Ob/Gyn Reacts: Didn't Know I Was Pregnant | TWIN BABY SURPRISE

Hello! Welcome back for another episode of OBGYN React. That was a lot of drama to announce that I'm watching a TV show with you guys again. Today's episode is going to be, I didn't know I was pregnant. YouTube likes to demonetize some of these videos because gynecology is scary. If you'd like to support my channel, dangerous for advertisers, you can get some merch. That's right, we have merch. You don't get to be offended by science. On Teespring, which will be linked below. If you like this video, hit that like button. If you don't, nothing will happen. If you don't like this video, you can do the little downing button, but that's kind of passive-aggressive. Twins! I've always been heavyset. I'd weigh myself all the time. I knew I would never be that perfect size. I just have to deal with that. At the age of 24, 5 foot 7 inch Jasmine has ballooned to 350 pounds. Okay, first off, can I just say that's like, why would you put it like that? Come on, TLC ballooned to a certain weight. Like, that is so disrespectful of this person and anyone else who struggles with their weight. They literally just said this person is self-conscious and struggling with her weight and then they follow that up with, and she's ballooned to whatever pounds. Like, how rude? Just leave that out. Like, that editing, that just makes me uncomfortable. I don't want to see her have hypertension or diabetes or have a stroke, but her weight has been an issue for her and she's struggled with it. You know, her mom makes a couple of good points here. Obesity is related to things like diabetes and hypertension and cardiovascular complications. It's also related to higher risk pregnancies. So, I decided it would be best to take the morning after pill. The morning after pill is a combination of progesterone and estrogen. These pills can prevent ovulation and if you don't ovulate, you can't get pregnant. Um, okay, so what they're talking about here is she had sex, the condom broke, and so she decided to take the morning after pill. The doctor that they talked to says the morning after pill is a combination of estrogen and progesterone. I don't know when this was filmed, but most morning after pills actually don't have estrogen in them. They're just progesterone or another medicine called ulipristol. Um, the morning after pill is about 95% effective and you can take it in the first five days, although the first three days is kind of where it's the most effective. The sooner you take it, the more effective it is. It works by, like he says, preventing ovulation. Another way that it works is by preventing implantation. If you've already ovulated and you take it soon enough, then you can prevent implantation from happening of a fertilized embryo. So a common question is, is the morning after pill a abortion pill? And it's not. Actually, progesterone is progestational. That's the name of the hormone and it supports pregnancy. So if you took the morning after pill, plan B, the over-the-counter one, and you were already pregnant, that wouldn't interfere with an already established implanted embryo because progesterone levels go up after implantation and that is supportive of the pregnancy. If you take it and you've already got a fertilized embryo that's implanted, it won't do anything. That's why it's over-the-counter and it's not a termination pill. But in March, she realizes she hasn't had a period in months. She's used to having an irregular cycle, but just to be safe, she goes to the doctor. Even if she took it the morning after, it's still got a 5% failure rate. My menstrual cycle is very irregular. I talked to my doctor. He made the evaluation that due to my weight, it was quite possible that I could skip for long periods of time. So I find this really interesting and it's always hard to know if you're getting the full story, but if a patient comes to me and goes, I take the morning after pill in whatever month and I haven't had a period since then, and I go, oh, it's just because you're overweight, that seems like you would just go like, hey, let's do a pregnancy test. Make sure. Additionally, after you take the morning after pill, if you don't start a period within the next couple of weeks, probably shorter time frame than that, then you should be going in to see your OBGYN because the morning after pill works by preventing ovulation, but also by inducing a cycle. So after taking the morning after pill, you should expect to have a period. And if that doesn't happen, you should be making an appointment with your friendly neighborhood OBGYN or advanced practice provider. Let them know what the situation is or at least take a pregnancy test at home. I mean, you can't really blame her for not knowing she was pregnant at this point. She's been told by a doctor that it was normal and then she had spotting. So I definitely can see why she wouldn't have thought anything of this, but I'm still curious about what was done at that visit. About three o'clock, I started getting really bad stomach pain. I thought it was just my cycle returning. I was one to 10. My pain was at a million and a half. Labor. I walked myself to the stretcher. She was in obvious pain, tears in her eyes. Just knowing how painful labor is, I can't imagine what goes through your head when you're having that amount of pain and you don't know that you're pregnant. You just must really think that you're dying. I mean, what else would you think? That is like such an intense pain. And if you don't know why it's happening, it must be extremely scary. Pressure was through the roof. 200 over 140. It was very, very high. So now I'm a little bit worried that she's also developing preeclampsia because the first pregnancy, twins, and that blood pressure are all things that make me start moving my brain towards preeclampsia. She was afraid I might go into cardiac arrest with my blood pressure being so high. Upgrade to priority one. Cardiac arrest is probably not the first thing that I think about with blood pressures that high. Although, I mean, certainly that should always be on your list. But I worry more about like stroke before I was worried about cardiac arrest. But obviously, you know, they should be prepared for anything. When the ambulance pulls up to the hospital, it is immediately met by the on-call doctor. What do we have? 24-year-old female. Here she is on a stretcher and there's three EMTs. Wait, I'm confused. This person is an OBGYN and it says she's immediately the one that meets them. Why is the OBGYN the one that meets them down there when what they think they have is a not pregnant female with severe abdominal pain and hypertension? Shouldn't it be the ER doctor or the general surgery team or trauma team or something? I don't understand why OBGYN is the first person that meets them. A quick evaluation and all of a sudden there was 10 little toes aligned like this. Now she's got not only an undiagnosed pregnancy that's just been diagnosed by finding feet coming out of the vagina, but we've got a footling breach presentation in a person who's never had a baby, which is really concerning. On top of that, you have no idea what her gestational age is or how big the baby is. And so when I see that, I'm going straight to the operating room and I hope that's what they decide to do with her as well. This is not good. This is a footling breach. And the baby was breached and coming out feet first. Just a PSA, it's breach. There is no ED on the end of that. Not that she should know that, but just a little bit of a pet peeve of mine that it's not breached. I didn't understand how it could possibly be because I'd taken the morning after pill. Only 85 to 95% effective. I also am getting just a little vibe of denial is a very strong and powerful thing. I need to do an emergency c-section right now because the baby is presenting feet first. The blood supply that goes to the baby can be compromised. And within minutes you can have brain damage and then ultimately fetal death. Although there are some risks that come along with any kind of breach delivery, a footling breach delivery is particularly risky to the baby in terms of cord compression and head entrapment in the cervix. So what can happen is that a baby's legs and body can come through the cervix before it's fully dilated enough for the head to come through. You get compression of that cord which cuts off the baby's oxygen supply and the baby becomes acidemic and can have hypoxemic injury from the compression of the umbilical cord. That's a lot to process when an hour ago you didn't even know you were pregnant. So I can't imagine how scary that that would be from her standpoint, but I definitely agree with everything that OB is saying. At 9-10 in the morning they told me I was having a baby and by 9-12 I was on the OR table being put under. Two minutes from decision to OR, that is fast. Good for them. If these babies do well it's got to be in part because of the quick actions of both EMS and the doctors who met them at the hospital. Started the incision and within five minutes I was right at the uterus. When I opened the uterus I pretty much just grabbed the baby by the shoulder and just pulled the baby out. That depiction of grabbing the baby by the shoulder probably doesn't quite get across what actually I know what she means, but I'm trying to figure out a way. One second. A baby! This baby is coming out feet first. So mom's head is up there, mom's feet are down there, baby's feet are going this way through the cervix and into the vagina and then when you make your hysterotomy, which is the incision in the uterus, you're going through about right here. So when she said she grabs the baby's shoulders, she doesn't mean she grabbed the baby's shoulders and brought it out like this. Obviously you can't deliver a baby like that. So what she did is open the uterus, she feels, she finds the baby's shoulders and because the baby was so far down that way, she's going to deliver the baby kind of in a reverse head first position. Normally when you deliver head first the baby's coming out this way, but because we're this way she's going to deliver, so she's going to reach in and she's going to grab the head here and flex the head just a little bit and then when she says she grabs the shoulders, that's just to help her guide the baby out. So she brings the head up through the incision and then the shoulders. It didn't appear that the blood flow was going to the limb. How's she doing? If doctors can't get the circulation back, they may have to amputate the baby's leg. That's not something I've ever heard of before. Maybe the way the baby was laying off like the femoral artery blood supply. I'm not sure that's interesting. I'm sure there's probably case reports of this so I need to look it up. I'm interested to see what happened now. Oh my god! Oh my god, doctor! Another one! So I turned my head and what I saw was an arm sticking out of the uterus. It's twins. And my head was like, that cannot be. As if this is not enough surprise for one day, you have a patient who had no idea they were pregnant come in. Surprise! It's not only a baby. You're not only in labor. It's footling breech! And then we get the baby out and it's got this unusual compromised blood supply to the leg and she's worried about, oh my gosh, are they going to have to amputate the baby's leg? And then another surprise! There's another baby in here. It's twins! Need more hands! The second baby had no tone. It was not breeding. She was very pale. It was scary. I didn't think she was alive. So what she's saying is the baby doesn't have much tone. That just means baby's floppy. And that's part of what goes into an APGAR score. APGAR is a score that the nurses or the pediatricians or whoever's evaluating the baby at delivery give to the baby based on how it's acclimating to being earthside. Doctors are just as worried about Jasmine. She has HELP syndrome. HELP syndrome is a form of severe preeclampsia. Remember when we talked about maybe this is preeclampsia? She has preeclampsia that has progressed to HELP syndrome and that is where you get hemolysis which is destruction of the red blood cells, elevated liver enzymes, low platelets. And it's a severe form of preeclampsia and it can be really life-threatening and dangerous and she's really, really lucky that in a completely unmonitored pregnancy where she didn't know this was going on that she didn't have a worse outcome. You can see in this frame how swollen and edematous she is. She's holding on to fluid and that's a common finding in somebody who has preeclampsia or HELP syndrome. Can have bleeding issues. They have certainly liver problem and severe anemia. We're going to start treatment right away. Treatment would be magnesium sulfate which is a drug that helps prevent that from becoming eclampsia which is seizures. There's not actually other than delivery a lot of other treatment for HELP syndrome. Usually it starts to resolve although sometimes you can have at day two or three after delivery kind of a drop in all of those labs and then hopefully people kind of turn the corner and start getting better. She had to have a NG tube inserted because she had a small bowel obstruction. Her red blood cell hadn't come back up. She was very sick. I was absolutely concerned for her survival for sure. I don't know how a small bowel obstruction is related. It's not something you generally see with any of the things that she's had. A complication of the C-section that would be still extremely unusual but I don't know. Regardless, it sounds like that's what she had. That's a lot. True or false? Premature babies are more likely to be breech. Look, a trivia question. Put your answer in the comments below. Your answer when we return. Your answer, true. It's the weight of the baby's head that draws it to a down position. Therefore, the percentage of breech babies goes down drastically as the baby gets heavier. 10 days later, to everyone's relief, Amber's prayers are answered. She started to do- 10 days is a long time. When Jasmine got to see her daughters, I think it was such a state of shock for her. And went with their hands like they were reaching for me. It was one of the best feelings in the world. I couldn't believe how perfect they were. Oh my gosh, did you see the little painted toenail? I'm gonna cry. I wonder if they're identical. That's another thing that's kind of interesting. You know, if they're fraternal twins, that is a little less scary like as far as pregnancy complications go to baby. But if they're identical twins, particularly if they shared a placenta or they shared a amniotic sac, the fact that they made it to term with no complications is really, really impressive. That was a super fun episode. I hope you learned something and I would love if you would leave some comments telling me what you thought about it. If you've ever been pregnant and didn't know, I would love to hear your story. Like this video, subscribe if you want to. Be kind to yourself, to each other, to me. In the comments, be kind. And I will see you next time.