WILTIMS #357: Factoid overload!

Today was a didactic day up at our school, so I am lacking in stimulating clinical stories. But I have oodles of facts! To keep you company through the onslaught of knowledge, to the right is my classmate Caitlin successfully delivering a fake baby from a fake pelvis in our school's simulation center. Enjoy!

TIL: Pulmonary hypertension is one of the only absolute contraindications to pregnancy. There are many things that increase the risk of danger to the fetus and/or pregnant woman, but if the mother is willing to take those risks, then we are generally willing to help her through the process. But pulmonary hypertension, where the blood vessels of the lungs start down a feedback loop of constriction and loss of flow, is all but certain to kill the mother of she tries to bring the fetus to term.

35 years old is the age that we consider "advanced maternal age" because it is the year that research has shown that the risk of chromosomal abnormalities like Down's syndrome start to equal the risks from the tests like amniocentesis that we can use to test for chromosomal abnormalities.

Unlike women who develop gestational diabetes partway through their pregnancy, women who already had diabetes before being pregnant have a risk of their baby having birth defects as well as the normal complications from uncontrolled diabetes late in development. Somewhat intuitively, this is because the high blood sugar must be present during the developmentally crucial first trimester to actually cause birth defects and gestational diabetes usually begins long after that.

VDAC and TOLAC stand for vaginal delivery after cesarean and trial of labor after cesarean respectively.

The chance of uterine rupture is prohibitively high at 7-10% during VDAC if the prior cesarean was done via a vertical incision, but only 0.7% if the incision was horizontal. This accounts for part of why few VDACs where traditionally attempted - because vertical incisions used to be the norm. But the far less damaging horizontal incision has been the standard for a while now, and research has shown that VDACs can actually be quite safe in these patients.

When the first movements of the baby are felt by the mother it's called "the quickening." This may seem like a weird term for that phenomenon, but actually that usage is far older than our current meaning of the word quicken. Instead of meaning "to go faster," to quicken" meant "to come alive." Thus "the quickening" was the time when you could tell that the baby was alive in utero.

One of the tests that can be done toward the end of a pregnancy to check fetal health is called a non-stress test. This test looks at the fetal heart rate which, rather counterintuitively, we don't want to be stable. Unstable in certain ways would be bad too, but the ideal situation is for the fetal heart rate to spike upward by ~15 beats per minute for 15 seconds every minute or so. If the heartbeat is too calm or it drops downward, that is a bad sign.