About Me

Larbert, Scotland, United Kingdom

Saturday, January 17, 2009

Straightforward cases and ethics!

I'm finding Obs/Gyn a strange block - Obstetrics seems to be a mix of sonography, surgery, medicine, and being a referral service for Midwives. A lot of the consultant work involves initial assessment by sonographer / midwife and then just a quick consultation by SpR / Consultant. This makes trying to talk to people for long enough to get a case study quite difficult.

One day I spent time on the Maternity suite / labour wards, initially shadowing my consultant, but later the Spr & Fy2 who seemed to be doing most of the work. There was less of the competition and agro between Midwives and Medical staff than i had been lead to believe existed, and also less resentment to my presence as a Medical student.

Two cases filled a large part of our day - a young woman who had a C Section and also had HELLP which meant her blood wasn't clotting correctly. She developed a haematoma under the would and was taken back to theatre to have it removed. As they undid the staples, there was a strange sound, and a plume of blood sprayed towards me as I jumped backwards to escape the pool of red arterial blood on the floor. The clot was removed, and the bleeding vessels were sealed. It was an interesting case, because she was at that moment receiving lost of blood products and transfusions, and the situation had fairly rapidly escalated from a post op patient who was a bit sick, to a surgical emergency. Interesting to see, but not very mentally taxing.

The second case left me thinking for a long time about ethics and my opinions. Itw as a patient who had gotten pregnant despite a contraceptive implant, and then decided to have a medical termination. The implant secrete progesterone (which IIRC both 'prevents' implantation to stop a pregnancy, but once one has started, maintains the placenta). The Medical termination pills cause blocking of progesterone receptors, causing the placenta to die and the uterine contents to be delivered following further medicine administration a couple of days later.

In this case the patient had passed the foetus into the vagina, and the placenta was coming out. My consultant used a speculum to open the vagina and said, "Look in there. see the hand and face...." I was quite unprepared for that to be what I saw. Medical termination sounds very sanitised and clean. The actuality is less nice, and quite traumatic on the mother.

This has contributed to a growing ethical dilemma for me over the issues of terminations and abortions, which I may explore in a future post once I get time to read more on the subject.

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