“Oh wow, look at you! How many weeks are you now?””30 weeks already!? It sure is going by fast! How much longer are you planning to work?”
Indications: This 36 year old G3P2 woman was admitted to hospital with a history of a missed first trimester abortion. She was referred to our care after a community ultrasound performed on [date] at 17 weeks 5 days gestational age revealed a fetus measuring 11 weeks 6 days with no fetal heart rate activity. She was recommended to have a D&C by aspiration. The risks of the procedure, including infection, bleeding, and uterine perforation with injury to adjacent pelvic viscera were discussed with the patient, along with the benefits, and she gave informed consent.
“You’re having a girl!?! Oh, I didn’t know that! What do you have at home again? 2 Boys – oh, you must be so excited!”
“You must be getting tired now, with all these hours that you work. Are you done call now?”
Procedure: The patient was taken to the operating room and received a general anesthetic by Dr. X. She was placed in the dorsal lithotomy position and prepped and draped in the usual manner. Examination under anesthesia revealed a 13 week sized uterus and no palpable adnexal masses.
“Well, you look great! It is your third after all, everyone looks a little bigger the third time around.”
“I had a boy and two girls, and let me tell you, it was the time of my life! This time will go by so fast!”
A weighted speculum was placed into the vagina and the anterior lip of the cervix was grasped with a double toothed tenaculum. The uterus was sounded to a depth of 16cm. The cervix was dilated without difficulty to accommodate a size 14 suction curette. We then proceeded with the suction curettage. Tissue was obtained and sent to pathology. We then proceeded with a gentle blunt curettage and no tissue remained.
“Are you all ready at home yet? Oh, the boys must be excited to share a room, no?”
“They must be thrilled to be having a baby sister! Do they understand what’s going on? Maybe they’re still too young yet…”
The patient tolerated the procedure well and was returned to the recovery room in stable condition. Estimated blood loss was 100cc and there were no apparent complications. The patient is requested to follow up with her practitioner in 6 weeks time.
“I don’t think they’re too young, they know exactly what’s going on… for sure.”
“I should get going and eat some lunch, you never know what the afternoon will bring.”
And, so I walked briskly out the of the recovery room.
End of dictation.