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AliceUK
07-07-2016, 01:33 AM
One of the main characters in my novel suffers an injury while she's skiing in Canada. She is helped by a fellow skier or skiers and taken to hospital by the emergency services. I want her to eventually make a full recovery except... while she's being treated in hospital the doctors tell her that because of her injuries she'll be unable to carry a baby to term. I want her to know before she leaves the hospital that she won't be able to have children, which is why I'm thinking she needs to have a damaged uterus rather than an infection which causes scarring and then infertility.

I don't have a medical background so wondering if anyone here could suggest a) if this is credible (Could her uterus be this badly damaged in a skiing accident?) and if so b)what would need to happen to cause that sort of injury and c)What other injuries would she be likely to have as well?

Thank you.

cornflake
07-07-2016, 01:38 AM
Not a doctor but I don't think a. it'd be possible to damage your uterus skiing (and I've heard of some weird stuff but...), b. what damage you could do that'd do that.

The only thing I can think of (hopefully some medical professional will come along with actual info) would be some terrible back injury but even then I think you'd be hard-pressed, as people do this with rods and shit in their back, people with different forms of dwarfism carry pregnancies, people with no legs have done it...

Also, I feel obliged to point out that even if you found some way she couldn't carry a pregnancy, has nothing at all to do with having children.

Katharine Tree
07-07-2016, 01:53 AM
Yeah, all I can think of is that she impales her abdomen with her ski pole, and the damage to the wall of the uterus is so severe that ...

Wait. That doesn't make sense. I had a four-inch incision put in my uterus when I had a C-section, and C-sections sure don't stop people from having more children.

I think you're SOL on that line of thought. You could perhaps say that she got a hard knock on the head, and her pituitary gland was severed from the rest of her brain. That's a fairly common injury--the pituitary gland sits in its own cup of bone, and with enough G-force the brain can slosh around so hard that the pituitary gland snaps off. Then your character would have a lot of hormonal problems. Probably too many to ever have a successful pregnancy.

CEtchison
07-07-2016, 02:59 AM
A uterine rupture directly related to a traumatic pelvic injury might work according to this.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162726/

"Regardless of etiology, spontaneous uterine rupture is a life-threatening emergency that requires immediate resuscitation, identification, and surgical intervention with either primary repair or hysterectomy."


Maybe GeorgeK will stop by with an answer. ;)

josephperin
07-07-2016, 04:09 AM
As I understand your question, you want your MC to be able to get pregnant. I'm a cardiologist, not an OB, but all I can think of are horrendous accidents causing such bad scarring that not having a child would not be her main worry.

Infections can still cause difficulty in carrying a baby to term depending on where the scarring is.

WeaselFire
07-07-2016, 03:36 PM
Most injuries (maybe all) that would preclude carrying a baby to full term would be indicators not to get pregnant or to have tubal ligation to prevent pregnancy. Purposely getting pregnant while knowing a full term pregnancy is impossible could technically be charged as child endangerment in the US, though it's doubtful may, if any, prosecutors would do so. Insurance companies might even decline coverage due to the reckless nature of the act.

For your story to be believable, you would need to provide for the possibility that future treatment might mitigate the risks. The problem is that so many options exist as alternatives to pregnancy, surrogates, adoption, etc. Maybe give her a prognosis as "extreme risk of inability for full term pregnancy" and not an absolute.

Jeff

MaggieMc
07-07-2016, 03:40 PM
What if she had a pre-existing condition that was discovered while she was in hospital due to ski injury?

cornflake
07-07-2016, 06:05 PM
Most injuries (maybe all) that would preclude carrying a baby to full term would be indicators not to get pregnant or to have tubal ligation to prevent pregnancy. Purposely getting pregnant while knowing a full term pregnancy is impossible could technically be charged as child endangerment in the US, though it's doubtful may, if any, prosecutors would do so. Insurance companies might even decline coverage due to the reckless nature of the act.

For your story to be believable, you would need to provide for the possibility that future treatment might mitigate the risks. The problem is that so many options exist as alternatives to pregnancy, surrogates, adoption, etc. Maybe give her a prognosis as "extreme risk of inability for full term pregnancy" and not an absolute.

Jeff

Hold up. There are very, very few states that have gone anywhere close to that level of insanity. That's not a U.S. thing.

Perks
07-07-2016, 06:29 PM
It's possible that a terribly scarred uterus would cause troubles in later pregnancies. It's one reason they really try to avoid the old classical cesarean, the vertical cut through the abdominal wall and uterus. It has a bad habit of making the uterus prone to rupture in future pregnancies. Not guaranteed, of course, but risky.

It brings to mind one the most horrofascinating injuries I have ever heard of. A family friend, a really good skier, took a spill on an extremely steep expert slope. The trouble with steep slopes is that once you start falling, you're kind of Sir Isaac Newton's bitch until the bottom. So Eric went ass-over-teakettle for what felt like forever, skis and poles and legs and arms just everywhere - and adrenaline. Lots and lots of adrenaline.

When he ran out of fall, he took inventory, all splayed out on the snow. He first checked that he wasn't dead and that he could feel himself. He realized that at some point he must have hit a tree, because clearly there was a small branch shoved up under his belt, poking him achingly in the belly. But that wasn't quite right, was it?

It wasn't a branch. It was his femur.

Urg.

Crazily, all they had to do was pull his leg back into place (it wasn't broken) and let all the soft tissue heal. He recovered fully. Although I don't know if he gave up skiing.

:e2thud:

cornflake
07-07-2016, 06:47 PM
You always have the most... interesting stories.

I know someone who has a round scar on her cheek, like a smallpox vax scar. It's from a skipole going through her face. The round flat guard thing stopped it from doing more damage than a hole in her cheek.

A wonderful writer I know refers to what you describe as "gravity having its way with you."

Katharine Tree
07-07-2016, 07:18 PM
Hold up. There are very, very few states that have gone anywhere close to that level of insanity. That's not a U.S. thing.

Seriously. Things aren't that bad here yet. WeaselFire's assertions might hold if your character is Of Interest to the FBI/CIA and they're looking for any little reason to prosecute. For an average Jane? No way.

AliceUK
07-07-2016, 07:21 PM
What if she had a pre-existing condition that was discovered while she was in hospital due to ski injury?

Thank you for all those replies

I can see now that my original idea is probably a bit far fetched, but this suggestion (above) sounds good.:) (The damage in the past would probably be scaring from an appendicitis operation?) Not sure how it would be discovered while she was recovering in hospital from a skiing injury though but all I want to happen is that she discovers she can't have children while she's in hospital being treated for her injuries.

If there's no way that could work perhaps it could be a car or train crash she's involved in instead.I want a medical drama as the story opening, with her life being saved by someone present at the scene.Then once she's recovering in hospital I want her to find out she can't have children.

Perks
07-07-2016, 07:27 PM
Seriously. Things aren't that bad here yet. WeaselFire's assertions might hold if your character is Of Interest to the FBI/CIA and they're looking for any little reason to prosecute. For an average Jane? No way.

I seriously doubt there are any contortions law enforcement could do to arrest, much less prosecute, a woman for getting pregnant, regardless of the likely outcome of the pregnancy.

Criminal Gestation is pure fantasy.

cornflake
07-07-2016, 07:27 PM
Seriously. Things aren't that bad here yet. WeaselFire's assertions might hold if your character is Of Interest to the FBI/CIA and they're looking for any little reason to prosecute. For an average Jane? No way.

I don't think there's a federal statute that'd allow for that. Might be one but...?

AliceUK
07-07-2016, 07:48 PM
As I understand your question, you want your MC to be able to get pregnant. I'm a cardiologist, not an OB, but all I can think of are horrendous accidents causing such bad scarring that not having a child would not be her main worry.

Infections can still cause difficulty in carrying a baby to term depending on where the scarring is.

Thank you. I don't want her to get pregnant later but to have to deal with the newly discovered issue of infertility.

cornflake
07-07-2016, 08:03 PM
Thank you. I don't want her to get pregnant later but to have to deal with the newly discovered issue of infertility.

Again, I just want to point out you're not talking about infertility anyplace. You've only asked about the inability to carry a pregnancy to term.

Perks
07-07-2016, 08:15 PM
Again, I just want to point out you're not talking about infertility anyplace. You've only asked about the inability to carry a pregnancy to term.

This is true and an important distinction. An injury could take out an ovary, but it would have to be pretty convoluted to take out both of them without making hash of everything inside of her.

Orianna2000
07-07-2016, 08:52 PM
I agree, infertility is not the same as being unable to carry to term. With infertility, you can't get pregnant in the first place. With the latter, you can get pregnant, but you just can't stay that way. Under those circumstances, you'd probably need to consider a means of contraception to prevent pregnancy, since you wouldn't want to risk a spontaneous abortion (miscarriage).

There are plenty of reasons why a woman may decide it's not wise to get pregnant, but it's always possible to adopt, use a surrogate, etc. For example, I've chosen not to have a baby because, for one, I have a broken tailbone, which healed in an L-shape, bent inwards toward my uterus. Doctors told me that if I had a baby, the tailbone would have to be re-broken prior to delivery, otherwise the baby might get stuck on its way out. For another thing, I'm on several medications that could pose a risk to a developing fetus, but it would cause me problems if I went off them for nine months, plus however long I chose to breastfeed. Also, I have several medical conditions that are hereditary, and I wouldn't want to pass them on to an innocent child. So, after careful consideration, my husband and I decided to not have kids. If it wasn't for my poor health, we might've considered adopting, but the truth is, I don't have the necessary energy to raise a child.

Now, in my case, I was told it would be difficult, at best, for me to get pregnant, because I have such an irregular cycle. Without my birth control pills regulating things, I might have a period after just two weeks, or none at all for six months. It's totally random! When I stopped taking my birth control pills in order to switch to a different brand, I was supposed to wait so many days after my period began, and then start taking the pills. Well, I waited . . . and waited . . . and waited . . . and after five months or so, I still hadn't had a period, so my doctor had to give me a hormone pill that sort of jump-starts your cycle, forcing you to have a period. Otherwise, I never would've been able to start the new birth control pills.

Now, I'm not a doctor, but I'm pretty sure an appendectomy wouldn't cause scarring to the uterus. Not unless it was botched by someone with no knowledge of anatomy. I had my appendix out when I was ten, and the doctor took a peek at one of my ovaries and told me that they were developing, so I would likely be starting my period within a year or two. So it's possible to look at the reproductive organs while performing an appendectomy. But ovaries are off to the sides, apparently not that far from where the appendix is, so it's not that much of a stretch. The uterus is farther down and in the middle, as I recall, so it'd be a lot harder to cause damage there. You shouldn't need to cut through it to reach the appendix, so there'd be no cause for scarring. (And btw, an appendix scar is pretty small. I had mine done in the 80s, before laparoscopic surgery was developed, and my scar is only about 2" long. I'd imagine that with modern tech, it would be a lot smaller than that. My gallbladder scars from two years ago are about 1/2" long each, there's three of them on the side of my ribcage, plus a 1" scar that emerges from my belly button. Almost invisible.)

You could research other causes of infertility and inability to carry a baby to term. There are some immune disorders that cause the body to attack the fetus, as if it was a foreign invader, which inevitably ends in miscarriage. There's treatments that can help, but it's still risky, from what I understand. A woman might well decide to avoid pregnancy in that case. Then there are things that cause the inability to conceive, like endometriosis, fibrous scarring, cysts, the absence of ovaries, etc. An accident could cause it, too. Say she needs a hysterectomy due to the accident, a branch stabbed through her uterus, causing uncontrollable bleeding, so they had to remove the uterus to save her life. Or maybe she has a tumor or cysts that require the removal of both her ovaries, which they might discover if she collapses while skiing. That would cause her to become infertile.

Lots of possibilities!

MarkEsq
07-07-2016, 09:09 PM
I seriously doubt there are any contortions law enforcement could do to arrest, much less prosecute, a woman for getting pregnant, regardless of the likely outcome of the pregnancy.

Criminal Gestation is pure fantasy.

IAAL, and a prosecutor, and I concur. Heartily.

GeorgeK
07-07-2016, 09:11 PM
Possible scenarios

Right ovarian tube damaged beyond repair from an old appendicitis and Left tube or ovary damaged in the skiing accident. It wouldn't necessarily make getting pregnant impossible, just highly unlikely. Even tubal bandings have a failure rate of somewhere between 1 in 200 to 1 in 600 depending on whose studies you favor.

Impalement injury involving damage to the cervix and distal uterus would greatly increase the risk of rupture during pregnancy and delivery and may even prevent dilation of the cervix during labor with a best case scenario of simply requiring a C-section.

Ultimately almost anything is possible. It's just a matter of how unlikely you want something to be

CassandraW
07-07-2016, 09:27 PM
IAAL, and a prosecutor, and I concur. Heartily.

IA(also)AL, and um, yeah. I concur as well.

AliceUK
07-08-2016, 01:12 AM
Again, I just want to point out you're not talking about infertility anyplace. You've only asked about the inability to carry a pregnancy to term.

Yes...I did suddenly switch from one to the other. When I realised that a ski accident would be unlikely to result in her being unable to carry a child to term I began to consider to the idea she would instead discover, while she was in hospital that she was unlikely to ever get pregnant. But I can see now that both situations would involve such huge contrivances that I'm going to have to re-think.

A big thank you for all the comments.

AliceUK
07-08-2016, 01:14 AM
Possible scenarios

Right ovarian tube damaged beyond repair from an old appendicitis and Left tube or ovary damaged in the skiing accident. It wouldn't necessarily make getting pregnant impossible, just highly unlikely. Even tubal bandings have a failure rate of somewhere between 1 in 200 to 1 in 600 depending on whose studies you favor.

Impalement injury involving damage to the cervix and distal uterus would greatly increase the risk of rupture during pregnancy and delivery and may even prevent dilation of the cervix during labor with a best case scenario of simply requiring a C-section.

Ultimately almost anything is possible. It's just a matter of how unlikely you want something to be

Thank you.

AliceUK
07-08-2016, 01:17 AM
You could research other causes of infertility and inability to carry a baby to term. There are some immune disorders that cause the body to attack the fetus, as if it was a foreign invader, which inevitably ends in miscarriage. There's treatments that can help, but it's still risky, from what I understand. A woman might well decide to avoid pregnancy in that case. Then there are things that cause the inability to conceive, like endometriosis, fibrous scarring, cysts, the absence of ovaries, etc. An accident could cause it, too. Say she needs a hysterectomy due to the accident, a branch stabbed through her uterus, causing uncontrollable bleeding, so they had to remove the uterus to save her life. Or maybe she has a tumor or cysts that require the removal of both her ovaries, which they might discover if she collapses while skiing. That would cause her to become infertile.

Lots of possibilities!

Thank you.

josephperin
07-08-2016, 01:30 AM
If it doesn't have to involve the ski accident, coagulability disorders are a good bet. Frequently diagnosed after serial miscarriages

josephperin
07-08-2016, 01:33 AM
Hypercoagulability problems are treatable, though.

AliceUK
07-08-2016, 11:12 AM
A uterine rupture directly related to a traumatic pelvic injury might work according to this.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162726/

"Regardless of etiology, spontaneous uterine rupture is a life-threatening emergency that requires immediate resuscitation, identification, and surgical intervention with either primary repair or hysterectomy."


Maybe GeorgeK will stop by with an answer. ;)

Thank you.
From the article: Uterine rupture most often occurs during pregnancy or as the result of trauma; the incidence is 0.07%
Probably too rare to make it credible in someone who'd never been pregnant. I'll probably have to rethink this.

James D. Macdonald
07-16-2016, 08:07 PM
Speaking of rare events that she could learn in-hospital, she could be one of the rare (1 in 13,000 births) people with Complete Androgen Insensitivity Syndrome, which means that while she has female secondary sexual characteristics, and female external genitalia, was raised as a girl and may well think of herself as female, she is male genetically (XY chromosomes), and incapable of getting pregnant.

Quickbread
07-24-2016, 11:19 AM
Coming in very late to this thread, but I just wanted to chime in. I was impaled by a ski pole in my groin area. In fact, I was coming down from a jump and fell onto the tip with all my weight. The tip was sharp at the end rather than blunt, and it stabbed me in three places along my pelvis. A few inches up and to the right or left and I shudder to think what could've happened. A fall like that could certainly could puncture an organ, though I agree with everyone that uterine injury is an unlikely cause of infertility.

But if you're still looking for a solution, have you considered giving your character some kind of congenital uterine abnormality, like a bicornuate uterus or septate uterus? That's a condition where the uterus is divided to some degree, and depending on the severity of the deformity, it can cause miscarriages and an inability to carry to term. Sometimes, the placenta attaches to the septum division and doesn't get enough blood flow, leading to early miscarriage. Other times, it attaches to healthy uterine wall, but the fetus might still run out of room to grow, leading to either problems with the baby or early delivery.

Uterine deformities are a big cause of miscarriage, and they're fairly common. Usually they're discovered by accident either during the first pregnancy ultrasound or before then during an ultrasound for something else, such as ovarian problems. So if your character got scanned because of some other injury in the same area, that could be plausible.

Deb Kinnard
07-24-2016, 09:08 PM
Bicornuate or septate uterus, congenital malformations of the Naughty Bits that your character might not have known about until the accident and the CT or MRI they'd have done to rule out internal injury. That is, if it works for your story.

ETA: Dang, Quickbread beat me to it.

autumnleaf
07-25-2016, 06:28 PM
This made me think about the artist Frida Kahlo, who suffered horrific injuries from a tram accident in her teens. In later life she had several miscarriages as well as medically-necessary abortions; she illustrated this physical and emotional pain in some of her paintings. At least one modern doctor theorised that the accident may have damaged her uterus: http://vitals.nbcnews.com/_news/2012/04/22/11311488-doc-solves-mystery-of-frida-kahlos-infertility?lite