all fours. However, with the help of my mum and my partner I made it to my hospital appointment at 2.15. Within 20 minute of being in hospital an ectopic had been diagnosed with the added complication of a ruptured fallopian tube and excessive internal bleeding. My parents were told to expect the worse and I said goodbye to my partner thinking I was on my way to heaven! Lucky for me I received the best care possible by the surgeon and hospital staff and am here today able to tell my story. I had just under a litre of blood in my peritoneal cavity and was told the following day “you are very lucky to be alive” I felt far from lucky, I’d just lost a baby that was desperately wanted and had surgery to remove what was left of my tube! The road to recovery has been long and hard – the physical, emotional and mental affect this has had on me exceeds the extremes of pain and loss. 7 months have passed and I still experience pain in my abdomen, my periods are irregular and I have hormone imbalances which have caused me to lactate. I feel hatred towards the doctor who misdiagnosed a condition as severe as an ectopic pregnancy. I can only hope that I do make a full recovery and my life will not be childless – time will tell. I remain positive and am lucky to have a very supportive partner and loving, caring parents to fall back on. I live to tell my tale! ( this is a person’s true story as posted on a discussion forum at patient.co.uk)

When a woman’s egg is fertilised, there is a path the newly formed embryo passed so it can arrive in the internal lining of the uterus (womb) which is already prepared to receive the incoming pregnancy. However for one reason or the other, the embryo either lost its way or gets stuck somewhere else, either inside the woman’s tube or enters the wall of the uterus or any other site other than the internal lining of the uterus that was prepared for it. Pregnancies that lose their way like this are called ectopic pregnancies. It is one of the commonest cause of pregnancy related death.

EmbryonicDevelopmentEarly2

The movement of fertilised egg through the fallopian tube to the uterus where it implants in a normal pregnancy

 

Image1

The pregnancy fertilised egg starts developing in any other location apart from the internal lining of the uterus that has been prepared to receive it

Causes

  • Previous history of sexually transmitted disease – when the common bacteria causing infections enter the uterus and find their way to the woman’s tubes, they can damage it and after the body immune system fights them, they heal but they leave a scar behind, making the tubes rough, so the embryo’s journey through it may be rough, delayed or halted entirely, leading to an ectopic pregnancy.
  • Egg stimulating drugs – there is a higher risk of having ectopic pregnancy in women who become pregnant by taking drugs to stimulate their ovaries to produce egg.
  • Previous ectopic pregnancies – women who have had an episode of ectopic pregnancy are at a higher risk of having it again than women who never had it at all.
  • Previous surgeries in the woman’s tubes – if a woman tied her tubes ones and chooses to have them untied again or if she had surgery done for an ectopic pregnancy previously on that tube or has any such surgical procedures done on her tubes, she is at a higher risk of developing EP.
  • Congenital problems with the tubes
  • Certain types of pills taken to prevent pregnancy – progestin only pills are associated with a higher incidence of ectopic pregnancies.
  • Advanced maternal age

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Symptoms

The manifestation of this condition is in a spectrum. At the beginning of the spectrum is a person who have their embryo  implanted in the wrong location such as the tubes but it is not showing any symptoms (yet). Then later, because the location wasn’t designed to support an embryo, it can eat into the wall of the tubes resulting to internal bleeding; this can occur slowly or rapidly. Most people are only aware there is a problem when there is bleeding.

  • Missing period – the woman might have noticed she hasn’t seen her period when expected
  • Vaginal bleeding – this is usually present in about 70% of people who have ectopics but some people may not bleed at all.
  • Sharp lower abdominal pain
  • Fainting
  • Dizziness
  • Abdominal distension – the person’s abdomen may be seen to be increasing in size

Any woman noticing any symptoms such as this should be rushed to the hospital as quickly as possible. Time is of essence in the management of this case as an urgent intervention may be necessary.

Tests

  • Ultrasound scan
  • Pregnancy hormones – some hormones are on the increase in the body during a normal pregnancy, the same thing happens in ectopic pregnancy but there won’t be an evidence of a fetus in the appropriate location – then you question where the baby is located
  • Test to determine the blood level
  • Laparoscopy

Live Laparoscopic Surgery Session 2

Treatment

Depending on the way this condition presents. If it is slow leaking type or the unruptured ectopic pregnancy, some medications may be given or the patient may just be observed but if it is the more serious type, the woman may need a surgery which may involve complete removal of the tube or a part of the tube or just creating an opening by which the embryo causing the problem can be removed. This decision will be made by the specialist attending to the patient. Some other supportive care will be given to the patient before and after surgery.

The following conditions may mimic an ectopic pregnancy:

  • Miscarriage
  • Pelvic inflammatory disease
  • Acute   appendicitis
  • Incomplete  abortion
  • Ruptured  ovarian cyst
  • Endometriosis
  • Dysfunctional  bleeding

The most important thing in the management of this condition is the time factor. If the patient gets to the hospital early enough and the hospital is equipped enough to handle emergencies and even have surgeries done, this can be lifesaving. Share  this information with your friends. We will like to get feedbacks from you, kindly post them in the comment box below.

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Fear Not Ebola: Read This & U Will Never Be Afraid Of Ebola Again.

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US STATE DEPARTMENT EBOLA ALERT

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In order to help our Embassy Community better understand some of the key points about the Ebola virus we have consulted with our medical specialists at the U S State Department and assembled this list of bullet points worded in plain language for easy comprehension. Our medical specialists remind everyone that they should be following the guideline from the center for Disease Control and the World Health Organisation.

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Why Not A Counter culture ( A short story)

BY AYOKUNLE OLAGOKE 

scd

Tayo kept adjusting himself on the cushion chair, he
was really looking restless as he would get up and sit
down again till he finally grabbed the phone

Tayo: hello Bims… I’m sorry its late… please… em I need
your help, Tomi and I just…err … broke up

Bims: what! Ki lo sele (what happened)

Tayo: em… I can’t really explain now but I’m sure she

will be so destabilized and down now, I want you to
please help me call her, please, I won’t mind if you can
even go to her place to sleep over please, I can come
drop you

Bims: chill Tayo, I don’t get it as in you guys are cute
together, did you cheat on her?

Tayo: No! I won’t do that you know

Bims: yeah I know but I’m just trying to imagine what
could have happened, she will be so broken right now I
know

Tayo: yes she is, please help me try and get to her
tonight, I can come drop you

Bims: no don’t bother, I’ll drive down, its just 8:30

Tayo: alright dear thanks, just ping me when you’re
there ok?

Bims: (sighs) okay, I hope to understand sha

FOUR DAYS LATER

Bims was on phone with Tayo

Bims: she’s still not picking your call right? I will give
her the phone as I go in now

She walks in and stretches the phone to Tomi who is in
her pajamas on the three-sitters chair in the living room
watching a comedy on the TV

Bims: hey!

Tomi: who? Where did you get this movie from? ‘Cause I
know you don’t watch films, it looks like a film Tayo will
love to buy

Bims’ facial expression shows she is surprised because
Tayo actually gave her the comedy to give Tomi to make
her laugh. She collected the phone from her still
laughing. Tayo was smiling broadly on the other side as
he was listening to the conversation

Tomi: hello (with laughter in her voice)

Tayo: (clears his voice like he was suddenly choked)
baby please don’t hang up please… please… I just want
to hear your voice, I want to ask about your proposal
defense 2 days ago, I want to know if the toothache is
still there, I want to know if the plumber came to repair
the leaking sink in your kitchen, I want to know if
grandma’s visa has been released, baby I just want to
know you are fine, I’ve missed you and I just want to
know you’re fine… I called Bims because you won’t pick
my calls and I understand, I really do, hello… say
something baby

Tomi had tears streaming down her cheeks
uncontrollably till she completely broke down into
complete tears

Tomi: what do you want me to say? I’m… I’m trying to
be fine

Tayo: hmmmm (sighs) this is really hard

Tomi: I read there’s only a 25% chance of giving birth to
an SS as in, if we have four kids only one may be SS

Tayo: that’s not what the doctor explained baby, he
meant for each child we have there is 25% likelihood
that the child is SS, that’s why the whole 3 we plan
having can all be SS

Tomi: please let’s not talk about it again, I think I’ve
heard enough, you’ve made the right decision though
hard, breaking up though we say we believe in miracles

Tayo: hmmm! I won’t lie to you baby, I can’t get over
you

Tomi: good night

Tayo: please… before you hang up, can I come see you
tomorrow?

Tomi: okay
10 MONTHS LATER
“I Oluwatayo Williams take you Oluwatomi Adeniyi as
my lawfully wedded wife to love and to hold, in sickness
and in health, in poverty and in…”
Priest: so now I introduce to you the latest couple in
town “Mr. and Mrs. Adepese”

5 years from then

Tayo: my wife and I really appreciate everybody present
at our baby’s naming ceremony. We all know our story,
we got married 5 years ago and since then we have
been trusting God for a child, it pays to serve Him, you
can see the little baby, she’s as pretty as her mom, now
I have two of them around me.
There was applauds from the well wishers
The child kept growing and becoming more and more
beautiful by the day, she looked so much like her
mother. She was named AdeToun, she has long hair like
her father, sparkling eyes like her mother with a shinny
skin.

Toun: Mummy, I want to be a pilot when I am big…
(Those are one of her favorite lines of words)

Tomi: yes baby girl, you can be one (she responded with
a broad smile)

About 2 days to her 4th birthday she became very sick,
luckily Tayo’s mother who is a nurse was around with
them that night, she was the one who noticed there was
something wrong with the little girl, she called the
parent’s attention to it so they decided to visit the
hospital, Toun was on admission for 3 days, along the
line, her genotype was taken and was confirmed that
she has the Sickle cell disorder, the parents turned to at
each other’s face as the doctor broke the news to them
in his office.

Doctor: it’s not the end of the world…

From that day on, Toun has been in and out of hospital,
there has been so much depression in the house;
sleepless nights by the parents, there are times her
school teacher would call that she has been admitted in
the school clinic and the parents will run down from
work. Her situation will get critical and mild and critical
and mild and more critical; as she kept growing up she
kept getting more and more aware of her predicament.
One day in school, they were being taught about
genotype and  blood groups in their Biology,
she could not help the tears streaming down her pretty
cheeks as she excused herself and ran to the restroom.
That day, she got home not talking to any of her
parents, they kept wondering what could have been
wrong with her so they both decided to go meet her in
her room to find out what was wrong with her, they
knocked but there was no response, her father opened
the door quietly and they both stepped in; they met her
sobbing quietly with her face swollen, the mother
quickly approached her to throw her arms around her

Toun: don’t touch me!

Her mother was scared as that sounded strange

Toun: why? Why? You two are selfish!

Tayo: baby what are you talking about?

Toun: you both knew about your genotype before you
got married but you chose to marry anyway, because
you don’t care about me, you only cared about your
selfish love! I hate you two, I hate you! I am the one who
break down every time not you, I am the one in and out
of admission not you, I am the one on drugs every time
not you! I feel the pain; I go through the shame not you!
Then you want me to believe you love me, if you loved
me you would not want me sick, you make me sick and
pretend you love me, yes! The two of you make me sick,
I know very soon I may die because I am not afraid of
death, I have come face to face with it severally, if I do,
don’t bother mentioning God for taking my life because
you two did, you two are evil,
For a while the parents were mute and speechless not
knowing how to respond to the shocking expression
from their daughter.

6 months after then

Doctor: Mr. Williams, you are the man of the house and
that was why I called you out to tell you this. I just
pushed the women to go home and bring some stuffs,
you really need to be strong for your family at this
point… we tried our best Mr. Williams we did…
Tayo: (looking at the expression on the doctor’s face
knew where he was going)ah! Yehhh! Toun ti lo (Toun is
gone) ha! (he had his two hands on his head as he
collapsed to the chair beside him)
Around four million Nigerians are estimated to suffer
from the disease, while 25 million others carry the genes
which they pass to their offspring.
“From available statistics, 100,000 infants die from
sickle-cell disease in Nigeria annually, making it the
number one sickle-cell endemic country in Africa,”
Sadiq Wali, president of the Nigeria Sickle-cell
Foundation
“Based on World Health Organization [WHO] indices,
Nigeria accounts for 75 percent of infant sickle-cell
cases in Africa and almost 80 percent of infant deaths
from the disease in the continent.
Sickle-cell disease is an incurable genetic disorder
widespread in sub-Saharan Africa and among
descendents of Africans worldwide. Sufferers have no
visible symptoms, but periodically experience severe
pain and are also highly prone to anaemia because the
blood cells break down after only 10-20 days, rather
than the usual four months.
Although sickle-cell in infants is curable through bone
marrow transplants, lack of expertise and the high cost
of the operation makes preventive measures the best
option, medical experts say.
“This is why we advocate genetic counselling by
intending couples before marriage to determine the
status of their genes”, Nigeria Sickle-cell Foundation’s
Wali said.
“People should go for a genetic test in the same way
they determine their HIV status before marriage as the
most effective way to protect their children and curtail
the disease”, he said.
Before you two get into that stage here you are head over
heel in love with each other PLEASE GO FOR YOUR
GENOTYPE TEST E JOR!!!

you can read more about sickle cell disease here

SICKLE CELL DISEASE PART 2 (MANAGEMENT)

BY DR EMORUWA OPEYEMI

girl-on-couch

In part 1 we talked about the burden of sickle cell, in this post we will discuss the precautions patients and parents should take so they can reduce crisis and limit complications, we will also discuss the available cure and associated constraints.

What patients and parents of sickle cell patients should know

Once a child is found to have sickle cell disease, parents should know some precautions to take because they cannot be raised like an otherwise healthy child.

  • Immunisation: if SCD is detected in a baby, in addition to the routine immunisations that every child gets, pneumococcal conjugate vaccine should be given to these children up to the age of 5.
  • Malaria prevention: in this environment, sickle cell patients are placed on daily malaria prevention drugs by their doctors and are advised to avoid mosquito bites as much as possible
  • Penicillin to prevent certain infections: the spleen (an organ) is unable to produce immune cells to fight certain types of infection, hence the need to take penicillin to prevent these infections. This will be given daily and dose is according to the age of the patient.

Uptown_HPV-Vaccination

  • Daily folic acid supplements
  • Elevated temperature (>37.5 C) in a SCD child should prompt the parent to take him/her to a hospital. They shouldn’t wait to watch or try to treat at home. In adult patient, persistent fever, should make them present in a hospital. Other symptoms such as cough, chest pain; symptoms of acute anaemia (shortage of blood) including weakness, shortness of breath, or dizziness; abdominal pain with nausea and vomiting; symptoms of urinary infection; or unusually severe headaches.
  • Healthcare provider should teach patient and their parents about different pain medications, when to use them and when to report to the hospital
  • Patient should avoid strenuous exercises, drink a lot of water.
  • Patient should avoid cold weather, wear warm clothing in such weather.
  • Patient or parents of SCD patients should seek medical advice before traveling. If traveling by air, they should travel in pressurised aircrafts, drink a lot of fluids, wear warm clothing and move about frequently. Going to heights above 20,000 ft. in a non-pressurised aircraft can trigger a vaso-occlusive crisis, oxygen masks should be provided as the airline should be informed before commencing the journey. Travel by road is not usually associated with crisis but frequent stops and refreshment is advised.
  • Childbearing and birth control should be discussed with patients and their partners. Discussions should include the risks during pregnancy, the potential for spontaneous abortion, and the physical and emotional challenges of raising an infant.

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Test

A blood test will be required to detect what your haemoglobin genotype is. If one of the parents is a carrier (AS), it is advisable the test is done twice in a very good laboratory so one can be sure. There have been reported cases of people who got wrong results for their haemoglobin genotypes. It is advisable everyone knows their genotypes and parents should even know for their parents. This will help people make informed decisions in choosing a life partner. The genotype of an unborn child can also be determined while the  baby is still inside the womb.

For a patient who has HbS, there are tests that will be required regularly to monitor his/her body function. This includes:

  • Haemoglobin concentration
  • Packed cell volume
  • Complete blood count
  • Urinarlysis
  • Occasional electrolyte and urea
  • Fundoscopy to check the eyes
  • Lung function test
  • Transcranial doppler ultrasound to assess risk for stroke
  • Some other tests will be done based on the complaints or other complications of the disease-X-rays, MRI, CT scan etc.

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Psychosocial Implications of Sickle Cell Disease

  • Regular hospitalisation and painful procedures
  • Missing school
  • Depletion of family financial resources
  • Marital disharmony
  • Depression
  • Fear of death
  • Low self esteem
  • Inability to do what peers are doing
  • Drug and alcohol addiction
  • Relationship problems
  • Difficult pregnancy
  • Disability due to some complications of the disease
  • Losing job opportunities or losing jobs altogether.

Cure

Hematopoietic cell transplantation (HCT) is the only known cure. The hematopoietic cells are cells that produced other blood cells, so in HCT hematopoietic cell of a normal person is transplanted into the patient so that it can start producing normal cells. This procedure however has some constraints; patient must be less than 16 years of age and must have a sibling who is HLA compatible (test done to know if a person can donate an organ to another person without significant problem) and then the cost is above the head of most people in countries where this disease is prevalent that is if the patient have a sibling with normal genes and their genes are compatible. The procedure has a mortality rate of about 5% and some patients who had a successful procedure developed some complications. This will be fully discussed before the procedure.

Amos Igwe, 13, left, suffers from sickle cell disease, but is no longer plagued by symptoms of the disease after receiving an experimental bone marrow transplant from his sister Chi-Chi Igwe, 8, right. A U of L researcher may be close to finding a cure for the disease.(By Sam Upshaw Jr., The Courier-Journal)Jan. 14, 2010 C-J

Amos Igwe, 13, left, suffers from sickle cell disease, but is no longer plagued by symptoms of the disease after receiving an experimental bone marrow transplant from his sister Chi-Chi Igwe, 8, right. A U of L researcher may be close to finding a cure for the disease.(By Sam Upshaw Jr., The Courier-Journal)Jan. 14, 2010 C-J

Sickle cell disease is a painful disease and the impact on the patient, family and society is grave. The available cure is not readily available and to prevent it is very easy. Know your genotype and if you are a carrier of the sickle cell trait (AS or AC) don’t attempt to produce a child with another carrier. That way you will be saving a child from pain, yourself from trouble and the society from unnecessary loss of precious lives. First things first, KNOW YOUR GENOTYPE. Share this information with your friends and family, like us on twitter, click the follow button to follow this blog.

SICKLE CELL DISEASE part 1(The burden of the disease)

BY DR EMORUWA OPEYEMI

sickle-cell-center

Haemoglobin disorders are inherited blood diseases that affect how oxygen is carried in the body. Below are some facts about the disease:

  • Approximately 5% of the world’s population carries trait genes for haemoglobin disorders, mainly, sickle-cell disease and thalassaemia.
  • Haemoglobin disorders are genetic blood diseases due to inheritance of mutant haemoglobin genes from both, generally healthy, parents.
  • Over 300 000 babies with severe haemoglobin disorders are born each year.
  • The health burden of haemoglobin disorders can be effectively reduced through management and prevention programmes.

Read More…

DEALING WITH A CONVULSING CHILD

DR ZELDA EWAH

convulsion

As we are in the raining season, more and more people will likely be coming down with malaria especially children below 6years of age. Malaria in this age group is a lot more serious as many of them tend to come down with febrile convulsion (when a child with high body temperature has an episode(S) of convulsion). Many times this happens at home or school, the caregivers are scared that the child would die, they are shocked, they panic and are at loss for what to do.

There are however various harmful traditional practices that have been handed from generation to generation that have been used and are still being used today; some of such practices include:

  • Burning the fingers and toes of the child on a stove
  • Read More…

HEPATITIS

BY DR ENEFO ARIA

hepatitis1

Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the liver.

There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.

Hepatitis A
This is caused by eating infected food or water. The food or water is infected with a virus called HAV (Hepatitis A Virus). Anal-oral contact during sex can also be a cause. Nearly everyone who develops Hepatitis A makes a full Read More…

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