By Tedler D. Depaynos
After quite some time, a coffee mate friend with his wife suddenly appeared in the clinic tagging along their only daughter and son-in-law. They rushed from their farm in the province when they learned that their only daughter who had her menstruation delayed for more than 2 months unexpectedly bled. Their daughter is already 3 decades old and had been married for half a decade already and they were so joyous that they are finally blessed with a grandchild. They were hoping that he would be a junior and by the end of this year they would start their dreamed “apostolic” work. The news that their daughter had been bleeding without their knowledge was devastating to them so they had to hurry home. Being their long time family MD they came for advice.
Having not met my friend for quite some time, we had a mini reunion as we walked to consult a neighboring young newly trained female Ob-Gyn specialist. Sensing probably our obvious ignorance, the young smart looking specialist started lecturing us on the probable causes of the vaginal bleeding as she interviewed and examined the patient.
Since the menstruation was delayed, probably the patient is pregnant and is on her first trimester (first 3 months). This could be easily confirmed by a routine pregnancy test. Hence, threatened abortion is the first consideration. For unknown many reasons the uterus bleeds where the fetus is attached so that the danger of complete detachment called “threatened abortion” is present.
Another probable condition the young serious but smiling specialist mentioned is the so called “Hydatid Mole”. This may be rare but the incidence in Southeast Asian countries is higher than in the Caucasian areas so that they always include this in their considerations. In simple language, the patient appears to be pregnant and the placenta may be present but there is no fetus. My friend made a very puzzled smile and whispered that he hopes this is not the case especially when our spontaneous lecturer emphasized that this may become malignant.
As she was examining the patient’s abdomen, she noticed that there was no tenderness which may eliminate the third possibility which is “ectopic pregnancy.” In this condition, pregnancy occurs but the fetus is implanted somewhere else instead at its normal location in the uterus. It may be implanted anywhere in the fallopian tube or even outside it, into the abdominal cavity. Most common however, is at the widest part of the fallopian tube which is the distal 3rd.
The fetus may grow normally but as it reaches the 4th to 6th weeks of pregnancy, the tube may rupture and bleeding ensues. The blood in the abdominal cavity may cause abdominal pain mostly in the lower area called hypogastric area. In most cases, the bleeding maybe continuous and insidious so that if not diagnosed early the patient may go suddenly into unexpected shock.
The vaginal bleeding is due to the blood flowing from the site of rupture thru the fallopian tube into the uterus and then externally. It may sometimes appear merely as spotting.
After examining the patient the young specialist suggested confinement and work-up. Ultrasound must be done because it is very specific and clear. She also proudly mentioned that she underwent training on this procedure as a gynecologist. They insert an ultrasound probe into the vagina and the female reproductive organs could easily be discerned. They could easily detect an abnormality!
As parting words as she ended her very educational lecture, she emphasized that threatened abortion is initially treated conservatively in an attempt to save the fetus. Complete bed rest must be a must and medications are given to calm the uterus. Hydatid Moles since they may become malignant has to be removed. Ectopic pregnancy definitely has to be operated upon and the site of implantation which is usually the fallopian tube has to be excised. If this is the case, the surgery would be on an emergency basis.
My friend who obviously was very concerned with a worried look consented to all the recommendations of the lecturing specialist and as we parted he requested my prayers that everything would be alright. The consultation on my part was a very exhaustive review so that definitely other OB-Gyn referrals would be sent to her.
It was several weeks after when I met my coffee mate friend again and he was all smiles and happy. As we savored our Starbucks-like beverage, he was openly thinking of what nickname he would be giving to his future “apo” who from the ultrasound appeared to be a male. The threatened abortion was overcome! A low profile lawyer coffee mate friend who was with us, suggested “Bert”.**
