Yesterday was ok... I think. I'm not actually sure, since I was dozing off at every opportunity. After a week of night shifts and a weekend of failing at readjustment, I was a mess. Then when I got home, I all but immediately passed out on the couch. But, in the little time I was conscious, I learned and saw quite a bit.
In the morning we had the first Monday conference in which we've been able to take part, thanks to a series of holidays/teaching days/night shifts. This meeting mostly consisted of the attending physicians reviewing some cases from the week and discussing what they thought the plan should be. One of the more interesting debates was about what kind(s) of doctor(s) should be in the room for a complicated delivery this week involving a fetus with a potentially cancerous cyst. Pediatric gynecologist? Gynecologic oncologist? Both?
In the afternoon, we witnessed the fastest delivery we've ever seen for someone who actually made it to L&D. We were talking to the patient one minute, she started painful contractions then next, she gave one good push, and, before any of the staff could even gown-up, the baby was out. That's the way to do it!
YesterdayIL: If a pregnant woman's water breaks early, it's a serious complication and can require an immediate delivery regardless of the fetal maturity. Sometimes, though the amniotic sac can stabilize and reseal allowing for a more mature birth. To test for this you can use indigo carmine dye, which is injected into the amniotic sac, turning the fluid there a rich blue color. Then you observe over the following hours and days. If there is no blue vaginal discharge, then the amnion is in tack and you can be more conservative and wait for a closer to full term delivery.
Vasa previa is a condition where the umbilical cord vessels separate from each other somewhere between the placenta and the fetus and then get lodge near the cervical opening. The vessels are more fragile in this state and may be punctured when the membranes are ruptured prior to delivery. This bleeding can be severe and will likely require and immediate delivery or c-section.
I you've ever seen a real umbilical cord, you'll notice that both the larger cord structure and the vessels within are extensively coiled to the point of looking like a spring. This is a purposeful design because a straight cord would be very easy to compress, cutting off the fetal circulation. All those loops allow the cord to be squished quite a bit but the loops just fold over each other and don't pinch off readily.
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