She worked into the consultation room with so much anxiety and abdominal pain. After establishing rapport with my chief, the consultant, she went on to give her history, including that of the index pregnancy.
I was chosen to do the physical general and obstetric examinations. My examination revealed a solid mass toward the supra-pubic region co-existing with a foetus in an oblique (abnormal lie).
What struck me was that the history revealed that the patient, had already been told that her baby was dead in a peripheral centre. This was the source of her anxiety.
The consultant needed to be sure, so he ordered that an ultrasound scan be other immediately. Before then, I had listened for a foetal heart sound, but the abdominal pain and the fact that the mass was an obstacle, made it totally impossible to elicit the heart sound. She was panicking and shedding tears, as she does not want to lose her baby she had waited 8-years to get. I whispered a little prayer for her!!!
I noticed a young man, I later discovered to be her younger brother, was prancing along the corridor. Though this may be a regular feature in most fertility clinics, I had never been on a team that is to manage infertility of such duration.
Ultrasound findings revealed that the solid mass was actually a leiomyoma, in red degeneration-- because of the abdominal pain.
She had to be admitted and since was near term, she would be monitored pending when she gets to 37weeks of gestational age (she was 36weeks and 1day today). The consultant assured her that since she has presented to a tertiary centre, maximum obstetric care would be given to her.
I got to find out that she could deliver per vaginam, and after 6weeks post delivery (pueperium), and she is still symptomatic, then an elective abdominal myomectomy would be done for her!!!
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