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!

Advertisements

Lactation: Mother’s Milk

So, since we talked about conventional cow milk a couple of days ago as well as soy and organic milks, I thought we should spare a thought for human-produced milk.  I have no firsthand experience with human lactation, so please feel free to jump in with your two cents!  Many new mothers will tell you, though, that they did not realize how difficult breastfeeding would be.  Babies, unfortunately, don’t just attach themselves naturally to a woman’s breast and easily begin to suckle.  It is a skill that must be cultivated.  (No wonder wet nurses came to be.)

During a woman’s pregnancy a woman’s breasts become enlarged, to varying degrees, due to a chemical released by the placenta called human placental lactogen (HPL).  The first stages of lactation begin during the latter part of a woman’s pregnancy.  During this period a woman’s breast begin to produce “first milk” called colostrum that can be yellow in color.  Progesterone during this time is too high to allow true milk production.

When the placenta is delivered following birth, the woman’s body experiences a sudden drop in progesterone, HPL, and estrogen.  This shift causes the breast tissue to begin to produce real milk.  Milk will usually be produced within a day or two of birth, though it is not uncommon for it to take longer.  Colostrum production will slowly cease over a two week period as mature breast milk as steadily produced.  Colostrum is an important part of breastfeeding, though, because it contains larger amounts of antibodies and white blood cells helping to protect the child from germs and food allergies.

After the breasts become more accustomed to producing milk they begin to function on what I call a “made-to-order” system.  A woman’s breasts produce milk as the milk is removed from the breasts (through direct latching, breast pumps, or otherwise.)  Breasts will continue making milk so long as it is being removed.  The only other reasons that would inhibit continued milk production are maternal endocrine disorders, maternal malnutrition, breast hypoplasia, and in some cases lack of sexual activity, as sexual activity increases milk production.

When actually breastfeeding, the mother may experience milk ejection reflex though it is not unusual to not have this experience.  Essentially, the muscles in the breast push out the milk which may result in pain or a tingling sensation.  Another cause of pain due to lactation is contraction of the uterus.  The same hormone that causes the muscles in the breast to contract and express milk also cause the uterus to contract helping it return to its original size.  These contractions may range from mild and menstrual-like to severe and labor-like.  I shudder to think what they would feel like following a c-section.

That, in a nutshell, is the basic biology of lactation, though it does not begin to touch on the enormous issue of breastfeeding (perhaps in later entries).  But here are a few interesting facts about lactation you might not have known:

*Men can lactate, it’s true!  They have mammary glands just like women, and it can result due to a hormone imbalance.

*A woman can lactate without ever having given birth.  It is a phenomenon known as galactorrhea and happens either due to a specific hormone imbalance, continued stimulation to the nipples, and in rare cases is caused by prescription drugs.

*New born babies often lactate, colloquially called “witch’s milk,” as a result of the mother’s hormones just before birth.  It generally only lasts a few hours.

Questions?  Comments?  Don’t be shy.