Puberty, Pregnancy, Parturition, Puerperium—Surveillance by Intertwined Innumerable Neurohumoral Factors —Proof of Basic Concept Study by Retrospective Analysis
New Horizons in Medicine and Medical Research Vol. 3,
6 April 2022
Case 1: In 1990, a 23-year-old woman, married for two years, with primary infertility, was brought by her husband, with ultrasonography of abdomen, pelvis report stating multiple tiny cysts in both ovaries, infantile uterus; so husband claimed he was cheated to marry a woman with an infantile uterus, he wanted to divorce her on medical grounds. Analyzing the problem revealed that the woman had irregular menstruation prior to marriage due to polycystic ovaries; the husband received a prescription for oral contraceptive pills from a clinician for one cycle to regularise his wife's menstruation; which he continued to administer for two years, with the desire to enable conception of his wife, not understanding that oral contraceptive pills with their exogenous oestrogen suppress endogenous oestrogen, preventing ovula formation Case 2: In 1996, a 25-year- old woman underwent lower segment Cesarian section, 10 days prior to her EDC [expected date of child birth], as per the request of her husband who desired to see the baby before boarding his flight overseas; lower segment Cesarian section was performed by a urologist, general surgeon, but the mother expired on the theatre table, probably because the woman’s expected date of childbirth range would have fallen into the 15 days after expected date of childbirth norm, when her oestrogen would not have dipped, oxytocin would not have been released, to prevent postpartum haemorrhage. Case 3: In 1998, a 27-year-old woman presented with postpartum haemorrhage of one hour duration, following vaginal delivery of foeto placental unit; with haemoglobin of 3 gm%; immediately hysterectomy of the soft uterus was performed, mobilising 10 units of blood; once bleeding uterus was severed, all the 10 units of blood were transfused immediately, she survived. Case 4: In 1999 woman of 32 years [without antenatal screening] was delivering a twin breech presentation, she was detected to be hepatitis B surface antigen positive, she had jaundice total bilirubin 3 mg/dl, anaemia-haemoglobin of 6.5 gm%, her twins were managed at higher centres, for jaundice during pregnancy; she received 3 units of packed red blood cells, during postpartum; she returned for next pregnancy in the second trimester, with both twins crawling at her sides, Hepatitis B surface antigen had turned negative. Case 5: In 2003, a 32-year-old woman presented to emergency with dyspnoea with desaturation of 60%, she was ventilating but oxygen saturation was low; she had consumed hormonal pills for 3 days to postpone her menstruation to enable her to attend a wedding; she had undergone puerperal sterilisation in the past; her electrocardiography showed S1, Q3, T3 changes suggesting pulmonary embolism; thrombolysis, heparinisation was initiated, intubated, ventilated without improvement in oxygen saturation; hence saddle thrombus possibility was considered and she was referred to higher centres but she succumbed. This persons contraception status increases thrombogenicity due to reduced endogenous oestrogen status secondary to germ cells destruction by contraception, over that her consumption of hormonal pills to postpone menstruation further decreases endogenous oestrogen, increased vulnerability for pulmonary thromboembolism. Case 6: In 2014, a 29-year-old woman presented with unconsciousness of 30 minutes duration to emergency; she had infertility for 11 years and had delivered a precious baby, 34 days prior to admission; due to social ignorance [to enhance mothers milk baby shark food helps] she had consumed baby shark food one hour prior to admission; on examination she had quadriparesis, she was unresponsive. Her Magnetic Resonance Imaging [MRI] brain, with arteriogram, venogram showed multiple vessel narrowing suggesting vasculitis with bilateral asymmetrical, multifocal infarcts. She was treated with IV immunoglobulin, [0.4 gm/kg/day*5 days] needed ventilatory support, antiedema measures, antiepileptics, parenteral hydration, enabling a slow recovery, on referral to higher centres. Emergency hysterectomy with preanesthetic panel workup, blood transfusions, given after ligation of uterine vessels, severing the soft uterus, lifesaving in postpartum haemorrhage following vaginal delivery of foetus, placenta.
- Endogenous oestrogen
- neurohumoral factors