When a woman is pregnant, and the doctor misses the diagnosis, it could be called a 'missed pregnancy'. That is possible when the pregnancy is very early, the woman has a rather stout tummy, and the woman is uncooperative during clinical examination. This can be avoided by performing a pregnancy test on her urine. What I am writing about is pregnancies that are missed surgically.
I recall that as junior residents we were so terrified of perforating a pregnant uterus during first trimester termination of pregnancy, that we tended to introduce the MTP cannula less than appropriate. Once I had suctioned only the cervical canal and thought the procedure was complete. A more experienced person showed me my error, and I did not repeat it again.
When I became a Lecturer, another Lecturer performed first trimester MTP on the daughter of one of class 4 employees, and the pregnancy continued. When the pregnancy reached second trimester and became palpable abdominally, this Lecturer declared it was an ovarian tumor and advised a laparotomy to remove it. Luckily her father changed the gynecologist, and brought her to us. We performed a second trimester MTP and she went home fine.
This story I heard from a colleague. There was a patient scheduled to undergo a second trimester pregnancy. She was given misoprostol and passed something in the toilet. The House Officer said that she had aborted. The Registrar confirmed the abortion. A day later she underwent an abdominal sterilization operation through a small incision. It was assisted by an Assistant Professor, under the supervision of a Professor. No one thought she was pregnant, despite such a large and soft uterus seen and felt directly. They could have even ballotted the baby and reported it as direct ballottement- a new technique, different from conventional external and internal ballottements. The patient went home fine, but came back after two months with an ever enlarging tummy.
"She was 26 weeks pregnant" the colleague exclaimed. "Her husband is very angry. He wants the fetus out without spending any more money. He has talked to a civic corporator who is threatening t make trouble."
"But you cannot terminate the pregnancy at 26 weeks legally" I said. "You cannot induce labor too, because there is no indication, and if it fails, you will have to perform a cesarean section. Such measures are unjustifiable."
"What shall I do? Shall I tell the Dean?"
"That would be a good idea" I said.
The Dean was told.
"Get Head of Department from another civic hospital, and perform an MTP on that patient jointly" was the advice.
'God be praised' I thought because he had not asked me to get involved in this procedure that was against the MTP act, for violation of which one goes to jail. A week passed. The concerned consultant met me again.
"What happened to that failed MTP case?" I asked.
"The other head of department was reluctant to come. He advised me to go ahead and do it." Naturally so, I thought. WHo would want to go to jail because a Dean ordered it? But God is on my side" she continued. "The patient came back with premature rupture of membranesand cord prolapse. She aborted on her own. God saved me."
I wondered if God caused this outcome directly, or just gave a thought of discrete use of misoprostol.
I recall that as junior residents we were so terrified of perforating a pregnant uterus during first trimester termination of pregnancy, that we tended to introduce the MTP cannula less than appropriate. Once I had suctioned only the cervical canal and thought the procedure was complete. A more experienced person showed me my error, and I did not repeat it again.
When I became a Lecturer, another Lecturer performed first trimester MTP on the daughter of one of class 4 employees, and the pregnancy continued. When the pregnancy reached second trimester and became palpable abdominally, this Lecturer declared it was an ovarian tumor and advised a laparotomy to remove it. Luckily her father changed the gynecologist, and brought her to us. We performed a second trimester MTP and she went home fine.
This story I heard from a colleague. There was a patient scheduled to undergo a second trimester pregnancy. She was given misoprostol and passed something in the toilet. The House Officer said that she had aborted. The Registrar confirmed the abortion. A day later she underwent an abdominal sterilization operation through a small incision. It was assisted by an Assistant Professor, under the supervision of a Professor. No one thought she was pregnant, despite such a large and soft uterus seen and felt directly. They could have even ballotted the baby and reported it as direct ballottement- a new technique, different from conventional external and internal ballottements. The patient went home fine, but came back after two months with an ever enlarging tummy.
"She was 26 weeks pregnant" the colleague exclaimed. "Her husband is very angry. He wants the fetus out without spending any more money. He has talked to a civic corporator who is threatening t make trouble."
"But you cannot terminate the pregnancy at 26 weeks legally" I said. "You cannot induce labor too, because there is no indication, and if it fails, you will have to perform a cesarean section. Such measures are unjustifiable."
"What shall I do? Shall I tell the Dean?"
"That would be a good idea" I said.
The Dean was told.
"Get Head of Department from another civic hospital, and perform an MTP on that patient jointly" was the advice.
'God be praised' I thought because he had not asked me to get involved in this procedure that was against the MTP act, for violation of which one goes to jail. A week passed. The concerned consultant met me again.
"What happened to that failed MTP case?" I asked.
"The other head of department was reluctant to come. He advised me to go ahead and do it." Naturally so, I thought. WHo would want to go to jail because a Dean ordered it? But God is on my side" she continued. "The patient came back with premature rupture of membranesand cord prolapse. She aborted on her own. God saved me."
I wondered if God caused this outcome directly, or just gave a thought of discrete use of misoprostol.
