Rare Ectopic Pregnancy, again

In the last blog entry I detailed the story of Zahra Aboutalib, a Moroccan woman with a rare complication of an ectopic pregnancy, a lithopedion.  The second incredibly rare complication of an ectopic pregnancy that I will cover happened to an English woman named Jane Ingram.  Jane was a 32 year old woman living in Suffolk, England, when she discovered in early 1999 that she was pregnant for the third time.  She and her husband Mark had a total of four children from previous marriages; this was their first child together.

Shortly into the pregnancy, a routine scan showed that she was carrying twins.  Continued abdominal pain led to further scans that showed eighteen weeks into pregnancy that Jane was indeed carrying triplets, the third baby had not implanted in the uterus as the other two had and had ruptured Jane’s fallopian tube.  This baby, the only boy of the pregnancy, had miraculously survived the rupture and continued to grow attaching his placenta to the outside of Jane’s uterus.  Jane had not been taking fertility drugs, a frequent cause of sets of multiple babies.

Immediately, the rarity of Jane’s case caught the attention of top doctors in the United Kingdom and leading obstetrician Davor Jurkovic at King’s College Hospital in London became the lead attending physician.  Jurkovic placed the odds of all three children and the mother surviving this situation were one in 60 million–if they did all survive it would be the first time in medical history.

Jane was closely monitored and at twenty-nine weeks, eleven weeks prematurely, it was decided that the cesarean section should go ahead.  A team of twenty-six medical professional assembled at King’s College Hospital on September 3, 1999 to assist in the two-hour long procedure.  The twin girls, Olivia (2lbs 10oz) and Mary (2lbs 4oz) were delivered first and the procedure went routinely.  The next challenge was to safely access the boy, who was in an awkward position.  Doctors decided to shift Jane’s intestines in order to reach him and successfully delivered Ronan (2lbs 4oz).

Amazingly, the triplets were born with no more complications than would be expected of any other triplets born at twenty-nine weeks.  Each was kept in the intensive care unit and placed on ventilators.  They only remained on the ventilators for about a week, Ronan being the first to grow strong enough to not need its assistance.  The worry remained that the pieces of Ronan’s placenta that could not be removed would cause complications for Jane.  No such complications arose and Jane was discharged from the hospital after about a week.

Today, the triplets are in fine health and not long ago celebrated their ninth birthdays.  The parents say that each has his or her own very distinct personality.  Doctors and newspapers have called Ronan a miracle baby.  Mark Ingram described himself shortly after the birth of the triplets as “the luckiest man on earth.”  With such amazing odds against them, many point to Jane’s optimistic though realistic attitude as the key to their survival.  So what do you think about Jane and her triplets?  Such a rare complication is not likely to be see again during our lifetimes.  Comments, questions, or otherwise?  You know what to do!

Rare Ectopic Pregnancy

Last night The Learning Channel replayed a program that I originally saw about a year ago entitled “Extraordinary Pregnancies.” It told the story of two women and their ‘extraordinary pregnancies’: Zahra in Morocco and Jane in England. The program is the repackaging of two other British programs that aired several years ago. Both women experienced rare complications from ectopic pregnancies. Each case is fascinating, to me at least, so let’s explore their cases a little more in depth–Zahra here, Jane in the next entry.

Zahra Aboutalib, a woman from just outside Casablanca, became pregnant at twenty-six years old and early in her pregnancy experienced excruciating abdominal pain. The pain eventually went away and in 1955 she went into labor. After laboring for more than two days, her family decided to take her to the closest hospital. In the hospital she saw other women undergo cesarean section and die because of the poor conditions in the hospital. Doctors told her she must have a c-section, too, and she decided she did not want to die too. She left the hospital still in pain and went home. Eventually the pain ceased and she remained pregnant. In Moroccan culture, there is a belief that babies can “sleep” inside of their mothers for indefinite periods of time. Assuming she had a sleeping baby, Zahra continued her life and adopted three children remaining pregnant for 46 years until terrible pain returned in her early 70s. Her children finally insisted she see a doctor. Doctors examined her and believed she had an ovarian tumor. After several rounds of testing and imaging, the doctors realized she was still carrying the child she conceived nearly five decades before.

When Zahra had become pregnant years before she had had an ectopic pregnancy in the fallopian tube. An ectopic pregnancy is any implantation of a fertilized egg outside of the uterus. As the fetus grew the fallopian tube expanded and finally burst, cause the pain early in her pregnancy. This occurrence can be quite dangerous for the mother and very often results in the death of the fetus. Amazingly, Zahra’s fetus continued to grow and attached itself through its placenta to Zahra’s internal organs. Because her fetus was outside of the uterus she could not vaginally deliver the child when she went into labor. C-section would have been the only way to extricate the child, though because of the dangerous circumstances she and her child may have perished. When the pain of labor subsided it was because her child has died inside of her. Her body could not absorb the child and, recognizing it as a foreign object, began to calcify the child resulting in what is called a lithopedion (stone child).

When the doctors decided to operate they faced a difficult challenge. The calcification of the baby Zahra bore had attached itself to many of her internal organs and her peritoneum (the lining of the abdominal cavity). The surgery was dangerous, but after hours of delicate maneuvering the surgeons were able to remove the whole, calcified child from Zahra’s stomach. The medical team dissected the lithopedion to study just how the calcification process works in cases like this. Zahra’s is one of the oldest lithopedions ever recorded. Zahra recovered fully from the procedure and returned to normal life.

Lithopedions are rare and are an extremely interesting occurrence. As the world moves towards a more Western model of medicine it is less likely that lithopedions will develop as most ectopic pregnancies can be surgically treated with less of a risk of to the mother and child. However, when other complications arise, that may change as we will see with the case of Jane in the next entry. Stay tuned! Comments, question? I’d love to hear from you.

Sperm

Sperm may seem an odd choice of subject for a “young woman’s guide to gynecology and obstetrics.”  But it is this last word, obstetrics, that makes sperm a good choice for an entry subject.  Arguably, without sperm, obstetrics would not exist.   This may not always be the case, but for the time being, each human pregnancy makes use of sperm somewhere in the process.  So, let’s talk about sperm, baby!

Sperm is the male counterpart to the female gamete, the ovum (or egg).  Technically, what we commonly refer to as a sperm should be considered more of a sperm cell called a spermatozoon (spermatozoa, plural).  Since virtually everyone refers to the spermatozoon as a sperm, I will continue to use the word sperm in its place.  The human sperm consists of, ostensibly, a head an a tail.  This simple-looking structure belies its key importance in creating life.  Stored within the sperm is a complex DNA code that will (usually)[1] determine the sex of the resultant child and influence its phenotypical appearance–short or tall, dark or light, thin or stout–and many other genetic factors.

Each sperm is about three micrometers at its widest and about fifty micrometers long.  The tail of the sperm powers it forward, almost like a propeller, at about 1 to 3 millimeters per minute.  The semen, the fluid in which sperm are expelled from the male, has a chemical balance that keeps the sperm mostly inert until it is neutralized by the acidic environment of a vagina.  The sperm, when entering the vagina, journey upward in search of an egg to fertilize.  If the sperm do find an egg they will attempt to penetrate the membrane.  A single  sperm will succeed in penetrating the egg and the fusion of the two begins the process of meiosis in which the DNA of the mother and the father are spliced together to form a new set of DNA.

At this point, the sperm has reached its goal and blends into the developing human.  However, the sperm has many variations and not all sperm conform to the usual model we have in mind.  Abnormal sperm are actually quite common and come in many varieties.  For example, there are sperm with two heads, two tails, both, neither, and various other extra and missing parts.  Most abnormally structured sperm do not pose a genetic complication or threat to a potential pregnancy.  Because of structural deficiencies these abnormal sperm are not likely to reach an egg in the first place.

In all, sperm are an interesting and integral part to creating life and without them, there would be little basis for obstetrics.  So, any time you are thinking about obstetrics keep in mind the “little swimmers” that help make it possible.  Comments, questions, otherwise?  Please bring them forward!

[1] I am careful to say that the sperm usually determines the sex of a child because certain genetic problems can preclude a child with XY sex chromosomes from developing male characteristics, including genitalia, thus the Y-sperm from the father in this case does not determine the sex of the child.

Quick Update

I live! Yes, I have been absenting myself from the blog, but for a good reason. I needed to concentrate on school until the end of the semester. I am within hours of finishing this semester, and had planned to return with a bang. Yet, I saw this article just now and thought it would be of interest to readers. I have to say, I saw this coming because of articles I had read in TIME, but it is certainly interesting. Keep your eyes peeled–I will return soon! Thanks for reading.