Blood and Loss

The majority of pregnancies result in miscarriages. Most of the time a woman is not even aware she was pregnant before she loses the embryo, so it's hard to obtain accurate data of how often miscarriages occur, but most doctors agree that a full term live birth is relatively rare.

Probably the most common reason for gestantes to come into the emergency room here is because of bleeding. Bleeding during early pregnancy is a telltale sign of spontaneous miscarriage (in Spanish it's called aborto, which signifies something distinctly different in English). However, before Sunday, the bleeding women have presented with very little drama. The blood is more like spotting, and they are admitted to the hospital and placed under observation, rather than subjected to any invasive procedures. Often the bleeding stops on its own in a day or so and the pregnancy continues.

Sunday was different. A gestante, 12 weeks pregnant, staggered into the emergency room, blood soaking through her pants and dripping onto the floor. She left a messy trail down the hall up into the stirrups, and I heard the word hemorragia thrown about by the on-duty obstetrician. Nurses and technicians started running around in response to the ob's orders, fetching gloves and gauze and the box of specula. The ob took one look into the woman's vagina and said, el cuello está abierto. Meaning that the cervix had opened and the contents of the uterus were being expelled. Sure enough, when she reached in with the gauze on the end of a metal pincer-like thing, chunks of red gloopy stuff the consistency of jello plopped out.

This was a case of a partial miscarriage, in which some of the contents of the uterus were leaving through the open cervix, but some of the products of pregnancy were still inside. The fetus is no longer viable at this time, and any remnants of it or the placenta left inside the body have the potential to cause massive bleeding. And so the gestante was wheeled into another emergency room, where the on-call doctor performed what's called a legrado uterino. Basically, she inserts this metal rod with curved ends into the uterus and scrapes out all the contents. It's super disgusting and sad to watch, manually removing what could have resulted in a baby under different circumstances (actually many spontaneous abortions are the result of chromosomal defects in the embryo/fetus, so it could never develop into a normal baby, but environmental factors can also harm an otherwise normal embryo). I saw mostly the same red gloopy stuff as well as a miniature placenta exit, but no tadpole-fetus, for which I am glad.

The procedure was successful, meaning that the now non-gestante stopped bleeding and was allowed to leave the hospital at the end of the next day. It turned out that she had reported bleeding, in the form of spotting, as much as two days before the emergency. She had even been checked out by a different doctor the day before but had refused hospitalization. This was her sixth pregnancy and had said that her five children and husband needed her at home. The ob was highly critical of this decision, for obvious reasons, but I think it's relatively reasonable to want to take care of your family and forego hospitalization. She'd done the whole pregnancy thing before and there's a good chance she'd experienced harmless bleeding. Plus, I find it difficult to be disdainful of a patient whose just lost her pregnancy, no matter how careless she may have been.