Pregnancy

Modern Family: S10/E7 Disclosing Pregnancy Results

/ Jordyn Redwood / Leave a comment

This blog post does contain spoilers for episode seven/season ten of Modern Family— you’ve been warned!

On a recent episode of the wildly popular ABC series Modern Family  (which I personally thoroughly enjoy) it was disclosed that Haley Dunphy is pregnant. However, the way her pregnancy was disclosed was a violation of patient privacy.

In the episode, Haley and her boyfriend, Dylan, are playing bumper cars when he playfully rear ends her while she’s applying lipstick (yes, in the bumper car). The end of the lipstick gets shoved up her nose and breaks off leading to a trip to the ER.

Evidently, Haley was given anesthesia to remove the piece of lipstick from her nose. They also x-rayed the nose (at some point) because they tell her it’s not broken. There’s some witty banter about how the injury happened and that she and Dylan want to remain childlike as long as possible which is when the doctor says, “Oh, we did a pregnancy test prior to your anesthesia and you’re pregnant.” This was done via a blood test.

Problem One: There’s really no reason to give anesthesia in this case. We remove foreign objects from pediatric noses all the time and never give anesthesia. Anesthesia is reserved for the OR. Sometimes, a patient might need a little something to chill them out for a procedure, for which we would use nasal Versed or Fentanyl. You don’t need to start an IV and recovery is not too long.

Problem Two: Not even sure why they needed to do an x-ray for a broken off end of lipstick in the nose. I don’t think the mechanism of injury warrants even thinking the nose is broken. Lipstick is soft after all.

Problem Three: A blood test used to determine pregnancy. This is rarely done and would be used more specific to determining pregnancy where problems in early pregnancy might be the concern— such as ectopic pregnancy or early pregnancy miscarriage. In this case, a urine test would suffice.

Problem Four: These days, disclosing pregnancy results must be done very carefully. As healthcare professionals, we don’t know who the male is at the bedside and if the patients wants that male to know about the pregnancy or not. The doctor should have asked Dylan to step out of the room as she disclosed the results to Haley. Then it’s Haley’s decision about whether or not to tell her boyfriend. The same is true if we discover a teen is pregnant in the ER who might be there with her parents. The parents are asked to step out and we’ll tell the teen. It’s up to her whether or not to disclose the results to her parents. We as healthcare professionals will encourage her to do so, but it is ultimately her decision.

I think the best way to have handled this situation would have been to perform the pregnancy test prior to her getting an x-ray of her nose, but even this would be a little outside the norm because shielding her abdomen would have been easy in this scenario.

Author Question: Motorcycle Injuries

/ Jordyn Redwood / Leave a comment

Tory Asks:

I’m currently writing a fan fiction and the two main characters get in a motorcycle crash. The female just found out she was pregnant. I have three (very unrelated) questions. Could the crash send her into cardiac arrest? Would the male (who was driving) be able to survive with just a broken arm and a sprained ankle? And would the baby survive?

Jordyn Says:

Hi, Tory. Thanks for sending me your questions.

1. Yes, a motorcycle crash could send someone into cardiac arrest.

2. Could the male survive with just a broken arm and a sprained ankle? Sure, this is possible, but I don’t know if it’s probable. When looking at accidents, medical people always look at the injuries of the other people involved to determine how serious everyone’s injuries might be.

If the female in the accident suffers a cardiac arrest, it would be surprising that the male walks away with just, essentially, a broken arm. You could make it more believable in the description of how the accident happens. For instance, the female is thrown from the bike, but the male is trapped underneath it. You could also have them differ in the type of protective equipment they’re wearing (helmet, jackets, etc.)

3. Would the baby survive? Again, it depends on a lot of factors. How far along is she in the pregnancy? Cardiac arrest— how long is she pulseless? What other injuries does she get in the accident? The sicker she is from her injuries, the more likely she will miscarry the pregnancy. The body will defer energy and resources to the mother over the pregnancy. Then again, some women have maintained a pregnancy through terrible injuries so you would have some leeway as an author here.

If the mother is far along in the pregnancy (at least 22-24 weeks along) and in cardiac arrest the providers might consider C-section to save the infant. So, without more details as to the nature of the accident, her injures and the state of her pregnancy, it would be hard to say if the baby would likely live or die.

Good luck with your story!

Forensic Question: Testing a Blood Sample for Pregnancy

/ Jordyn Redwood / Leave a comment

Jordyn Asks:

Can you test a blood sample to see if the person who left the blood behind is pregnant?

Amryn Says:

For most traditional tests, it would require a fair amount of blood be left behind in order for perform a pregnancy test. The blood would also need to still be in liquid form rather than dried.

It’s not something that would be done for a variety of reasons, not the least of which is that samples are usually conserved as much as possible for forensic testing. So while it’s possible with the right set of circumstances, it likely wouldn’t be done since the blood would be used for DNA testing rather than diagnostic testing.

*******************************************************************************************

 

Amryn Cross is a full-time forensic scientist and author of romantic suspense and mystery novels. Her first novel, Learning to Die, is available on Amazon. The first book in her latest series, loosely based on an updated Sherlock Holmes, is available for pre-order on Amazon. Look for Warzone in January 2015. You can connect with Amryn via her website, Twitter and Facebook.

 

Zika Update

/ Jordyn Redwood / Leave a comment

On November 6th, 2016, 60 Minutes did a piece on the current state of Zika infection that I found quite intriguing. A runaway infectious virus is always good fodder for a novel, but as a healthcare provider I also feel there is a public teaching component so this blog piece serves as both. What follows is taken directly from this 60 Minutes piece and I highly encourage you to watch it.

Currently, there are 30,000 diagnosed Zika cases in the United States. It is present in every state but Alaska. Most of these cases are in Puerto Rico. Of these cases, there are approximately 1000 pregnant women in the US with the virus mostly obtained from travel. Of these pregnancies, twenty-five were born with birth defects and five ended with loss of the baby.

Zika has now been identified to be transmitted three ways: mosquito bite, blood, and sex (the very first mosquito born virus to be transmitted this way.)

Zika was first discovered in Africa in 1947 where it caused regional infections for sixty years. In 2007, it popped up in the Pacific Islands which became its launching point for worldwide infection because infected people traveled from there globally.

The infection stays in the bloodstream for approximately one week. What makes that problematic is the person can be infectious but asymptomatic. People tend to be less precautious when they think they aren’t sick.

Currently, the largest concern is infection among pregnant women where Zika has been positively linked with microcephaly– a severe brain birth defect. Infection in the first trimester is most critical though Zika has been shown to cause birth defects regardless of how far the mother is along in her pregnancy. In addition to microcephaly, Zika can cause seizures, difficulty swallowing, retinal damage which could lead to blindness, and hearing loss.

Zika infection causes a range of symptoms— the most common is what feels like the flu. However, a small number of patients go on to suffer more complicating neurological problems such as inflammation of the spinal cord and Guillain-Barre syndrome.

There is a vaccine in early clinical trials. If the vaccine proves successful, it could be available in early 2018.

Many doctors encourage women to delay pregnancy until a vaccine is available— particularly if living or traveling to a region where populations of the Aedes mosquito infected with Zika are high. If pregnant and in an area where Zika is present then good mosquito control measures.

What are your thoughts on Zika? Would you get a Zika vaccine if available?