PDA

View Full Version : One for the medical experts among us...



brinkett
10-08-2005, 03:34 AM
Is there any type of trauma a woman could experience during a fight that would render her unable to carry children (or make it inadvisable to)? Guns can't be involved, but weapons like knives and bats can. Any type of injury to the uterus, for example?

three seven
10-08-2005, 03:49 AM
Possibly some useful info here:

Adhesions form as a response to inflammation, infection, surgery or trauma. When they form on or near the delicate female reproductive organs, they may block fallopian tubes or adhere to the ovaries. They may bind like a glue to the finger-like fimbriae, preventing them from grasping the egg during ovulation. Adhesions may cling to the uterine surface, making it less receptive to the implantation of a fertilized egg. (http://www.clearpassage.com/femaleinfertility.htm)

Maryn
10-09-2005, 12:02 AM
Let me second that. Being really narrow, the fallopian tubes can be easily blocked or pressured closed by scar tissue forming in the vicinity. (Happened to a friend who'd had multiple abdominal surgeries.)

Does it have to be a trauma, or might an undetected or untreated infection serve you just as well? Sad to say, women who are raped sometimes are also infected with STDs.

Maryn, who recalls several novels that make mistakes with infertility and miscarriage

brinkett
10-09-2005, 02:31 AM
Thanks, Three, that gives me something to consider.

Maryn: Yes, it has to be trauma. You said:



Being really narrow, the fallopian tubes can be easily blocked or pressured closed by scar tissue forming in the vicinity.

Couldn't that be overcome with in-vitro fertilization, though (i.e. eggs can be harvested, fertilized outside the womb, and then implanted). I'm looking for something that would prevent a woman from carrying a child, so even if an egg could be fertilized with medical help, she wouldn't be able to carry the fetus.

ANNIE
10-09-2005, 07:59 PM
There are lots of things that can make a woman unable to bear children. First thing that comes to mind is earlier pregancy that went bad- miscarrage that caused uncontrolled bleeding. a historectomy might be needed in that case. Also car accident causing abdominal trama in which internal bleeding happened. If the uterus was ruptured during the accident then it would have to be removed. knife wounds to the abdoman might also cause enough trama, depending on what is injured, to cause removal of the utrerus.

brinkett
10-09-2005, 09:19 PM
There are lots of things that can make a woman unable to bear children. First thing that comes to mind is earlier pregancy that went bad- miscarrage that caused uncontrolled bleeding. a historectomy might be needed in that case. Also car accident causing abdominal trama in which internal bleeding happened. If the uterus was ruptured during the accident then it would have to be removed. knife wounds to the abdoman might also cause enough trama, depending on what is injured, to cause removal of the utrerus.
Annie, this is great information! Are you saying that if knife wounds cause enough damage to the uterus, it would have to be removed, or that other abdominal injuries (from being stabbed) could lead to removal of the uterus (and if so, what type of injuries)? If the uterus wasn't removed, could scarring result that would make it inadvisable for the woman to carry a child?

Sorry if these are dumb questions, but I want to make sure whatever I write is realistic. :)

Perks
10-09-2005, 09:28 PM
Annie, this is great information! Are you saying that if knife wounds cause enough damage to the uterus, it would have to be removed, or that other abdominal injuries (from being stabbed) could lead to removal of the uterus (and if so, what type of injuries)? If the uterus wasn't removed, could scarring result that would make it inadvisable for the woman to carry a child?

Sorry if these are dumb questions, but I want to make sure whatever I write is realistic. :)

Absolutely! An irregular, especially vertical breach of the uterus (think classical Cesarean incision, but worse when not performed with surgical precision) can render the scar in the uterine wall unstable and much more likely to rupture, making pregnancy unadvisable. (That's one reason the 'bikini line' incision is more popular. A scar running low across the bottom of the uterus will sustain less pressure during subsequent pregnancies and deliveries.) Also, because of the vast blood supply and location of the uterus, anything that could cause a hemorrage could necessitate its removal to staunch the flow.

ANNIE
10-10-2005, 08:35 PM
Sorry, it took me a while to get back to the boards, but I agree with everything perks said!Are you in the medical field perks?

Perks
10-10-2005, 09:20 PM
Hey Annie! No, but I actually contemplated (and did some study towards) beoming a midwife's assistant. Which is funny if you know me, because I'm not all that into babies. But the mechanics of pregnancy and childbirth are absolutely fascinating to me. And the sometimes ridiculous over-medicalization of the process in this country really prompted me to a lot of study. It's one of the few things I know a lot about! (That being said, I'm not one of those women wanting to squat in the woods to have a baby either. Lol!)

Barb
10-10-2005, 10:50 PM
Absolutely! An irregular, especially vertical breach of the uterus (think classical Cesarean incision, but worse when not performed with surgical precision) can render the scar in the uterine wall unstable and much more likely to rupture, making pregnancy unadvisable.

For a very long time, women who had one Cesarean section were adviced against having another baby. That is different these days (I don't know, but I'd venture the guess that surgical techniques in Cesarean sections have improved by now). And even the scar from a very bad Cesarean section of old times was probably better than the scar from a stab wound in the abdomen. In other words: should serves you for your literary purpose.

brinkett
10-11-2005, 05:19 PM
Thanks, everyone! :)

September skies
10-12-2005, 03:12 AM
Is there any type of trauma a woman could experience during a fight that would render her unable to carry children (or make it inadvisable to)? Guns can't be involved, but weapons like knives and bats can. Any type of injury to the uterus, for example?


If you're looking for it to be a product of a fight (and not an STD type of thing) ..I would have to say that you need to use a knife.

If there is extensive trauma (knife wound) to the pelvic area, there is a possibility that her ovary duct is slashed or uturus scarred. (say she only had one productive ovary, typical of many women, as the other may have been previously damaged by an STD or she may have been born with only one ovary to start with)

The scarring resulting from the injury could result in an inability to bear children later.

The worst case I ever saw in the emergency room was a 3-year-old child who was raped and sodomized. (every nurse there cried) That poor child will never have children. She was so torn up and messed up inside. So sad.

Depending on the age of your character...this may also work for a small-frame young woman.

September

brinkett
10-12-2005, 09:02 PM
Thanks, September!

ColoradoGuy
10-18-2005, 12:04 AM
A wide variety of injuries to the abdomen could serve your purpose. Much depends upon how distant in the past you want to place the injury. Are you interested in causes of infertility or just inability to carry a pregnancy to term?

Tell me your plot needs and I can suggest a plausible medical scenario. (I am a critical care physician with twenty-five years experience working in emergency rooms and intensive care units.)

brinkett
10-18-2005, 02:04 AM
A wide variety of injuries to the abdomen could serve your purpose. Much depends upon how distant in the past you want to place the injury. Are you interested in causes of infertility or just inability to carry a pregnancy to term?

Tell me your plot needs and I can suggest a plausible medical scenario. (I am a critical care physician with twenty-five years experience working in emergency rooms and intensive care units.)
I'm interested in the inability to carry a pregnancy to term. Even strongly inadvisable to carry a pregnancy to term would work for me. Assume that before the injury, the woman in question can only become pregnant through something like in-vitro fertilization. After the injury, I'd like that to be impossible or not advisable.

Ideal scenario: As far as time of injury goes, I'd like the physicians to give her the bad news when she comes around from whatever surgery she had to undergo to save her. I'd like them to tell her that because of the injury, they had to [do something] that has rendered her unable to carry a pregnancy to term, or that it would be a bad idea to carry a child because of [something], or [some other reason]. I'd like a knife to be involved.

Will anything work for the ideal scenario? If not, other suggestions would be most welcome. The important plot point is that after her injury, she can't (or shouldn't attempt to) carry a pregnancy to term. And no guns. :)

ColoradoGuy
10-18-2005, 03:50 AM
Brinkett:

Your scenario is easy in some ways, more problematic in others. There is no simple way to do it, but it still could be done. I assume that you want the issue to be one of a woman carrying the pregnancy long enough to produce a viable infant, not one of actual danger to the mother from doing so. I put the issue that way because these days the disorders for which pregnancy would constitute a danger to the mother directly (and thus the child indirectly) do not follow injuries; rather, they generally are medical conditions in the mother such as blood clotting problems, cancer, severe high blood pressure, or diabetes.

If you want an injury that will cause future problems both in getting pregnant and in carrying the pregnancy, then probably direct injury to the uterus is the way to plot it. You could have knife injury to the lower abdomen and pelvis lacerate a womanís uterus. If the victim were young, the surgeon might be inclined to repair the uterus rather than simply remove it. I would make the uterine injury pretty extensive, not just a slash. Have the surgeon remove part of the wall (maybe 25% or so) of the uterus as part of the repair of her knife injury because the damage was extensive. If the uterus is too small (like 75% of normal), pregnancy usually does not go to term. The problem here is that most trauma surgeons, faced with that situation (extensive knife wounds to the lower abdomen involving the uterus), would just take out the uterus and tell the woman that she can never have children. You could plausibly have a surgeon try to save the uterus by making the trauma surgeon a touchy-feely, sensitive person (maybe a woman who has had trouble herself with pregnancy?), but most trauma surgeons are pretty rough-hewn folks.

The infertility part would be another issue. You could have the injury slash her Fallopian tubes, but that can be repaired unless you make the injury fairly extensive, and you would need to get both of them to make her infertile. Subsequent scarring of the tubes as her injury healed could make her infertile, but the surgeon would not know that until much later. A tricky way could be for her to get a post-operative infection in her pelvis, which is common after injuries like this, particularly if you have the knife nick her intestines as well. The aftermath of the infection could scar her tubes and make her fairly predictably infertile.

But there is a problem with in vitro pregnancy part of your scenario; no infertility specialist is going to implant anything in a women who has a previously damaged uterus, precisely because the pregnancy is unlikely to go to term. So the in vitro thing really would be far-fetched.

So itís complicated. To me, the best thing would be for the surgeon to save the uterus (which, as I noted, would need some additional explanation), have the tubes damaged by the injury, and have the doctors tell her that it is unlikely that she could get pregnant, and if she did get pregnant, unlikely for her to carry the baby to term. (But not impossible.) Then get her pregnant the old-fashioned way.

Good luck. E-mail me privately if you want to discuss this further.

brinkett
10-18-2005, 04:05 AM
But there is a problem with in vitro pregnancy part of your scenario; no infertility specialist is going to implant anything in a women who has a previously damaged uterus, precisely because the pregnancy is unlikely to go to term. So the in vitro thing really would be far-fetched.
ColoradoGuy, I'll PM you to continue this, but I just wanted to clarify my last post in case anyone else wants to chime in. When I said that she can only become pregnant through in-vitro fertilization, I meant to begin with, before the injury. After the injury, I want a pregnancy through in-vitro fertilization to be impossible or not advisable. I never considered the possibility that the specialist might refuse, so you've given me even more to work with. Anyway, I'll PM you to continue the discussion. :)

reph
10-18-2005, 11:38 AM
An injury sustained in a bus accident made Frida Kahlo unable to have children. I don't know the details. I think something punctured her abdomen.

brinkett
10-18-2005, 03:50 PM
An injury sustained in a bus accident made Frida Kahlo unable to have children. I don't know the details. I think something punctured her abdomen.
I have to confess that I'd never heard of her. According to information I found on a web site, it sounds like she was almost crushed. Lots of broken bones, including the pelvis. Perhaps a bone punctured it. It did say that she suffered through numerous miscarriages.