One of the most basic instructions given to an undergrad is on the concept of gravidity and parity. Gravidity is the number of times a woman has got pregnant. Parity is the number of times she had delivered a viable baby. One adds abortion to the list, the number denoting the number of pregnancies that ended as abortions. If the woman is not pregnant at present, her gravidity is the sum of her parity and abortion number. If she delivers more than one fetus in a given pregnancy, her parity remains one irrespective of the number of fetuses she delivers.
The hospital nurses assign confinement number to every woman who delivers a viable baby. A tag with that number is ties around the wrist of the mother and another one with the same is tied around the wrist of the baby.
There was a curious situation the other day. The sister-in-charge of the labor ward stopped me during my ward round with a problem.
"Sir, a woman delivered a baby yesterday. Actually she had twins, but one of the babies had died in the uterus at 3 months of pregnancy. That small fetus came out after she delivered the first baby of nine months. We gave a confinement number to the first baby and the mother. We also gave the number to the other baby which had died at the gestational age of 3 months."
"You mean you tied a tape with that number around the very tiny wrist of a fetus of three months?" I asked incredulously."
"Yes" she said sheepishly.
"How did you manage that?" I asked. "That tape would have gone around the entire baby, not just its wrist."
"We managed" she said briefly. Obviously she did not want to go into the details of how they managed the feat. "What I want to know is that the Registrar told us not to give that number to that fetus. Were we right or was he?"
"He was right" I said.
She looked at me with accusing eyes. She probably did not take it well that I supported the doctor.
"By definition, if a fetus dies before the age of viability, it is called an abortion. If it is not expelled, it is called a missed abortion. So this woman with twins had a term delivery and an abortion together."
She looked at me skeptically. There must have been no such situation in their nursing books, nor in her nursing experience. My unit doctors looked like they thought I was putting them on. I assured them I was not. When I explained the logic, they were convinced.
"Now there is a problem in this" I said. "A woman pregnant for the first time in such a situation becomes Gravida 1 Para 1 Abortion 1 after her delivery of the fetuses, one being term and the other being an abortus. But the sum of her parity and abortions exceeds her gravidity. That is against the basic principle. What can be done to resolve this confusion?"
They thought about it, but had no solution. I had no solution too, mainly because I left it there and moved on with my ward round. I found the solution just now, when I reached the end of this post. It is as follows.
'The conventional teaching does not offer any solution here. No one has thought of such a situation before, though death and retention of one of twins is a known condition. We will have to accept the situation of having to call her Gravida 1 Para 1 Abortion 1, and write 'twins' in bracket.'
That sounds satisfactory to me. It is unlikely to find its way into obstetric textbooks, because I do not plan to write one, and people who write textbooks usually do not read blogs to get new ideas. :-)
The hospital nurses assign confinement number to every woman who delivers a viable baby. A tag with that number is ties around the wrist of the mother and another one with the same is tied around the wrist of the baby.
There was a curious situation the other day. The sister-in-charge of the labor ward stopped me during my ward round with a problem.
"Sir, a woman delivered a baby yesterday. Actually she had twins, but one of the babies had died in the uterus at 3 months of pregnancy. That small fetus came out after she delivered the first baby of nine months. We gave a confinement number to the first baby and the mother. We also gave the number to the other baby which had died at the gestational age of 3 months."
"You mean you tied a tape with that number around the very tiny wrist of a fetus of three months?" I asked incredulously."
"Yes" she said sheepishly.
"How did you manage that?" I asked. "That tape would have gone around the entire baby, not just its wrist."
"We managed" she said briefly. Obviously she did not want to go into the details of how they managed the feat. "What I want to know is that the Registrar told us not to give that number to that fetus. Were we right or was he?"
"He was right" I said.
She looked at me with accusing eyes. She probably did not take it well that I supported the doctor.
"By definition, if a fetus dies before the age of viability, it is called an abortion. If it is not expelled, it is called a missed abortion. So this woman with twins had a term delivery and an abortion together."
She looked at me skeptically. There must have been no such situation in their nursing books, nor in her nursing experience. My unit doctors looked like they thought I was putting them on. I assured them I was not. When I explained the logic, they were convinced.
"Now there is a problem in this" I said. "A woman pregnant for the first time in such a situation becomes Gravida 1 Para 1 Abortion 1 after her delivery of the fetuses, one being term and the other being an abortus. But the sum of her parity and abortions exceeds her gravidity. That is against the basic principle. What can be done to resolve this confusion?"
They thought about it, but had no solution. I had no solution too, mainly because I left it there and moved on with my ward round. I found the solution just now, when I reached the end of this post. It is as follows.
'The conventional teaching does not offer any solution here. No one has thought of such a situation before, though death and retention of one of twins is a known condition. We will have to accept the situation of having to call her Gravida 1 Para 1 Abortion 1, and write 'twins' in bracket.'
That sounds satisfactory to me. It is unlikely to find its way into obstetric textbooks, because I do not plan to write one, and people who write textbooks usually do not read blogs to get new ideas. :-)
