Category Archives: Obstetrics

Some shocking revelations on violence and trauma during pregnancy!

The American College of Obstetrics and Gynecologists (ACOG) has its annual meeting this week, and how I wish I could be there! Maybe next year. Meanwhile, some shocking new findings are being presented at the meeting!

The results are from researchers at the Perelman School of Medicine at the University of Pennsylvania, who analyze a statewide analysis, for pregnancy related hospital trauma cases over a decade, for the State of Pennsylvania.

Please read the key findings in the link below. You may also refer to the proceedings poster.

A Couple of Shockers

The data itself is shocking, about 1 in 12 women have trauma during pregnancy, that may be due to accidents or assaults. This is also the leading non-obstetric  reason for death among pregnant women. There are the usual caveats about how pregnancy complicates everything. But, I found a couple of things really shocking! Here is one from Neha Deshpande MD, the clinical resident, who is also the lead author of the study:

“Despite the severity of the issue, little is known about how trauma actually impacts pregnant women since accidental and incidental causes of death are excluded in many statewide and national maternal mortality reviews. The striking results of our study suggest that widespread screening for violence and trauma during pregnancy may provide an opportunity to identify women at risk for death during pregnancy.”

  1. The “little is known” gave me pause and I had to re-read it twice! And, apparently not much screening of trauma and pregnancy occurs!
  2. The second thing that shocks me is that “accidental and incidental causes of death” are excluded from many state and national maternity mortality reviews! Well, there is something in need of fixing! If we don’t even do a good job of counting the causes and cases carefully, how would we proactively fight pregnancy related trauma?

Other Findings

  1. Some of the other findings were disturbing as well. The study found that injuries in pregnant women were fewer than in women who weren’t, but even with the reduced severity, pregnant women were nearly twice as likely to die! Clearly, resource availability and planning have to be increased to give immediate special care and attention to pregnant women.
  2. The next one, mental health, ignored for long, seems to be particularly troublesome when it comes to pregnant women. Nearly 1 in 5 pregnant women reported some form of psychiatric illness. What little attention has been provided to pregnancy related mental health issues, usually focuses (not that it should be reduced) on postpartum depression. Well, it appears, this attention should be increased and should span the entire pregnancy timeline!
  3. In more disturbing news, minority and uninsured women were reported be significantly more likely to experience assault. It is already reported through many channels that minority women and uninsured women have the most problems, and this makes things worse. Given the recent proposed changes to healthcare laws in the US, and the debate surrounding affordable care, and access to care, these findings are the most disturbing and alarming!

The Future?

Results from a single state, spanning a decade are commendable, as much as their findings give much cause for concern. But, what of the future? I think alongside making more resources available, and creating more awareness, a few changes are in order:

  1. Change how pregnancy related morbidity and mortality data are collected, specifically to highlight accidents and violence.
  2. As I mentioned before, make maternal mental health a central issue through the pregnancy cycle. Is there any reason to believe (and this is in no way in defense of) that both parents face mental health issues during pregnancy, and perhaps, sometimes, violence is a result? This might be important to know.
  3. Do pregnant women know how to approach for help when abused? Where to go? What treatment options are available?
  4. How would this data about pregnancy look like, if collected and analyzed globally?

This study, from U.Penn is truly an eye opener, but if anything, it tells us not enough is being done.

Reference:

  1. The MedicalXpress Article: https://medicalxpress.com/news/2017-05-pregnancy-linked-higher-death-traumatic.html
  2. Image courtesy, Pexels: https://www.pexels.com/photo/motherhood-parenthood-pregnancny-mother-59894/

No, one pregnancy does not make Mirena or other IUDs useless

It is important to remember that the best source of advice is your Obstetrician/Gynecologist/Doctor, and regardless of all your research, you should always consult them for medical advice! 

The Backstory

Always on the look out for interesting medical device news, I came across this apparently humorous story of a baby, born through a pregnancy that occurred about 3 weeks (this is only an assumption based on what the mother herself has predicted) after the placement of a Mirena IUD.

The humor supposedly lies in the fact that the Obstetrician fished out the IUD, which was difficult to find and remove during the pregnancy, while the C-section was being performed. A nurse then put the IUD on the baby’s hand and captured an image with one of the ubiquitous smartphones, shared it, and the image then went “viral”.

What Ensued

Due to stiff competition among manufacturers and variable experiences from patients, Mirena, and IUDs in general, are discussed on and off, with their capabilities challenged. An incident such as this pregnancy always bring up questions, many fair, and many not. It is important that they be addressed, nevertheless.

I have always maintained, even in my earlier blog posts (one is linked below) on my main Medical Devices blog, that IUDs are the easiest and least invasive ways to prevent pregnancies, when compared to other devices.

Planned Parenthood appears to claim that IUDs are 99.9% effective. Now, I would be cautious even with the force of Planned Parenthood behind the statement. A pregnancy that was already initiated, hormonal imbalances or physiological oddities, improper placement, any number of things could potentially cause a pregnancy.

Even with both partners exercising birth control measures, you could still have a pregnancy!

Some Caution for Device Designers

People see the humor in the situation, but a health practitioner and a device designer/engineer should see something worrisome here. Of course, reporters (link below), don’t always know how to accurately represent information, but I find this particular sentence of concern:

The doctor was unable to remove the implant during her pregnancy, but while delivering the baby, Hellein said he found it behind her placenta.

Note: Hellein is the mother.

There are at least one of two things going on:

  1. It was simply difficult or impossible to remove the IUD during the pregnancy.
  2. It is possible that it was impossible to remove the IUD because it could not be found!

Understandably possibility no. 2 is quite worrisome. Without knowing much though, I cannot tell whether the IUD needs to have features that make it obvious during an X-Ray, Ultrasound or other imaging technique, preferably, an imaging modality whose radiation levels don’t present risks to mother or child.

Opportunities and Challenges

If the IUD is difficult to find due to anatomical challenges, whether they arise from a pregnancy or not, there is an opportunity to improve the design of IUDs. What form this might take is hard to say, and one thing to consider is, that the methods that help make the device visibility should be biocompatible and should in no way threaten the patient or any potential babies.

Further Issues

Here is something else from the article that gives me pause:

“This woman is very lucky that when the placenta grew over the IUD it did not disrupt the blood flow to the placenta,” Ghasseminia said.

She said this could lead to a miscarriage.

Laura Ghasseminia, is apparently a Planned Parenthood nurse practitioner, interviewed for the story by 10 News (link below). What she said here, gives one further pause. It is difficult to conceive, but it could be possible to design an IUD that  somehow loses flexibility or its shape once it dislodges from its location, whether due to a fertilized fetus, or due to some other reason.

All said, there are some challenges that this pregnancy and the “miracle baby” have unearthed, and this requires further consideration!

References: 

  1. The News Story Quoted Above: http://www.wtsp.com/news/exclusive-baby-born-holding-mirena-iud-mom-sets-the-record-straight/436603932
  2. An old blog post of mine: http://chaaraka.blogspot.com/2007/09/womens-health-devices-heat-upslowly.html
  3. Image courtesy, Pexels: https://www.pexels.com/photo/adorable-baby-baby-feet-beautiful-266011/