Pregnancy is Unpredictable: Be Prepared

Pregnancy is a normal physiological process through which most women go through without complications. Yes there are certain complications that are diagnosed  during the routine checkups but they can be subsequently managed on OPD basis.

On the other hand, Obstetricians world over can vouch for the unpredictability of pregnancy. There are complications that arise suddenly even when all prior tests and checkups are normal. At times there maynot be any physical symptoms.  Such situations are hard to grapple with, not only for the patients and their families, but also for the Doctor . It is hard to convince the patient the urgency of the follow up actions, needed to decrease further complications. I will highlight such a case that occurred in the recent past.

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 A pregnant patient who was registered at the hospital and coming for regular checkups, came to the emergency early morning with a history of bleeding.

She was in her 27^th week of pregnancy. It was known that she had low lying placenta (that can cause bleeding in pregnancy). Her Level 2 scan (ultrasound for noting any abnormalities in the baby) two months back was normal. On clinical examination the baby seemed fine but on conducting an ultrasound, we found that water around the fetus had drastically reduced (AFI of 1) and that the baby had retarded growth. Nothing could explain this sudden development.

Doctors explained the possible need for a caesarian and subsequent prolonged nursery stay for the new born. This was naturally shocking to the patient and her spouse since at their routine visit 2 weeks back nothing out of the ordinary was detected.  And as is usually the case they started doubting the radiologist who had done her Level 2 Ultrasonography and the gynecologist for not having detected any problems earlier.

A day later the patient started bleeding and the Doppler indicated  absent diastolic flow i.e the blood supply to the baby was

compromised.  At this juncture crucial time was lost in convincing the patient for an emergency cesarian . A premature baby of 700g was delivered by cesarian .

Apart from blood loss during the Caesarian, the patient lost additional blood in postpartum hemorrhage (due to placenta privea). She needed blood but instead of deciding on the options of blood and injectible iron, they were still pondering over why the complications occurred.  Counselling was done. She finally received blood and was subsequently discharged in a healthy state.

This episode reinforces the need for education of patients and effective communication between the care provider and the patients. Here one could consider a few tips for both the patients and the doctors on how to wade through such situations.

Accept unpredictability: Pregnancy leads to several changes in the human body & there is always a possibility of sudden developments in the mother or baby that cannot be predicted earlier or which cannot be avoided. No one size fits all here. All pregnancies are unique. Instead of pondering over why it happened discuss with your doctor about the management issues (what next, when, options available etc).

Avoid blame game:  Patients need not feel guilty that it is some food or activity that caused a particular complication. In fact you must ask your gynecologist in case you have any doubts regarding the same. Similarly there are instances where there is little scope for doctors to predict and avoid certain complications. Most of the first time obstetric events like bleeding, preterm pains, growth retardation and decreased fluid cannot be prevented.

Engage in trust building process:  All doctors should focus  on an open discussion with the patients encouraging to clarify their concerns. Adequate time, privacy and openness go a long way in allaying doubts and confusions. Inadequate counseling may leave a doubt in the patients mind about the validity of the diagnosis or the treatment. Similarly patients should understand the options in a particular situation and their pros and cons . They should be able to arrive on a decision when required.

Discuss with doctor about a second opinion:  If at all a couple want, they can discuss with the primary doctor about their desire for the opinion of another doctor. However the caveat is to know how much of time you have since certain situations like bleeding donot give much time.

The primary doctor too can discuss the matter with the patient and her family in the presence of another  experienced colleague. But one needs to remember that we cannot expect Dr A to follow the opinion of Dr B. Opinions may vary as do the pros and cons.

Both the doctors as well as the community have to be cognizant of these aspects which can go a long way towards effective trust building and avoid confusion during patient management. A good outcome is not sufficient for ensuring the doctor’s or patients’s satisfaction.

About the case above, the baby is doing fine !! A relief to all of us.