#33 weeks gestation

[vs-griffin]

Pregnancy Rox: The Finale

Postpartum Update Howdy Folks! It has been a wild 4 months since my last post. So here’s the tea… If I recall correctly, the last time I posted was a few days before my emergency c-section. Listen, I already know what you’re thinking… I just KNEW I was going to make it to 34 weeks gestation. However, my little sweet face decided that she wanted to be the first of my children to wish me a happy…

[ginontherox]

Pregnancy Rox: The Finale

Postpartum Update Howdy Folks! It has been a wild 4 months since my last post. So here’s the tea… If I recall correctly, the last time I posted was a few days before my emergency c-section. Listen, I already know what you’re thinking… I just KNEW I was going to make it to 34 weeks gestation. However, my little sweet face decided that she wanted to be the first of my children to wish me a happy…

[hontour]

soooo uncomfy 😖

[mychlapci]

You know how octopi lay tens of thousands of eggs at a time? Well turns out the mother octopus have to lay and thread each egg gently onto a surface so they don’t get blown away by the current. Sometimes even threading them together to create bundles.

My HC is that Brainstorm is a Reef Octopus and Percy is a Pacific octopus, but Pacific Octopi are HUGE compared to Reefs (size difference my beloved). When they mate the eggs take Percy’s genes and Stormy noticed immediately when he noticed his belly swelling much faster than his usual clutch.

When they’re finally due poor Stormy has to start laying thousands of these eggs that barely fit through his valve while painstakingly threading each and every one of them.

By the end Stormy is so exhausted that he asks Percy to put his tentacle in his valve and pull the rest of them out. But Percy’s tentacle is too big, even with the eggs stretching him. So Percy takes initiative by fingering Stormy to get his valve pliant enough and starts pulling the eggs out.

hoooly shit the size difference would be insane. i can't believe the terrible things we're doing to Brainstorm's valve… Brainstorm would be downright immobile by the last few weeks of his carrying cycle, tentacles lazily dragging him over the sea floor, barely getting him a couple feet away from where he'd started… but Perceptor would be attentive to his mate's plight, casting a shadow over him whenever danger swam overhead, carrying him with him whenever they needed to go somewhere… 

He takes Brainstorm to his laying spot later, rubbing his valve until it's throbbing on the edge of an overload, the cable walls contracting intensely as the first of the eggs start to come down. Percy even helps Brainstorm settle the eggs when he starts losing track, creating pretty little bundles while Brainstorm squeals and shudders with the next egg coming out <33 

Perceptor reaching into Brainstorm's valve when he's too tired to push anymore, coaxing the duct of his gestation sack open with titillating touches, the eggs squeezed out by the reflexive spasms of Brainstorm's overloading valve, poor little octomer sobbing with overstimulation as his giant mate assures him these are the last ones in the clutch...

[jcsmicasereports]

Acute Myeloid Leukemia In Pregnancy: Difficult Journey From Diagnosis To Delivery And Treatment by Vina Kumari in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

The incidence of Acute Myeloid Leukemia in pregnancy is about 1 in 75,000 to 1 in 100,000. Owing to the therapy attributable risks to mother and fetus, the management of AML in pregnancy is very challenging, both for the parents and the medical fraternity. Furthermore, the diagnosis of leukemia in pregnancy is very difficult owing to vague presenting symptoms like fatigue and weakness which are confused with physiological changes during pregnancy.

Case Report: Primigravida, 33 weeks 6 days gestation age, with history of weakness and fatigue for 15 days and fever, cough and cold for 3 days was referred to our hospital with blood reports of raised total leucocyte count. The lab reports showed thrombocytopenia, anemia and leukocytosis with increased circulating blasts in the peripheral smear. As she was in her third trimester, plan of induction of labor and delivery followed by chemotherapy was taken. She delivered a live healthy baby. Post-delivery, she was advised chemotherapy. She had an immediate remission after the chemotherapy. The disease relapsed after 10 months and she succumbed to the disease due to unavailability of facilities during the COVID pandemic.

Conclusion: AML during pregnancy is rare. There is no fixed protocol for management of AML during pregnancy .The aim of management should be to take care of the initial concerns regarding fetal well-being according to gestation age and commence chemotherapy as soon as possible. This would give the best survival chances to the mother.

Keywords: Acute myeloid leukemia, pregnancy, chemotherapy.

Introduction

The association of leukemia and pregnancy is very rare, rather under-diagnosed and sparsely reported. The prevalence based on diagnosed and reported cases is one in 75,000 to 100,000 pregnancies. Most of the leukemias diagnosed in pregnancy are myeloblastic.

Acute myeloid leukemia (AML) is characterized by excessive proliferation of blast cells of myeloid lineage. This results in hematopoietic insufficiency like anemia and thrombocytopenia. The symptoms are related to complications of the pancytopenia, such as infections or hemorrhagic diathesis. The mentioned initial symptoms of leukemia in pregnancy are easily attributed to physiological changes related to the pregnancy and hence are either missed or diagnosed late. We report a case of Acute Myeloid Leukemia in a pregnant patient, its management and outcome.

Case Presentation

18-year-old primigravida presented at 33 weeks 6 days gestation. She was referred with history of weakness since 15 days and fever, cough, cold since 3 days associated with raised leucocyte count. She belonged to low socioeconomic status, was unbooked and had two antenatal visits during her pregnancy. She visited the facility when she had symptoms of gross weakness.

Her first trimester was uneventful. She was registered at a local hospital but was not compliant. Dating scan, trisomy screening and anomaly scan was not done.

On examination, her pulse rate was 88, blood pressure 100/60, respiratory rate 20 per minute, and temperature 99 degree Fahrenheit. She was pale but there was no jaundice, icterus or edema. She had angular stomatitis, and glossitis indicating malnutrition. Lymph nodes were not palpable.

On per abdomen examination, Uterus was relaxed, 33-34 weeks size and fetal heart 143/min. Ultrasound showed a single live fetus in cephalic presentation with effective fetal weight of 2.4 kg and liquor 12.7cm. Placenta was in upper posterior position. The fetus had overdistended urinary bladder with hydronephrosis of fetal kidneys suggestive of bladder outlet obstruction. Moderate hepatosplenomegaly was present. She was moderately anemic with hemoglobin of 8.3 gm/dl. The leucocyte count was very high 2,66,000/cu mm with neutrophils 4, lymphocytes 1, eosinophils 1 and basophils 1. The blood picture showed marked leucocytosis with blasts cells predominating 86% and 2 myelocytes and 1 metamyelocyte. The blast cells typically showed large nuclei, opened up chromatin, prominent nucleoli and cytoplasmic blebs. This picture raised the suspicion of Acute Myeloid Leukemia in pregnancy. Her platelet count was 96000/cu mm. LDH was raised 995 U/L signifying cell lysis. Liver enzymes were also borderline raised. Dengue serology was found negative. Her blood group was O negative. Serum Creatinine - 1.05 mg/dl and Serum uric acid - 10.9 mg/dl were also raised. The blood picture thus indicated towards normochromic normocytic anemia, thrombocytopenia and leukocytosis. On further examination of the peripheral blood smear, a leukoerythroblastic formula was noted with the presence of predominant blast population (86%).

Peripheral smear showed mostly Monoblasts (red arrow), promonocytes (green arrow) and few myeloblasts (blue arrow) under the oil immersion object 100 X, Leishman stain.

Monoblasts are large cells with abundant cytoplasm, moderately to intensely basophilic, scattered fine azurophilic granules, round nuclei with lacy chromatin and one or more large nucleoli.

Promonocytes have moderate cytoplasm, less basophilic, granulated with occasional large azurophilic granules. Vacuoles are more irregular. Nuclei are delicately folded.

Myeloblasts have large nuclei, fine chromatin, 3-4 prominent nucleoli and few Auer rods in the cytoplasm.

In view of suspected Acute Myeloid Leukemia, she was advised Bone marrow aspiration, biopsy and immunophenotyping, flow cytometry and translocation (15:17) study by oncologist.

The obstetrical examination was normal. All cardiotocographies were reactive. She was started on IV antibiotics, Inj Ceftriaxone 1 gm IV BD and steroids, Inj Betamethasone was given for fetal lung maturity. In view of malignancy with pregnancy, the case was discussed in tumor board on 10/9/19 and a decision for delivery followed by chemotherapy was taken.

She was induced with one dose of intracervical dinoprostone gel following which she went into labour and delivered live baby 2.8 kg weight with good apgar. The baby was shifted to nursery in view of premature delivery and mother was planned to transfer to medical oncology department for Induction chemotherapy.

Repeat investigations three days after delivery, haemoglobin decreased to 7 g/dl, TLC increased to 3,81,000 cells per cu mm with neutrophils 2, lymphocytes 5 and myelocytes 5. The abnormal blast cells had increased to 88% and platelets decreased to 21000 per cu mm (TABLE 1). Serum creatinine also increased to 1.43 mg/dl and e-GFR decreased to 54 ml/min/1.73 m2, indicating compromised renal function. The peripheral picture showed mostly agranuloblasts with moderate to scanty grey blue vacuolated cytoplasmic nuclei showing convolutions and 1-3 nucleoli occasional myelocytes, metamyelocytes seen, findings in favour of Acute myeloid leukemia (M4/M5). On myeloperoxidase staining, only 40 % took up the stain indicating AML-M4 lineage. She was transfused with one packed cell and one single donor platelet, following which her condition improved. She was transferred to medical oncology ward where she received chemotherapy and had immediate remission of the disease.

Discussion

The Incidence of Acute Myeloid Leukemia is 1 in 75,000 to 100,000 pregnancies with maximum 40% presenting in third trimester and 23% and 37% in first and second trimester respectively. In a population based study by Nolan et al [1], out of total acute leukaemia cases, two thirds are myeloblastic and one third lymphoblastic leukemia.

The rarity of disease during pregnancy, might also be due to very low reporting in view of confusing diagnosis. The symptoms of AML can easily be confused with symptoms of anaemia like malaise, easy fatigueability, low grade fever. Thrombocytopenia and anaemia are relatively common findings in pregnancy. Although, Neutropenia is rare and merits further investigation or close monitoring. But in the developing country like India, it is majorly missed. Thus, whenever there is presence of circulating blasts in a blood film, it suggests a diagnosis of haematological malignancy and is an indication for bone marrow biopsy. The other differential diagnosis that should be kept in mind are Thrombotic microangiopathy, HELLP syndrome and Cytopenias of deficiency or immune origin [2].

The tests to be done before bone marrow aspiration are Full blood count, blood film examination, Vitamin B12, folate and ferritin measurement, Coagulation screen, Renal and liver function tests. All these were done for our patient and further bone marrow aspiration was suggested with studies directed at Immunophenotypic, cytogenetic and molecular analysis for accurate subtyping and understanding of prognostic features.

Once diagnosed, a Multidisciplinary approach comprising of hematologists, obstetricians, anesthetists and neonatologists is the key to appropriate management. Consideration should be given to health of both mother and baby. The woman should be fully informed about the diagnosis, treatment of the disease and possible complications during pregnancy , clearly implying that any treatment delays might result in compromised maternal outcome without improving the outcome for the fetus [3].

The risks of Leukemia, disease per se, to pregnancy is miscarriage, foetal growth restriction, perinatal mortality, premature labour and Intrauterine fetal death [4].

Due to the high risk of the disease, there are different recommendations for management of AML in pregnancy in the three trimesters owing to the urgent need of chemotherapeutic agents and the adverse effects of the drugs involved .

If it is diagnosed in the first trimester, the patient should be counselled for elective abortion, medical/surgical and starting of chemotherapy. Between 13- 24 weeks, the Induction chemotherapy should be started while pregnancy is continued [5]. Preterm termination of pregnancy is indicated after fetal viability. Similar conclusions were derived by Nicola et al and Farhadfar in a single centre study of 5 and 23 case of AML diagnosed during pregnancy respectively [6,7].

Between 24 - 32 weeks, chemotherapy exposure to the fetus must be balanced against risks of prematurity following elective delivery at that stage of gestation (Grade 1C). At gestation age more than 32 weeks, the fetus should be delivered prior to Induction chemotherapy.

Chemotherapy with anthracycline based regimens are favored. According to a meta-analysis done by Natanel A Horowitz et al, anthracycline based regimens were associated with maximum remission but overall maternal survival was very low (30%)[8]. Even in our case, although the mother immediately had remission with chemotherapy. There was a recurrence after disease free 10 months and she succumbed to the disease during the COVID pandemic. Quinolones, tetracyclines and sulphonamides are better avoided in pregnancy(Grade 1B).

In one case report by Abdullah et al, a trial of 5- azacytidine has shown promising results [9]. The antifungal of choice in pregnancy is Amphotericin B or lipid derivatives (Grade 2C). If blood transfusion is needed, the blood should be screened for Cytomegalovirus (Grade 1B). Supportive therapy like a course of Corticosteroids given if delivery is between 24 and 35 weeks gestation (Grade 1A) [10]. Magnesium sulphate should be considered 24 h prior to delivery before 30 weeks gestation (Grade 1A).

Delivery should be planned for a time when the woman is at least 3 weeks post-chemotherapy to minimize risk of neonatal myelosuppresion (Grade 1C). Planned delivery is preferred, like Induction of labour (Grade 2C). Caesarean section is indicated only for obstetric indications. Epidural analgesia is better avoided.

The Dose of chemotherapy is calculated on their actual body weight with dose adjustments for weight gain during pregnancy owing to various pregnancy changes.

The Chemotherapy agents have a MW of 250-400 KDa and hence can cross the placenta resulting in detrimental teratogenic effects on developing fetus.Sunny J. Patel et al have done a comprehensive analysis on outcomes in hospitalized pregnant patients with acute myeloid leukemia and come to conclusion that a multidesciplinary, holistic approach leads to quick remission of the disease [11]

After delivery, histopathologic examination of placenta to rule out placental transfer to fetus is advisable. Cytologic examination should be performed in both maternal and umbilical cord blood and neonates should be clinically examined for palpable skin lesions, organomegaly or other masses. If the baby is found to be healthy, a follow up after every six months for two years is recommended. In each visit, physical examination, chest x-ray and liver function tests should be done.

Conclusion

Acute myeloid leukemia in pregnancy is a Rare diagnosis and even rarely reported. With the trend for delaying pregnancy into the later reproductive years, we expect to see more cases of cancer complicating pregnancy. Presently, there are no clear management guidelines to address timing and dosing of anthracycline/cytarabine based regimens especially in pregnancy. The potential drug toxicity to mother and fetus and transplant considerations in intermediate and highrisk patients during pregnancy has not been addressed.

What we also need today is a National registry for leukemia patients, treated in pregnancy. This will help us to answer many unanswered queries and improve maternal and fetal overall survival rates. Although we have few comprehensive studies, but further studies and references are needed. Finally, a Multidisciplinary team is needed to provide comprehensive care to patients.

[celestie0]

HAIIII ELLIEEE!!! I’ve been doing well! HOPE U BEEN TOOO!!!! In one of your posts, you said, "I have lots of obscure science knowledge I get to torture people with." 👀 I'm curious, what's your favorite 'go-to' fact to spook people?

— frank ocean anon!

hiiii my dear i'm so glad to hear you're doing well <33 i'm doing well too!!!

omg yes HAHA i think most of the facts i know are not that spooky and moreso just me raving about how insanely complicated the biochemical processes are and having existential crises over it (like the electron transport chain hellooo??? i will never get over atp synthesis)

but HM i did read a cool thing recently about how female fetuses at i think just 20 weeks gestation already have SIX MILLION EGGS within them...and we already know that women are born with all the eggs they'll ever have in their lifetime at birth, but apparently by the time they're at actual child-rearing age (i'm assuming the paper meant by first menses) they only have like a couple hundred thousand eggs left?? im like??? where tf do all the eggs go, if not through menstruation? it's kinda crazy to think about, especially when you consider the fact that human eggs are visible to the naked eye...so, yeah. crazy stuff.

LOL hope this was sp00ky enough bb we're so close to halloween!! (time is but an illusion to me) love yaaa <33

-ellie (imagine white cloud here bc i'm on pc)

[fundielicious-simblr]

(Adalynn's POV) (AN: This is one of 2 POV posts from Harvestfest. Let me know if you'd like posts [or even just 1 summary post] from the rest of the families from the other gen 2 siblings - I take pictures to compile albums for my own personal satisfaction and for comparison, so I'll have them in my google drive)

L-R - Adalynn [33], Barrett [32]& Macie [32], Zoe [30], Maggie [26], Reece [25], Beckett [24], Amira [23], Priscilla [22] & Annette [22], Charles [20], Parker [19], Ashton [17]

Happy Harvestfest! It's my favourite time of the year because it's essentially our annual family reunion, everyone in my family makes the trek back to my parent's house in Newcrest for a weekend of family fellowship and togetherness - even Beckett and Mandy in Selvadorada. All week the boys were asking about when we'd be leaving to grandpa and nana collins' house, and the day before we left they spent it doing all these drawings for their grandparents and all the aunts and uncles that they're going to be seeing. Whenever we're in Newcrest, we stay at my parents house, the boys sleep in the old boys room, and the youngest 2 room with us in the spare room. Macie, Annette, and Ashton still sleep in the girls room, all our old bunk beds are in storage and they've all got their individual beds in there. We try and make it in a few days earlier to help my mum and sisters prepare all the food that we'll be consuming over the weekend, this year the other kids who had to travel in are either staying with relatives or in airbnbs in the area since I get first dibs on the spare room as the out-of-town sibling with the most children. Since most of my out-of-town nieces and nephews are quite young, it's important for them to have their own space to sleep and not have to deal with the noise of a house full of other kids. Barrett and Kyleigh have the most kids, but they live in the neighbourhood so there's no worries there on where they'll stay - though they are looking to move houses sometime in the new year with this newest addition on its way.

Picture 1: L-R [Back] Adalynn, Macie, Zoe, Maggie, Reece, Barrett [Front] Annette, Amira, Priscilla, Ashton [Middle], Beckett, Charles, Parker // Picture 2: L-R [Back] Barrett, Beckett, Adalynn, Macie, Zoe, Maggie, Reece, Charles, Parker [Front] Priscilla, Ashton, Annette, Amira

Taking family pictures might just be my favourite part of Harvestfest, getting to see the pictures from every year that goes by and seeing the family grow and grow with the Lord's goodness. It seems like just yesterday that we were all living at home and fully involved in the hustle and bustle of life with 13 children at home. Those days were the best and I thank the Lord for choosing to place me with my parents and my siblings, my childhood truly was the best. Getting to update the various groups of pictures yearly is one of my favourite things to do, especially now that there are the grandkids, they even outnumber the original 13 kids that my parents had (AN: I genuinely didn't have the fortitude to try and pose all those children, toddlers, and infants - so just imagine that it happened. Maybe the next sim year cycle when these gestating babies have been born, because I need a good picture to use for my future 'before and after' posts.)

(Back L-R -> Beckett & Mandy, Thomas & Amira, Robert & Priscilla, Lorilee & Charles, Parker & Lana // Front L-R -> Adalynn & Mason, Barrett and Kyleigh, Zoe & Francisco, Maggie & Shane, Reece & Stacie)

This was the first year we've ever taken a 'couples pictures' where all the married/engaged/almost engaged (*cough* Parker) got together for a picture. In almost 10 years we went from just Barrett and I being married to there being 9 married couples and 1 *almost engaged* couple. Between the 9 of us there are 26 children - with 3 more on the way! That's double the number of us kids, with the hope is that we will welcome many more in the years to come.

This year we've got 3 pregnancies at the big house, knowing how my family works a few of us were expecting someone to announce their pregnancy when we were all together, but so far it's just these three ladies having babies. Priscilla also announced to us all that she's having a baby girl! She's due this winter around Christmas time, so we'll be getting her baby girl joining the family first. Her son Andrew is turning 2 next year, so she should have the same gap that I have with my boys with her kids. Kyleigh is pregnant with baby number 11 - imagine that! She and Barrett elect not to find out the baby's gender until she gives birth, so we have no idea whether this baby is a girl or a boy, her last 2 pregnancies were boys so I wonder if she's on a boy streak, she's due in the spring so I guess we've got a little bit more of a wait until we find out. Sweet Lorilee is having her first baby and she's carrying it so well! She's also due in the spring so she's just entering her 2nd trimester, she mentioned the morning sickness going down quite a lot which means she's able to actually enjoy the pregnancy now. She and Charles haven't decided if they want to announce the baby's gender, but her baby shower will be in a few weeks here in Newcrest. It would have been wonderful for it to be here whilst we're all here, but our weekend it already jam packed as there's more than the usual amount of relatives that came into Newcrest for Harvestfest, so it's a weekend full of reunions

[killed-by-choice]

LouAnne Herron, 33 (USA 1998)

On April 14, 1998, 33-year-old Lou Anne Herron bled to death. She left behind two surviving children.

LouAnne was separated from her husband when she discovered she was pregnant with her third baby. She felt overwhelmed and ended up at the A-Z facility, which was home to rampant malpractice and employed abortionist J. Biskind. (Biskind had already Lisa Bardsley by tearing her uterus and letting her bleed to death.) Later in court, medical assistant Sylvia Aragon cried on the witness stand as she told what happened that day.

According to Aragon, Lou Ann's pregnancy was "too far along" for an abortion. Biskind kept ordering more and more ultrasound scans to try to get one that would seemingly document the baby as being younger than 24 weeks in order for the on-demand abortion to be legal. Seven ultrasounds later, he managed to get a scan at an angle that more or less measured as 23 weeks, even though any reasonable medical professional would recognize that LouAnne was at least 26 weeks pregnant. But at the time, Arizona law allowed the abortionist to have final judgment on gestational age, meaning that Biskind could now declare the abortion “safe and legal”. It is unknown if LouAnne herself was aware of his deception.

During the abortion, Biskind tore LouAnne’s uterus and left her to bleed to death. Police later found out that LouAnne was left bleeding in a room for three hours. She lost so much blood that her body was numb. Two medical assistants later testified that Lou Anne was terrified after the abortion. She begged to know what was wrong with her and cried out in pain until her body went numb as she lay in a puddle of her own blood for three hours. Biskind fixed her IV (since there was no qualified nurse on staff to do this) and left the building at around 3:45 PM.

By the time somebody finally called 911, it was far too late. Paramedics arrived on the scene to find Lou Anne Herron already dead. She had been perfectly healthy just a day before, but the A-Z facility killed her with what they told her was “healthcare” and “her right”.

Biskind surrendered his license in order to stop the medical board investigation. That didn’t stop more evidence of his horrific malpractice from coming to light. A doctor who specialized in obstetric ultrasounds testified that the quality of the scan used to justify Lou Anne's abortion was so bad that it appeared the machine was defective and improperly used.

But why all the effort to proceed with the abortion? The prosecution noted that the motive was simple: the abortion facility charged $1,250 for each abortion between 20 and 24 weeks. LouAnne and her baby were killed for $1,250.

The jury found those responsible for killing LouAnne to be guilty of manslaughter and negligent homicide.

None of this had to happen. Like so many others, Lou Anne and her baby were both killed for money in the name of “choice”.

[queen-esther]

This week is a nightmare. 😞 Foods that haven’t been making my blood sugar spike are all of a sudden making me spike. I know that gestational diabetes tends to get worse around 32-33 weeks because of the hormones, but I’m struggling with how to get my baby the carbs he needs without fucking up my sugars in the process.

[mochalottie]

Since na'vi are bigger then humans wouldn't a na'vi pregnancy take at least 1 year?

AHHH IM SO SORRY ANON!! Swear I was going to answer this earlier but stuff got in the way. Sorry <333

In terms of your question, in my opinion I think Na'vi and human gestation times are essentially the same. Because they have the same internal reproductive organs (not gonna go into the external ones) as we do, I would think it wouldn't really take a year.

And Na'vi babies aren't entirely a different size to humans, or that we know of. So really don't take my words as fact, I'm just making a headcanon that it's nine months for the child to grow in the mother's tummy. But if other people are more knowledgeable about this they can educated both of us XD

Thank you for your question anon! Hope you're having a lovely week <33

[abortionclinictoronto2]

Abortion Clinic Brampton

Abortion Clinic Brampton

Abortion Health Services in Brampton -Dr. Renu 

If you're in Brampton and in need of abortion health services, we're here to provide you with the support and care you require. Located at 33 Tiller Trail, Brampton, L6X4R6, our facility offers a range of services to ensure your well-being during this critical time.

Understanding Medical Abortion in Brampton

the process and facts about medical abortion in Brampton. Get informed and make empowered choices. Click to explore more.

Best Brampton Abortion Clinics: Your Options

Explore reputable abortion clinics in Brampton. Find safe and trusted services. Make an informed decision for your needs. Click for reliable clinics near you.

Medical Abortion Cost in Brampton: Affordable Options

affordable medical abortion cost in Brampton. Find budget-friendly solutions without compromising quality. Click to discover cost-effective options.

Navigating Access to Abortion in Brampton

Understand the accessibility of abortion services in Brampton. Know your options and access reliable information. Click to explore your choices.

Post-Abortion Care in Brampton: Your Guide

Discover essential aftercare tips post-abortion in Brampton. Ensure proper care for your well-being. Click to access a comprehensive guide for post-abortion recovery. Legal Requirements Abortion laws in Brampton Informational Understanding Abortion Laws in Brampton Learn about the legal framework surrounding abortion in Brampton. Gain insights into laws and regulations. Click to understand the legal aspects of abortion.

Finding Support During Abortion in Brampton

Seek guidance and support during the abortion process in Brampton. Access resources for emotional support. Click to find assistance and understanding during this time.

Services Provided

Pregnancy Options Decision-Making Support: We're committed to helping you make the best decision for your unique situation.

Aspiration Abortion Services: We offer termination of confirmed pregnancies up to 20 weeks gestation.

Abortion pill Services: For early pregnancy termination, we provide services using Mifepristone/Misoprostol (available at Woman's Health Options and Kensington Clinic).

Pre and Post Abortion Counseling: Our caring and compassionate team is here to provide emotional support.

Support Services for Early Pregnancy Loss: We offer assistance for pregnancies up to 20 weeks gestation.

Birth Control Counseling and Prescriptions: Including IUD (Intrauterine Device) insertion.

STI Testing and Treatment: Your sexual health is important to us.

The Abortion pill and DC Services in Brampton, Mississauga, Guelph

Abortion Clinic BramptonAcross Brampton at No Cost. received approval in Canada in July 2015. Since then, it has been effectively used to early terminate pregnancies in Brampton.

When it comes to accessing reproductive healthcare, individuals in Brampton can find comfort in knowing that the Abortion Pill is readily available, and what's more, it comes at no cost. This essential option ensures that people can make choices regarding their reproductive health without financial barriers.

The Abortion Pill Brampton, also known as medication abortion, offers a safe and effective way to terminate pregnancies in the early stages. It typically involves a combination of medications, including Mifepristone and Misoprostol, which are administered under medical supervision.

In Brampton, residents can benefit from easy access to this medical option through various healthcare providers and clinics. The availability of the Abortion Pill means that individuals can make informed decisions about their reproductive health, ensuring that their choices align with their personal circumstances and beliefs.

Moreover, the fact that it comes at no cost underscores the commitment to ensuring that reproductive healthcare remains accessible to all, regardless of financial constraints. This not only promotes physical well-being but also empowers individuals to take control of their reproductive choices.

In conclusion, the Abortion Pill availability across Brampton at no cost is a testament to the commitment to accessible and inclusive reproductive healthcare. It provides individuals with the freedom to make choices that align with their needs and values, promoting a healthier and more empowered community.

An abortion clinic or abortion provider is a medical facility that offers abortion services. These clinics can take various forms, including public medical centers, private medical practices, or nonprofit organizations such as abortion clinics in Brampton.

Here are some statistics related to abortion providers in different countries:

Abortions Pill at Abortion Clinic Brampton

The Abortion Pill, also known as Mifepristone and Misoprostol, received approval in Canada in July of 2015, offering a safe and effective method for terminating pregnancies. Notably, this method has been successfully and safely used in Europe since 1988.

At Abortion Clinic Brampton, we provide an alternative way to end early pregnancies, up to 63 days, without the need for surgical procedures or sedation. This approach allows women to undergo the abortion process in the comfort and privacy of their own homes.

The mechanism of Mifepristone involves blocking the hormone progesterone, which is naturally required by the body to sustain an early pregnancy. This action halts the growth of the pregnancy and prompts it to detach from the uterine wall. Subsequently, a follow-up step involves taking prostaglandin, typically two days after Mifepristone, to ensure the expulsion of the gestational sac.

It's important to note that 95% of women who opt for the Abortion Pill only require one appointment at our clinic. Following the medication, a follow-up blood test is conducted at a local lab to assess the effectiveness of the pill. Our medical professionals will then reach out to you over the phone to discuss the results and provide any necessary guidance.

It's essential to be aware that the Abortion  control be purchased online or through a pharmacy. Only specially trained doctors in abortion care, like those at Abortion Clinic Brampton, can procure and dispense the Abortion Pill. Our clinic's doctors and nurses possess specialized training in abortion care, ensuring that you receive the highest level of care and expertise during this process.

The Abortion Pill at Abortion Clinic Brampton: A Three-Step Process

The Abortion Pill process at Abortion Clinic Brampton consists of three essential steps to safely and effectively terminate a pregnancy:

Step 1: On the initial day of the process, you will take the first medication, Mifepristone. Mifepristone's function is to destabilize the lining of your uterus and bring an end to the pregnancy. It's important to note that once you've taken this medication, its effects cannot be reversed.

Step 2: The second step involves taking four pills of Misoprostol, which is done at home, approximately 24 to 48 hours after taking Mifepristone. Misoprostol tablets play a crucial role in causing the uterus to contract, leading to the natural evacuation of the pregnancy.

Step 3: After completing the first two steps, a follow-up assessment is conducted through blood work at a local lab, such as Dynacare or Lifelabs. This blood test is performed to measure the effectiveness of the Abortion Pill in terminating the pregnancy.

The Abortion Pill at Abortion Clinic Brampton boasts an impressive success rate of up to 97-98%. However, if, in rare cases, the Abortion Pill does not achieve the desired outcome, a follow-up aspiration procedure (DC) may be necessary to safely and completely remove the pregnancy.

Rest assured that our medical professionals are here to guide you through each step of the process, ensuring your safety, privacy, and well-being throughout your journey.

Abortion Clinic Mississauga Service

An abortion clinic serving Mississauga plays a vital role in women's healthcare by providing safe and legal options for individuals facing difficult decisions regarding their pregnancies. These clinics are staffed with experienced healthcare professionals who prioritize the well-being and autonomy of their patients.

Abortion Centre In Mississauga – Taking Care Of Your Needs

Dealing with an unplanned pregnancy can be an incredibly challenging and emotional experience. The pressure from family and society can feel overwhelming, leaving you in need of compassionate medical assistance to address your situation. In such trying times, you deserve the best care in town, and that's where FSIVF Research Centre steps in.

With years of experience in the field, we have supported countless women facing similar distressing circumstances, and we're here to assist you too.

To begin your journey towards resolution, simply visit our website or call us at +91 9892495128 to schedule an appointment. We'll provide the best possible care based on your current health condition.

Taking Care of Unwanted Pregnancy

There are various situations in which a woman may be hesitant to continue with a pregnancy. In such cases, it's advisable to consult with our Abortion Centre In Mississauga to explore available procedures. If motherhood isn't an option for you, terminating the pregnancy can spare both you and the potential child from future hardships.

During the initial consultation, we will thoroughly discuss the abortion process, including necessary tests, abortion techniques, and the cost. Your complete openness during this discussion is crucial to ensuring your safety and well-being.

When to Consider Medical Abortion

If you are within the first 6 weeks of pregnancy, this is considered an early stage. In such cases, we typically recommend oral medication for a safe, non-surgical abortion.

Our medical centre employs two medications for this purpose:

The first pill blocks the hormone progesterone, initiating the breakdown of the uterine lining, effectively terminating the pregnancy.

The second pill helps discharge the pregnancy, mirroring the process of a miscarriage.

When Surgical Abortion is Necessary

If your pregnancy has progressed beyond 6 weeks, medical abortion may not be effective. But don't worry; we offer surgical abortion services for pregnancies up to 16 weeks.

Our surgical procedures are safe and straightforward, especially if you contact us between the 10th and 11th weeks of your last menstrual cycle. We utilize suction abortion (vacuum aspiration) or dilation and evacuation, depending on your specific situation.

Before proceeding with the abortion, we may conduct routine blood tests and ultrasounds to determine the most suitable method based on your pregnancy's stage.

[vergess]

Here is a non paywalled copy. For future reference, if you use Firefox browser, you can circumvent this paywall by 1) entering Reader Mode then 2) refreshing the page while read mode is active. This bypasses the script that cuts the article.

Warren Hern: The Abortion Absolutist

Elaine Godfrey

26–33 minutes

This article was featured in One Story to Read Today, a newsletter in which our editors recommend a single must-read from The Atlantic, Monday through Friday. Sign up for it here.

The sky above Boulder was dark when the abortion doctor picked me up for dinner. I had to squint to recognize Warren Hern in his thick aviator glasses and fur-trapper hat.

At the restaurant—a kitschy Italian spot along a pedestrian mall—Hern ignored the table the waiter offered us, pointed at one in the corner, and clomped over in his heavy hiking boots. He’d like to order right away, he said: the osso buco and a glass of Spanish red. How long will that take?

Hern spent the next two and a half hours of our dinner correcting me. A baby is a fetus until it is “born alive,” he told me as I chewed my bucatini. His dear friend, the Kansas physician George Tiller, was not “murdered” in 2009, he was assassinated. The activists who scream outside his clinic are not “pro-life,” they are fascists.

Pausing, Hern sighed. He is very busy, he said, and there are many things he’d rather be doing than talking to me. “But I can’t complain that the pro-choice movement has completely failed” at communicating, he said, “and then turn down an opportunity to communicate.”

Read: What winning did to the anti-abortion movement

I’d met Hern before, so I wasn’t surprised by his gruffness. The 84-year-old can be a curmudgeon—he’s obstinate, utterly certain of his position, and intolerant of criticism even as he dishes it out. Useful qualities, perhaps, for someone in his line of work.

Hern is now nearing his fifth decade of practice at his Boulder clinic; he has persisted through the entire arc of Roe v. Wade, its nearly 50-year rise and fall. He specializes in abortions late in pregnancy—the rarest, and most controversial, form of abortion. This means that Hern ends the pregnancies of women who are 22, 25, even 30 weeks along. Although 14 states now ban abortion in most or all circumstances, Colorado has no gestational limits on the procedure. Patients come to him from all over the country because he is one of only a handful of physicians who can, and will, perform an abortion so late.

During the first 13 weeks of pregnancy, when about 90 percent of abortions in America are carried out, the fetus’s appearance ranges from a small clot of phlegm to an alienlike ball of flesh. At 22 weeks, though, a human fetus has grown to about the size of a small melon. The procedures that Hern performs result in the removal of a body that, if you saw it, would inspire a sharp pang of recognition. These are the abortions that provide fodder for the gruesome images on protesters’ signs and the billboards along Midwest highways, images that can be difficult to look at for long.

Many of the women who visit Hern’s clinic do so because their health is at risk—or because their fetus has a serious abnormality that would require a baby to undergo countless surgeries with little chance of survival. But Hern does not restrict his work to these cases.

The phone at Hern’s clinic rings constantly these days. Since the overturning of Roe and the corresponding blitz of abortion bans, appointment books are filling up at clinics in states where abortion remains legal. Women who have to wait weeks for an appointment may end up missing the window for a first-trimester procedure. Some book a flight to Boulder to see Hern, who is treating about 50 percent more patients than usual.

These later abortions are the less common cases, and the hardest ones. They are the cases that even stalwart abortion-rights advocates generally prefer not to discuss. But as the pro-choice movement strives to shore up abortion rights after the fall of Roe, its members face strategic decisions about whether and how to defend this work.

Most Americans support abortion access, but they support it with limits—considerations about time and pain and fingernail development. Hern is reluctant to acknowledge any limit, any red line. He takes the woman’s-choice argument to its logical conclusion, in much the same way that, at this moment, anti-abortion activists are pressing their case to its extreme. Hern considers his religious adversaries to be zealots, and many of them are. But he is, in his own way, no less an absolutist.

In May of 2019, an envelope landed on my desk at work with a nature calendar inside. The photos—an arctic tern landing on a hunk of ice, a shock of mountain maple in the Holy Cross Wilderness, two sandhill cranes taking flight—were all credited to Hern. I’d interviewed him a week earlier for a short article about abortion-rights activism, and it amused me that a working abortion doctor was making wildlife calendars and express-mailing them to journalists. This past December, I flew to Boulder to meet him.

The first day I visited, no protesters were chanting outside; it was a Monday, and they tend to show up on Tuesdays, which is patient-intake day. Hern’s staff sat me in an office near the front desk, where I could hear calls coming in. I listened as a receptionist told a patient named Lindsey that it was okay to be anxious; she paused a few times while Lindsey cried.

“The fee will be about $6,000,” the receptionist said. Late abortions are expensive because they are medically complex. For patients who need financial aid, the National Abortion Federation may cover some of the cost, and local abortion funds often contribute. The receptionist told this to Lindsey, and offered her the organization’s number. “You can do partial cash and credit card, yes,” she said. Often, if a woman cannot afford to pay for her hotel, her transportation to Boulder, or some part of her procedure, Hern will foot the bill himself, staff members told me.

Hern stopped performing first-trimester abortions a few years ago; he saw too much need for later abortions, and his clinic couldn’t do it all. The procedure he uses takes three or four days and goes like this: After performing an ultrasound, he will use a thin needle to inject a medicine called digoxin through the patient’s abdomen to stop the fetus’s heart. This is called “inducing fetal demise.” Then Hern will insert one or more laminarias—a sterile, brownish rod of seaweed—into the patient’s cervix to start the dilation process.

From the May 2022 issue: The future of abortion in post-Roe America

When the cervix is sufficiently dilated after another day or two of adding and removing laminarias, Hern will drain the amniotic fluid, give the patient misoprostol, and remove the fetus. Sometimes, the fetus will be whole, intact. Other times, Hern must remove it in parts. If the patient asks, a nurse will wrap the fetus in a blanket to hold, or present a set of handprints or footprints for the patient to take home.

I interviewed half a dozen of Hern’s former patients. Most of the women who agreed to talk had wanted a child. But they’d received serious diagnoses late in pregnancy: disorders with disturbing names such as prune-belly syndrome, trisomy 13, Dandy-Walker malformation, and agenesis of the corpus callosum. Some said they considered their abortions a kind of mercy killing.

“I put my baby down,” Kate Carson, who’d gotten an abortion at Hern’s clinic in 2012, told me.  She’d been 35 weeks into a much-wanted pregnancy when her doctor diagnosed multiple brain anomalies. Carson’s daughter, the doctor said, would have trouble walking, talking, holding her head up, and swallowing. “It’s euthanasia. That’s the kind of killing this is,” she said. “But I would do it again a million times if I had to.”

Amber Jones, who terminated her pregnancy at about 24 weeks in 2016, told me that her baby’s diagnosis meant he would not survive. Hern reassured her, she said, that she “shouldn’t be made to carry the pregnancy. That it’s bullshit, and we have the right to access health care.”

Carson and other patients described Hern as brusque. But they seemed to take comfort in that brusqueness, as though Hern’s fierce assurance helped them feel more sure themselves. “I wouldn’t say he has a great bedside manner,” Carson told me. But “the degree of respect that I felt from him was enormous.”

Abortions that come after devastating medical diagnoses can be easier for some people to understand. But Hern estimates that at least half, and sometimes more, of the women who come to the clinic do not have these diagnoses. He and his staff are just as sympathetic to other circumstances. Many of the clinic’s teenage patients receive later abortions because they had no idea they were pregnant. Some sexual-assault victims ignore their pregnancies or feel too ashamed to see a doctor. Once, a staffer named Catherine told me, a patient opted for a later abortion because her husband had killed himself and she was suddenly broke. “There isn’t a single woman who has ever written on her bucket list that she wants to have a late abortion,” Catherine said. “There is always a reason.”

The reason doesn’t really matter to Hern. Medical viability for a fetus—or its ability to survive outside the uterus—is generally considered to be somewhere from 24 to 28 weeks. Hern, though, believes that the viability of a fetus is determined not by gestational age but by a woman’s willingness to carry it. He applies the same principle to all of his prospective patients: If he thinks it’s safer for them to have an abortion than to carry and deliver the baby, he’ll take the case—usually up until around 32 weeks, with some rare later exceptions, because of the increased risk of hemorrhage and other life-threatening conditions beyond that point.

Even within the abortion-rights community, Hern’s position is considered a hard-line one.

Frances Kissling, the founding president of the National Abortion Federation, the professional association for abortion providers, admires Hern and his commitment to women. But she has misgivings about his work. “Later-term abortions are more serious, ethically, than earlier abortions,” Kissling, who left NAF after a few years and went on to lead Catholics for Choice, told me—and only more so in cases that involve women who have not received any serious fetal diagnoses. “My ethics are such that I would say to them, ‘I’m terribly sorry, but I cannot perform an abortion for you. I will do anything I can to help you get through the next two or three months, but I don’t do this,’” she said.

Hern bristles at the label abortion doctor. Too simplistic, he says. He will correct you if you use it. He is a physician, he says, who happens to specialize in abortion. Worse still is abortionist. He remains angry about a 2009 story in Esquire in which the author referred to him that way, again and again. It’s a pejorative, Hern says. He is more than his profession, he needs you to know. He is many things: an anthropologist, an epidemiologist, an adopted son of the Shipibo Indians in Peru. Abortion was never the destination for Hern, he insists; it was a detour.

As a child growing up in the suburbs of Denver, Hern dreamed of studying diseases in faraway places. During medical school, he worked as the unofficial doctor at a mining camp in Nicaragua, where he learned to speak Spanish. He spent six months in Peru, studying the culture and practices of the Shipibo. In 1966, the Peace Corps sent him to Brazil, where he learned Portuguese and trained under physicians who had started a family-planning association. Hern toured a maternity ward where one room was full of women recuperating from childbirth. Two other rooms held patients suffering from complications related to illegal abortions; at least half of those women ultimately died. This, he says, was formative.

From the June 1969 issue: The right of abortion

In 1970, Hern accepted a job at the now-defunct Office of Economic Opportunity in Washington, D.C., where he led the effort to open family-planning clinics across the country and launched a voluntary-sterilization program for adults in Appalachia. Given the link between the eugenics movement and the early birth-control movement, the word sterilization can carry an ominous ring. Hern says, though, that his work was intended to give low-income people choices and reduce their financial hardship. “Families like these,” he wrote in The New Republic at the time, require housing, clean water, food, and sanitation. “But one of the most important needs is freedom from the tyranny of their own biology.”

In 1973, Hern was back in Colorado—the first state to decriminalize abortion in some circumstances—acting as a consultant for family-planning programs when the world shifted. Sarah Weddington, a lawyer friend of Hern’s from D.C., had won the Roe v. Wade case before the U.S. Supreme Court, and abortion was now legal in all 50 states. Hern wrote op-eds defending the decision and an explainer about the procedure for The Denver Post. One day, he got a call from a Colorado group that wanted to start a nonprofit abortion clinic in Boulder. Would Hern be their medical director? Of course, he told them. Absolutely.

The Boulder Valley Clinic opened in November of that same year. Hern designed the medical protocols and performed all of the abortions himself. Although one major battle for abortion rights had been won, a larger war was just beginning. Demonstrators began gathering outside the new clinic. Two weeks after it opened, Hern received his first death threat—a late-night phone call at his secluded cabin in the mountains. The man on the phone said he was coming for Hern. The doctor began sleeping with a rifle next to his bed.

In 1975, Hern took out a loan and started his own practice. He named it the Boulder Abortion Clinic—avoiding euphemisms like women’s care because he wanted patients to be able to find him. At the time, Hern had never performed any second-trimester abortions, for which the standard procedure then was to inject a saline solution into the uterus to induce labor. But Hern had read about another method in a textbook that explained how Japanese doctors were using laminarias to end abnormal or dangerous pregnancies. The method took longer, but it was safer. Hern studied the technique, ordered laminarias, and got to work.

Hern was 34 when he performed his first abortion, a year before Roe v. Wade would be decided. A friend in D.C. who ran a local clinic invited him to come learn the procedure. Hern’s patient was 17 and in her first trimester of pregnancy. She wanted to be an anesthesiologist, he remembers.

Hern had learned how to do a dilation-and-curettage abortion in medical school, but still, he was terrified—and so was she. He recalls that after he finished and told her she wasn’t pregnant anymore, she wept with relief. He did too. “I was overwhelmed by the significance of this operation for this young woman’s life,” he told me. “This was a new definition, for me, for practicing medicine.”

But the work sometimes got to him. He would often retreat to his office to compose himself after an abortion. Partly, it was the high-stakes nature of the procedure. But he also needed time to process how the dead fetus looked, how removing it felt. Sometimes he’d sit in his office and think, What am I doing?

He had bad dreams too. In the 1970s, physicians did not induce fetal demise during abortion, and once or twice, during a procedure at 15 or 16 weeks, he used forceps to remove a fetus with a still-beating heart. The heart thumped for only a few seconds before stopping. But for a long while after, a vision of that fetus would wake Hern from sleep. He could see it in his mind, the inches-long body and its heart: beating, beating, beating. In one dream, Hern angled his own body to shield his staff from catching a glimpse.

Other people might have decided that this work wasn’t worth the haunting images, the pricks of conscience. They might have quit. But for Hern, the psychological stress of the work was the necessary cost of helping patients. He saw it as his job to carry some of the emotional weight. Over time, that stress became easier to manage. He stopped needing to compose himself between procedures. The bad dreams went away.

In 1978, Hern presented a paper before the Association of Planned Parenthood Physicians in San Diego titled “What about us? Staff Reactions to D&E”—dilation-and-evacuation abortion—in which he concluded that, though medically safe, surgical second-trimester abortions are clearly more emotionally difficult for providers than earlier ones.

Some part of our cultural and perhaps even biological heritage recoils at a destructive operation on a form that is similar to our own, even though we know that the act has a positive effect for a living person … We have reached a point in this particular technology where there is no possibility of denying an act of destruction. It is before one’s eyes.

I quoted that paper during a conversation with Hern, as we sat shoulder to shoulder at a bar in downtown Boulder. He was nodding before I finished. Many of his colleagues were annoyed by what he’d written, he said. The abortion-rights movement isn’t exactly eager to talk about these visuals, mostly because it gives fodder to the opposition. Hern’s comments about “destruction” still appear on a number of anti-abortion websites as evidence of the horror of the procedure.

But the point of his report was to be honest, Hern said, and he stands by it. Why not face the truth that abortion late in pregnancy is, at least in one way, destructive? He still believes that such destruction can be a profoundly merciful act.

Annie Lowrey: American motherhood

Regardless of the circumstances of pregnancy, in Hern’s view, a woman’s life—her humanity, her wishes—isn’t just more important than her fetus’s. It is virtually the only thing that matters. That approach is diametrically opposed to the view of anti-abortion advocates, for whom pregnancy means motherhood and, often, self-sacrifice.

Hern understands that few share his total conviction. “This is a grotesque conversation to many people,” he said at the bar. “But this is a surgical procedure for a life-threatening condition.”

During that conversation and the ones following it, I prodded for cracks in Hern’s certainty. At one point, I thought I’d found one: Hern had told me about a woman who’d sought an abortion because she didn’t want to have a baby girl. I thought he had refused. But when I followed up to ask him why, I learned that I had misunderstood. Hern said he had done abortions for sex selection twice: once for this woman; and once for someone who’d desperately wanted a girl. It was their choice to make, he explained.

“So if a pregnant woman with no health issues comes to the clinic, say, at 30 weeks, what would you do?” I asked Hern once. The question irked him. “Every pregnancy is a health issue!” he said. “There’s a certifiable risk of death from being pregnant, period.”

Hern met the Kansas abortion doctor George Tiller at a National Abortion Federation conference in the late 1970s. The two talked on the phone nearly every week for 30 years. Tiller was the opposite of Hern—gentle, soft-spoken, churchgoing. “George was a normal person,” Hern told me once. “That distinguishes him from me right away.” Yet Tiller was murdered for doing the same work.

The phone rang at Hern’s house one morning in May 2009, and Jeanne Tiller was on the line. “George is gone,” she told Hern. An anti-abortion fanatic had shot her husband at church, where he was serving as an usher. Hern flew to Wichita for the funeral, and helped carry his friend’s casket down the aisle of the packed College Hill United Methodist Church. Sixty federal marshals stood guard at the service, he said. They told him that he would likely be the next target. Later that week, Hern performed abortions for all of Tiller’s remaining patients at his clinic in Boulder.

Thirteen years after Tiller’s death, Hern and I stayed up late talking in the restaurant of my hotel. Hern was speaking so loudly—about Donald Trump, fascism, and anti-abortion violence—that the bartender had begun to stare. Opposition to abortion has long been “the hammer and tongs to power” for the Republican Party, Hern was saying, “because of their allegiance to the white Christian nationalists and white supremacists.” Christianity, he told me, not for the first time, “is now the face of fascism in America.” That moral arc of the universe bending toward justice? “That’s the belief, but I don’t believe it.”

David Frum: Roe is the new prohibition

I asked Hern whether he ever worried that now, in a post-Roe world, he might have an even bigger target on his back. I wondered whether it was a bit reckless for him to be so outspoken with reporters like me. Actually, it’s the opposite, Hern replied. Being so vocal “increases the political cost of assassinating me.”

“That’s dark,” I said.

He simply shrugged. “This is what I have to think about.”

Suddenly, he remembered that he’d brought me something. He dug around in his coat pocket, and pulled out a fridge magnet he’d made from a photograph he took a few years ago near the island of South Georgia: penguins diving off an iceberg into the deep blue ocean.

Hern is known for presenting such gifts to people—and for regularly mailing out his latest published works. In addition to the magnet and the calendar, Hern sent me a copy of his poetry collection and his new book on global ecology. In the latter, titled Homo Ecophagus, he compares mankind to a cancer on the planet, writing that our unrelenting population growth will ultimately lead to the demise of every species on Earth. To view human beings as a scourge seems a rather ominous perspective for a man who ends pregnancies for a living. Could he see his work as, even subliminally, a form of population control? When I asked about that, Hern shook his head vigorously, waving my question away, as if he’d been ready for it. “Being concerned about population growth is consistent with the idea of helping women and families control their fertility on a voluntary basis,” he said.

Gonzalez sometimes worries that Hern comes across as too intense. “I always tell him, ‘Don’t look like Bernie Sanders,’” she told me, in her thick Cuban accent. Part of her hates that he can be so angry, so severe. “But another part of me loves,” she said. “Because how many people do you know that live with the level of passion that Warren does?” Still, Gonzalez wishes he would retire so that they could have more time to travel together and photograph wildlife.

During my stay in Boulder, I did occasionally look at Hern and wonder: Would I want you in charge of my complex medical procedure? Next month, he’ll be 85, and when he shuffles around the clinic in his turquoise scrubs and white lab coat, he looks it.

Younger providers have opened a handful of new late-abortion clinics in recent years. Some of these providers and others in the field argue that Hern’s abortion procedures take longer than they need to, and that his methods are out of date. Hern should have retired decades ago, these critics say. “Being 84 and doing procedures is problematic,” one physician, who requested anonymity in order to speak candidly about Hern, told me. (When I asked Hern about the criticism of some of his methods, he said he has always emphasized patient safety and will alter his procedures if they make the abortion safer. “If people don’t agree with me, I don’t really care,” he said. “I don’t give a shit.”)

Hern is working with two other doctors in the hope that eventually they will take over the clinic. But he’s hard to please. “I have to find the right people, train them, get them to know what needs to be done,” he says. “Finding physicians willing to do this work—who will do it well, do it carefully—is difficult.”

One morning during my visit, Hern and I climbed up the hill behind his house. The ground was muddy, and, thanks to a recent skiing injury, Hern was unsteady on his feet. I briefly wondered if this hike might bring about the end of one of America’s most famous abortion physicians. At the top of the hill, Hern pointed up toward a grassy crest of land above us called the Dakota Ridge. A big problem with modern society is that we’ve forgotten that we’re part of all this, he said, waving toward the ridge. The Bible says to “go forth and multiply and dominate the Earth and blah-blah, but that is exactly the wrong advice.”

He’s read the Bible a few times, he said. But he’s not religious; he’s spiritual. “The natural world, the forest, is my cathedral,” he said. To watch the sunrise, to see a wild animal, “just to be there, that’s a spiritual experience for me.”

And then, suddenly, Hern was connecting it all, drawing everything together: religion, Republicans, the Supreme Court, the future of American society. “These people believe stuff that’s out of the medieval times. The Pleistocene!”

On my last day in Boulder, a few of the clinic staff gathered in the kitchen for an unofficial Christmas party. They’d finished the week’s procedures, and all of the patients had been sent home. Now it was time for eggnog. Gonzalez poured some into mugs, and the clinic administrator offered to spike it with a bottle of his homemade rum. They passed around a box of chocolate cupcakes that someone had brought in.

Hern congratulated his staff on a good year, and they listened, amused, while he explained that he wasn’t able to find any good Audubon calendars at Barnes & Noble for their annual staff Christmas gift. He made a joke that he’d already told me more than once: “I could just give you the calendars from last year to pass on to your Republican friends,” he said, with a laugh. “They won’t notice for about 300 years that they’re out of date.”

Read: The Roe baby

A dozen Christmas stockings hung on the bulletin board, each displaying a staff member’s name in glitter glue. Buttons were pinned on the board, too, including some emblazoned with George Tiller’s face. You will be greatly missed, one said. Someone had propped open an outer door for circulation, and a stack of papers near the phone rustled—instructions for how to talk to someone calling with a bomb threat. “TAKE A DEEP BREATH,” they read. “Questions to ask: When is the bomb going to explode? Where is it right now?”

Hern seemed not to notice the strange juxtaposition of it all—the eggnog and the abortions, the cupcakes and the bomb threats. The buttons with the image of his murdered friend and the fact of his own stubborn survival. Of course he didn’t. He has spent five decades living with these contradictions.

This was an interesting read. Surprisingly nonpreachy given the subject; and well worth the time.

[antti-nannimus]

THE HUMAN BODY

By: Massimo@Rainmaker1973

1: Number of bones: 206

2: Number of bones of a newborn baby: 306

3: Number of muscles: 639

4: Number of kidneys: 2

5: Number of baby teeth: 20

6: Number of adult teeth: 32

7: Number of ribs: 24

8: Number of heart chambers: 4

9: Largest artery: aorta

10: Normal blood pressure: 120/80 Mm hg

11: Blood pH: 7.4

12: Number of vertebrae in the spine: 33

13: Number of neck vertebrae: 7

14: Number of bones in the middle ear: 6

15: Number of face bones: 14

16: Number of skull bones: 22

17: Number of chest bones: 25

18: Number of arm’s bones: 6

19: Number of arm’s muscles: 72

20: Smaller muscle: stapedius (6 mm)

21: Largest and most resistant bone: femur

22: Number of foot bones: 33

23: Number of bones in each wrist: 8

24: Number of bones in each hand: 27

25: Largest organ: skin

26: Heaviest internal organ and largest gland: liver

27: Largest cell: egg cell

28: Smallest cell: spermatozoon

29: Smallest bone: ossicle of the middle ear

30: Average length of the small intestine: 7 m

31: Average length of the large intestine: 1.5 m

32: Average heartbeat frequency: 72 bpm

33: Normal average body temperature: 37°C (98.4°F)

34: Average blood volume: 4.5 / 5.5 liters

35: Average life span of a red blood cell: 120 days

36: Average life span of a white blood cell: 10/15 days

37: Average life span of a platelet: 5/9 days

38: Average gestation period: 280 days (40 weeks)

39: Largest endocrine cell: thyroid

40: Largest lymphatic organ: spleen

41: Number of chromosomes: 46

42: Averagle blood viscosity: 3.5 / 5.5 cP

43: Universal donor blood type: O

44: Universal recipient blood type: AB

45: Largest white blood cell: monocyte

46: Smallest white blood cell: lymfocite

47: Number of cranial nerves: 12 pairs

48: Number of spinal nerves: 31 pairs

49: Approximate number of cells: ~ 30 trillions

50: Average number of neurons: ~ 86 billions

The human body is an amazing machine, but don’t forget that nature wants 5 of your 7 children dead. It wants you dead by 40.

[the-pregnancy-experience]

I didn’t have a great body to begin with so that hasn’t been my issue. However I seriously underestimated the toll late pregnancy takes on your body. I’m 33 and this is my first. Starting at 20 weeks I started getting Symphisis pubis dysfunction pain. Look it up. It’s so fun. I can’t even take my pants on/off, lift my leg to get into the shower or rollover in bed without excruciating pain. Then last week I got diagnosed with gestational diabetes. I’m struggling more with this than the SPD tbh. I hate having to count every morsel of food that goes in my mouth and test 4x a day. I have bad anxiety over planning what to eat and it not keeping me full long enough. My entire day revolves around what I’m going to eat and none of it is what I want to be eating at 31 weeks pregnant. I have to be careful because the diabetes already has my son measuring a month ahead in growth. His stomach alone is in the 99th percentile. Oh also I don’t feel like I’m peeing myself but I constantly smell like pee. Idk if it’s my nose being more sensitive but I smell like a nursing home no matter how much I scrub down there and wear panty liners.

Reddit

[jcrmhscasereports]

ACUTE MYELOID LEUKEMIA IN PREGNANCY: DIFFICULT JOURNEY FROM DIAGNOSIS TO DELIVERY AND TREATMENT by Vina Kumari in Journal of Clinical Case Reports Medical Images and Health Sciences 

ABSTRACT

The incidence of Acute Myeloid Leukemia in pregnancy is about 1 in 75,000 to 1 in 100,000. Owing to the therapy attributable risks to mother and fetus, the management of AML in pregnancy is very challenging, both for the parents and the medical fraternity. Furthermore, the diagnosis of leukemia in pregnancy is very difficult owing to vague presenting symptoms like fatigue and weakness which are confused with physiological changes during pregnancy.

Case Report: Primigravida, 33 weeks 6 days gestation age, with history of weakness and fatigue for 15 days and fever, cough and cold for 3 days was referred to our hospital with blood reports of raised total leucocyte count. The lab reports showed thrombocytopenia, anemia and leukocytosis with increased circulating blasts in the peripheral smear. As she was in her third trimester, plan of induction of labor and delivery followed by chemotherapy was taken. She delivered a live healthy baby. Post-delivery, she was advised chemotherapy. She had an immediate remission after the chemotherapy. The disease relapsed after 10 months and she succumbed to the disease due to unavailability of facilities during the COVID pandemic.

Conclusion: AML during pregnancy is rare. There is no fixed protocol for management of AML during pregnancy .The aim of management should be to take care of the initial concerns regarding fetal well-being according to gestation age and commence chemotherapy as soon as possible. This would give the best survival chances to the mother.

Keywords: Acute myeloid leukemia, pregnancy, chemotherapy.

INTRODUCTION

The association of leukemia and pregnancy is very rare, rather under-diagnosed and sparsely reported. The prevalence based on diagnosed and reported cases is one in 75,000 to 100,000 pregnancies. Most of the leukemias diagnosed in pregnancy are myeloblastic.

Acute myeloid leukemia (AML) is characterized by excessive proliferation of blast cells of myeloid lineage. This results in hematopoietic insufficiency like anemia and thrombocytopenia. The symptoms are related to complications of the pancytopenia, such as infections or hemorrhagic diathesis. The mentioned initial symptoms of leukemia in pregnancy are easily attributed to physiological changes related to the pregnancy and hence are either missed or diagnosed late. We report a case of Acute Myeloid Leukemia in a pregnant patient, its management and outcome.

CASE PRESENTATION

18-year-old primigravida presented at 33 weeks 6 days gestation. She was referred with history of weakness since 15 days and fever, cough, cold since 3 days associated with raised leucocyte count. She belonged to low socioeconomic status, was unbooked and had two antenatal visits during her pregnancy. She visited the facility when she had symptoms of gross weakness.

Her first trimester was uneventful. She was registered at a local hospital but was not compliant. Dating scan, trisomy screening and anomaly scan was not done.

On examination, her pulse rate was 88, blood pressure 100/60, respiratory rate 20 per minute, and temperature 99 degree Fahrenheit. She was pale but there was no jaundice, icterus or edema. She had angular stomatitis, and glossitis indicating malnutrition. Lymph nodes were not palpable.

On per abdomen examination, Uterus was relaxed, 33-34 weeks size and fetal heart 143/min. Ultrasound showed a single live fetus in cephalic presentation with effective fetal weight of 2.4 kg and liquor 12.7cm. Placenta was in upper posterior position. The fetus had overdistended urinary bladder with hydronephrosis of fetal kidneys suggestive of bladder outlet obstruction. Moderate hepatosplenomegaly was present. She was moderately anemic with hemoglobin of 8.3 gm/dl. The leucocyte count was very high 2,66,000/cu mm with neutrophils 4, lymphocytes 1, eosinophils 1 and basophils 1. The blood picture showed marked leucocytosis with blasts cells predominating 86% and 2 myelocytes and 1 metamyelocyte. The blast cells typically showed large nuclei, opened up chromatin, prominent nucleoli and cytoplasmic blebs. This picture raised the suspicion of Acute Myeloid Leukemia in pregnancy. Her platelet count was 96000/cu mm. LDH was raised 995 U/L signifying cell lysis. Liver enzymes were also borderline raised. Dengue serology was found negative. Her blood group was O negative. Serum Creatinine - 1.05 mg/dl and Serum uric acid - 10.9 mg/dl were also raised. The blood picture thus indicated towards normochromic normocytic anemia, thrombocytopenia and leukocytosis. On further examination of the peripheral blood smear, a leukoerythroblastic formula was noted with the presence of predominant blast population (86%) (Figure 1).

Peripheral smear showed mostly Monoblasts (red arrow), promonocytes (green arrow) and few myeloblasts (blue arrow) under the oil immersion object 100 X, Leishman stain.

Monoblasts are large cells with abundant cytoplasm, moderately to intensely basophilic, scattered fine azurophilic granules, round nuclei with lacy chromatin and one or more large nucleoli.

Promonocytes have moderate cytoplasm, less basophilic, granulated with occasional large azurophilic granules. Vacuoles are more irregular. Nuclei are delicately folded.

Myeloblasts have large nuclei, fine chromatin, 3-4 prominent nucleoli and few Auer rods in the cytoplasm.

In view of suspected Acute Myeloid Leukemia, she was advised Bone marrow aspiration, biopsy and immunophenotyping, flow cytometry and translocation (15:17) study by oncologist.

The obstetrical examination was normal. All cardiotocographies were reactive. She was started on IV antibiotics, Inj Ceftriaxone 1 gm IV BD and steroids, Inj Betamethasone was given for fetal lung maturity. In view of malignancy with pregnancy, the case was discussed in tumor board on 10/9/19 and a decision for delivery followed by chemotherapy was taken.

She was induced with one dose of intracervical dinoprostone gel following which she went into labour and delivered live baby 2.8 kg weight with good apgar. The baby was shifted to nursery in view of premature delivery and mother was planned to transfer to medical oncology department for Induction chemotherapy.

Repeat investigations three days after delivery, haemoglobin decreased to 7 g/dl, TLC increased to 3,81,000 cells per cu mm with neutrophils 2, lymphocytes 5 and myelocytes 5. The abnormal blast cells had increased to 88% and platelets decreased to 21000 per cu mm (TABLE 1). Serum creatinine also increased to 1.43 mg/dl and e-GFR decreased to 54 ml/min/1.73 m2, indicating compromised renal function. The peripheral picture showed mostly agranuloblasts with moderate to scanty grey blue vacuolated cytoplasmic nuclei showing convolutions and 1-3 nucleoli occasional myelocytes, metamyelocytes seen, findings in favour of Acute myeloid leukemia (M4/M5). On myeloperoxidase staining, only 40 % took up the stain indicating AML-M4 lineage. She was transfused with one packed cell and one single donor platelet, following which her condition improved. She was transferred to medical oncology ward where she received chemotherapy and had immediate remission of the disease.

Table 1: Sequential Investigation Reports during hospital stay

DISCUSSION

The Incidence of Acute Myeloid Leukemia is 1 in 75,000 to 100,000 pregnancies with maximum 40% presenting in third trimester and 23% and 37% in first and second trimester respectively. In a population based study by Nolan et al [1], out of total acute leukaemia cases, two thirds are myeloblastic and one third lymphoblastic leukemia.

The rarity of disease during pregnancy, might also be due to very low reporting in view of confusing diagnosis. The symptoms of AML can easily be confused with symptoms of anaemia like malaise, easy fatigueability, low grade fever. Thrombocytopenia and anaemia are relatively common findings in pregnancy. Although, Neutropenia is rare and merits further investigation or close monitoring. But in the developing country like India, it is majorly missed. Thus, whenever there is presence of circulating blasts in a blood film, it suggests a diagnosis of haematological malignancy and is an indication for bone marrow biopsy. The other differential diagnosis that should be kept in mind are Thrombotic microangiopathy, HELLP syndrome and Cytopenias of deficiency or immune origin [2].

The tests to be done before bone marrow aspiration are Full blood count, blood film examination, Vitamin B12, folate and ferritin measurement, Coagulation screen, Renal and liver function tests. All these were done for our patient and further bone marrow aspiration was suggested with studies directed at Immunophenotypic, cytogenetic and molecular analysis for accurate subtyping and understanding of prognostic features.

Once diagnosed, a Multidisciplinary approach comprising of hematologists, obstetricians, anesthetists and neonatologists is the key to appropriate management. Consideration should be given to health of both mother and baby. The woman should be fully informed about the diagnosis, treatment of the disease and possible complications during pregnancy , clearly implying that any treatment delays might result in compromised maternal outcome without improving the outcome for the fetus [3].

The risks of Leukemia, disease per se, to pregnancy is miscarriage, foetal growth restriction, perinatal mortality, premature labour and Intrauterine fetal death [4].

Due to the high risk of the disease, there are different recommendations for management of AML in pregnancy in the three trimesters owing to the urgent need of chemotherapeutic agents and the adverse effects of the drugs involved .

If it is diagnosed in the first trimester, the patient should be counselled for elective abortion, medical/surgical and starting of chemotherapy. Between 13- 24 weeks, the Induction chemotherapy should be started while pregnancy is continued [5]. Preterm termination of pregnancy is indicated after fetal viability. Similar conclusions were derived by Nicola et al and Farhadfar in a single centre study of 5 and 23 case of AML diagnosed during pregnancy respectively [6,7].

Between 24 - 32 weeks, chemotherapy exposure to the fetus must be balanced against risks of prematurity following elective delivery at that stage of gestation (Grade 1C). At gestation age more than 32 weeks, the fetus should be delivered prior to Induction chemotherapy.

Chemotherapy with anthracycline based regimens are favored. According to a meta-analysis done by Natanel A Horowitz et al, anthracycline based regimens were associated with maximum remission but overall maternal survival was very low (30%)[8]. Even in our case, although the mother immediately had remission with chemotherapy. There was a recurrence after disease free 10 months and she succumbed to the disease during the COVID pandemic. Quinolones, tetracyclines and sulphonamides are better avoided in pregnancy(Grade 1B).

In one case report by Abdullah et al, a trial of 5- azacytidine has shown promising results [9]. The antifungal of choice in pregnancy is Amphotericin B or lipid derivatives (Grade 2C). If blood transfusion is needed, the blood should be screened for Cytomegalovirus (Grade 1B). Supportive therapy like a course of Corticosteroids given if delivery is between 24 and 35 weeks gestation (Grade 1A) [10]. Magnesium sulphate should be considered 24 h prior to delivery before 30 weeks gestation (Grade 1A).

Delivery should be planned for a time when the woman is at least 3 weeks post-chemotherapy to minimize risk of neonatal myelosuppresion (Grade 1C). Planned delivery is preferred, like Induction of labour (Grade 2C). Caesarean section is indicated only for obstetric indications. Epidural analgesia is better avoided.

The Dose of chemotherapy is calculated on their actual body weight with dose adjustments for weight gain during pregnancy owing to various pregnancy changes.

The Chemotherapy agents have a MW of 250-400 KDa and hence can cross the placenta resulting in detrimental teratogenic effects on developing fetus.Sunny J. Patel et al have done a comprehensive analysis on outcomes in hospitalized pregnant patients with acute myeloid leukemia and come to conclusion that a multidesciplinary, holistic approach leads to quick remission of the disease [11]

After delivery, histopathologic examination of placenta to rule out placental transfer to fetus is advisable. Cytologic examination should be performed in both maternal and umbilical cord blood and neonates should be clinically examined for palpable skin lesions, organomegaly or other masses. If the baby is found to be healthy, a follow up after every six months for two years is recommended. In each visit, physical examination, chest x-ray and liver function tests should be done.

CONCLUSION

Acute myeloid leukemia in pregnancy is a Rare diagnosis and even rarely reported. With the trend for delaying pregnancy into the later reproductive years, we expect to see more cases of cancer complicating pregnancy. Presently, there are no clear management guidelines to address timing and dosing of anthracycline/cytarabine based regimens especially in pregnancy. The potential drug toxicity to mother and fetus and transplant considerations in intermediate and highrisk patients during pregnancy has not been addressed.

What we also need today is a National registry for leukemia patients, treated in pregnancy. This will help us to answer many unanswered queries and improve maternal and fetal overall survival rates. Although we have few comprehensive studies, but further studies and references are needed. Finally, a Multidisciplinary team is needed to provide comprehensive care to patients.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

[dungeonsndiapers]

33w6d

I wish I would stop crying and losing it with the nurses at my doctors office. They must all hate me. Yesterday I go to check in for my NST and they tell me I have a $20 co payment and like... what? I have like 12 more of these appointments and you want me to pay $20 every damn time?! I didn’t request this, I didn’t ask to come twice a week, you guys are making me do this. Bill called our insurance and they said unless I am caterogized as “high risk” that there is a co payment.... You stupid fuckers, obviously if there wasn’t some sort of higher risk to the baby I wouldn’t have to come in twice a god damn week!

So when the finally call me back, the nurse asks me how it’s going and I start crying out of frustration and she’s like “Well that’s not us that’s the business office” and that just sets me off more because I am just frustrated and tired and alone and being told no one can help you doesn’t make me feel better. She set me up and quickly left, she probably just wanted to get away from me and I don’t blame her. This is the third nurse who has got the worst of me. Nothing really got handled, and I’m sure I’ll end up paying for the appointments because I don’t really have a choice and our for profit health care system is stupid and I know I have really great insurance so there are people out there getting screwed big time. Parents shouldn’t have to worry about medical bills when bringing a new baby home. In the end $240 won’t kill us and we can afford it, but it’s real shitty to have this dumped on me at 33 weeks pregnant.

I had some painful Braxton Hicks contractions last night, and up until this point I wasn’t anxious about labor... but that’s because you forget how painful it is. Sooooo now that’s on my mind. More so concern over having on going contractions/not getting sleep while trying to care for Kennedy. It will all work out and everything will be ok, but the lack on control is difficult for me.