Tag Archives: pediatrics

SUA Single Umbilical Artery

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SINGLE ARTERY UMBILICAL CORD

About 30 years ago, a baby boy was born at home in a town about 90 minutes drive away from where I lived in Vancouver, BC. All was normal with the birth (first baby for the family). The baby was about 8 pounds and he seemed healthy.

I was taught to inspect every placenta carefully at some point in the hours after birth. One part of the placenta exam was to look at the cut end of the umbilical cord and make sure there were 3 little openings where the 2 arteries and one vein were. Remember, this was in the days pre-internet. Midwifery training was accessed by reading thick obstetric/midwifery text books in those days. This little boy’s umbilical cord had only 2 vessels. Oh no. Where was that third little opening for the second artery? I re-cut and peered at the end of the cord but, no, only two vessels. The only instructions in any of my textbooks about that possibility were to “call the pediatrician”. So, I did. At that time, we had a kind pediatrician who always took calls from home birth attendants. When I told him the situation, he said “Hmmmmm, I don’t know what that means. Could you go in to Children’s Hospital to the library and look it up?” I didn’t like to leave the family’s home without knowing for sure that the baby would be okay and I had that 90 mins between their home and the hospital library. I decided to call a friend who was a long time hospital nurse. She didn’t know either but thought it might have something to do with the heart. The baby wasn’t showing any signs of blueness around the mouth and was a keen breast feeder so, I didn’t see or hear any heart problem indicators. After a few hours, I headed back to town and went straight to the Hospital Library.

Vein larger than the 2 arteries

In those pre-computer days, the hospital Librarian was a God-send. She was very helpful and looked up a bunch of articles for me but they really didn’t tell me much more than “it could mean a kidney problem”. I was feeling frustrated but, then, got an idea. I could find the pathology department in the hospital and speak to a person who had seen babies with kidney problems and maybe get some useful help.

I was a bit nervous going to Pathology because I was afraid I’d see dead bodies but, no, the place was clean as could be. The Pathologist was glad to see me and have someone to talk to. (I think that’s a lonely job). I told him what was going on and the first question he asked was “How much did the baby weigh?” He then told me that babies with kidney problems tend to be very small so he doubted my finding that there were only two vessels in the umbilical cord of an 8 lb. baby. He suggested that I should bring the placenta in so he could take a look. I wasn’t relishing the 90 minute drive back and forth again but I was more than willing to be wrong about my count of the vessels if it meant I could relax about the baby.

One vein, two arteries

I returned to the family home, got the placenta from the fridge and drove it back to show the pathologist. He cut the end of the cord on his marble slab and peered at it and then said “Well, I see what you mean. There are just two but can you see that the vein, which is usually larger than the arteries, and the one other vessel are both about the same size? I think what happened here is that the two vessels grew together. If the baby is pee-ing normally and eating well, I don’t think you have anything to worry about.” He then proceeded to reach up on to his shelf and bring down a copy of a thick text book entitled “The Human Placenta”. He told me that it was a fascinating book by a pathologist who had been a veterinarian before he pursued pathology. When I expressed amazement that there was enough to say about the placenta that it could fill a whole book of its own, he said that a lot of the information was comparing the human placenta to that of zebras, gorillas, and other wild animals. Somehow, I’ve never been tempted to buy the book. . . I like to keep my placenta knowledge on a “need to know” basis.

That little boy did just fine and he’s a big man now. That’s the only 2 Vessel cord I’ve ever encountered in 1500 plus births, so it’s very rare (and, in this case, not even a real finding).
I hope this story is informative and reassuring to parents/practitioners about SUA (single umbilical artery) diagnoses in babies with normal growth.
Gloria Lemay, Vancouver BC Canada

From www.midwifethinking.com
A great blog

BABIES BORN IN THE CHRISTMAS SEASON–KEEP THEM HEALTHY

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It’s a special thing to have a baby in North America at Christmas time. Photos of the new baby under the tree with the gifts, extra time off from work, a time of holiness joy and good cheer, . . . you would think it would be the ideal time to give birth. Unfortunately, many little newborns end up in hospital at this time due to the timing of their arrival.

No Finer Gift

No Finer Gift

Photo credit http://www.gracemogadamphotography.com/2015/05/08/newton-newborn-photography-william/

1. This is sugar time. The chocolate, cookies and candies are everywhere you look and sugar undermines the immune systems of the family members leading to colds and flu.
2. Staying up late. Parties given by neighbours, school, church, etc., tend to go late and the older kids in the family are affected and can get sick at this time by the late nights AND THE SUGAR.
3. The pregnant parent is either nesting in with the new baby or is hugely pregnant and doesn’t want to go to events, so the other parent takes the bigger kids and doesn’t pay close enough attention to the sugar or the late hours.
4. The children at school tend to be getting coughs, colds, flu and they spread it to the siblings of the new baby. Those older siblings sneezing or coughing on the new baby leads to trouble.
5. Christmas travel. A lot of pressure can be put on the family of a new baby to drive 100 miles (or more) for Christmas day family dinners. No matter how much the family thinks this is a good idea, IT IS NOT. The newborn should be kept warm and cozy at home because those long car trips are exhausting, no matter how much planning happens in advance. The nursing parent has to take care of her breasts/breast milk supply. All this is best done at home.
If the breast feeding gets thrown off at this season of the year, it can result in the newborn baby failing to thrive and/or the nursing parent getting mastitis, sore cracked nipples or a diminished production of milk.

What can you do to make sure that your new baby stays out of the hospital during this season?

1. Screen all visitors by asking them “Are you sure you are completely well? We don’t want any bugs around the new baby.”
2. Buy lots of grapefruit, kiwi fruit and oranges and make them the whole family’s dessert through this time. Keep a big bowl of this healthy Vitamin C-packed fruit out and visible. Keep stocking it up. Don’t bring sugar-y foods into the house.
3. If you have older kids in school, pay close attention to their diet and sleep. Keep them healthy. Both parents need to be responsible and communicate with each other about this.
4. Both parents need to watch their own health. Stay away from alcohol, take your vitamins, keep your schedule calm, have afternoon naps, avoid annoying people, etc.
4. Take a year off from the hype and pretend you’re in a stable with cattle lowing. In the big scheme of things, you’ll be glad you did. Have a really peaceful Christmas giving thanks for the miracle of your very own healthy newborn Christ child.Christmas warmth

Q & A: Caring for my son’s intact penis

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    Question from a mother:

Obviously our little guy is not getting circumcised (unless he decides he wants to when he’s older and can make that decision independently) but I was wondering how to go about cleaning him, moreso when he is a bit bigger, but like I have heard you are not supposed to pull the foreskin back, but surely at some point that will need to happen to clean in there right? I don’t want to hurt/harm him, but i want to make sure that area doesn’t get full of bacteria. What is your advice on this?

    Answer from Gloria:

Oh, so glad you asked, Karin. Right now, and until he is about 4 years old, his foreskin is actually attached to the glans just as the fingernails are attached to the nail beds. You only clean what is seen. Never retract the foreskin or you could damage that natural attachment and don’t let any medical professionals do it either.

When he’s about 4, he’ll reach into his pants and find his “toy” and then he will start playing with it. (They continue that till about age 80). That is the only way that the foreskin should come back—the boy doing it himself. The age that the foreskin is retractible can vary from early childhood to very late teens. There’s lots of variation. Most boys/men simply retract their own foreskin in the shower and rinse with plain water and replace the foreskin back over the glans. That is all the cleaning that is needed. It’s very easy.
ColoradoNocirc.org is a good resource place for medical reassurance on the care of boys’ genitals. https://www.coloradonocirc.org Congratulations on your new little son. Love, Gloria

sonandmom

Additional comment, June 12,2015 Bodies are designed for pleasure. Only a big meanie would deprive anyone of having fun with their own body. Part of my education on boys having fun with their toy came from my brothers. When we were little, my mom would plunk all 5 of us kids (we were 18 months apart in age) in the bathtub. My brothers would do very impressive tricks with their toys,– popping out the shiny purple surprise from inside the foreskin. There was no need for my mom to clean anything, All that bathtub play took care of things. Gloria

The Foreskin–it’s there to protect a boy

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foreskinaap

This graphic was posted on Facebook by Chase’s Guardians on April 6, 2015

This news story of a baby boy screaming in an operation for three hours and being discharged without a penis really brings home the point, KEEP OUR BOYS INTACT.

    MEMPHIS, Tenn. (FOX13) –

Nov. 7, 2013

It doesn’t happen often, but when a doctor botches a child’s circumcision, it’s heart-breaking.

Maggie Rhodes is dealing with that heartbreak right now, after a catastrophic mistake on the operating table.

Removal of the foreskin from a child’s penis is rooted in concerns about health, hygiene and religion. But some question the necessity of the procedure.

Rhodes is sorry she ever took her young son to get circumcised.

“After I went home and I discovered that my son’s penis was not there, I immediately froze, like, oh my God,” Rhodes recalls.

The mother said she couldn’t believe what happened when she took her three-month-old son Ashton to Christ Community Health Center on Broad Avenue for a circumcision in August. She says doctors told her the procedure would take about 20 minutes.

But after a couple hours, Ashton was still in surgery.

“It took them about three hours to do the circumcision and so my baby screamed the whole three hours, like the whole process,” Rhodes said. “Then even when she gave him back to us, he was still screaming.”

Rhodes said the doctor performing the surgery obviously botched the procedure. But when it was over, she says they simply returned her screaming son to her, never telling her about the devastating mistake that had happened in the operating room.

“I should have been notified that something went wrong in this room with your baby,” she said. “I wasn’t notified. They gave me back my baby like nothing was wrong. They said, ‘here go your son.’ Yeah, something went wrong in that room.”

It’s something Rhodes said she didn’t find out about until she went home with a still screaming son, and a diaper filled with blood.

She said her curious sister finally discovered Ashton’s mutilated penis.

“When my sister pulled the cloth back, it was covered in blood and it was no penis there,” Rhodes said.

All that was left was a partial penis and his tiny testicles. Rhodes said Ashton urinates through a hole in his penis. She says she can’t imagine what she’ll say to her son, when he’s old enough to understand what happened to him.

“Like, ‘Momma like, how could this happen to me? How could this happen to me?,'” she said. “How could you explain that to your child that you don’t have a penis that they have to reconstruct one or you probably have might not never be able to have kids? That don’t sit well with me at all.”

Rhodes has hired an attorney and is pursuing a medical malpractice suit against Christ Community Health Centers.

As for little Ashton, a reconstructive surgery planned for October has been rescheduled for early next year.

FOX13 News contacted Christ Community Health Centers for a comment. We’re told the CEO is aware of our request, but so far has not returned our repeated calls.
http://www.myfoxmemphis.com/story/23912521/mother-upset-over-botched-circumcision