Pimping

Today, I was pimped. what? you might be thinking. Pimping in medical school refers to an attending (the doctor in charge of the med students & residents) or a resident who asks us questions. This can either be done with good intentions to help us learn or more maliciously to demonstrate to us our inferiority. Thankfully for me, my attending this rotation is awesome. He pimps in a friendly sort of way as he told us on our first day of orientation.
My one big pimping question for the day was to come up with 20 reasons for a C-section. Ready go!....

Let's just say this took me a while, with quite a few wrong guesses and with the help of some nurses and a 4th year medical student. But I learned. I'm going to attempt to list all 20 reasons from memory for you.

1. non-reassuring fetal heart tones
2. gastrochesis (when part of the abdominal wall is missing and guts are spilling out of it - no sac covering it, if a sac were covering it then it's an omphalecele)
3. Breech position or abnormal positioning
4. macrosomia (large baby - must be over a certain size, but this I do not remember)
5. Multiple gestation (twins with one baby presenting abnormally)
6. Abnormal Labor (failure to progress, etc)
7. placenta accreta
8. placenta previa
9. placenta abruptio
10. Herpes outbreak
11. HIV
12. Infection
13. previous uterine surgery
14. aortic stenosis
15. trauma, maternal death
16. cancer - gyn
17. cervical fibroid
18. previous classical CS
19. repeat CS
20. elective CS
21. cerclage (the 4th year came up with this one)

There you have it. the list. I'll admit I did have to cheat and look at my notes for about 5 of them.

Now on to the EXCITING part of my day.
I got to scrub in on 2 of the C-sections today AND I delivered a placenta! After the baby is delivered the uterus is pulled out of the mom and placed on her stomach. It's amazing how small the uterus becomes right after the baby is born. It contracts and clamps down to a much smaller size. It truly is fascinating. Outside of the body I think the uterus sort of looks like an uncooked chicken or turkey. Pulling the uterus out allows the physician to exam the uterus, the fallopian tubes, etc and I think grabbing the uterus helps stimulate it to contract. Also, drugs are given to augment contraction. I was allowed to follow the umbilical cord into the uterus and feel where it inserted on the placenta. Then he had me place my hand under his and he removed his had and had me move my hand in between the placenta and the uterus. I was basically scraping the placenta off the uterine wall. It was cool. Then he had the 4th year student stitch her up and we were on our way.
Watching the C-section was fascinating. It reminded me how much I enjoyed anatomy lab and dissecting the cadavers. The human body is amazing. I can't really describe how cool it is to see how different layers of the body separate from one other and that it's ok to just pull out a woman's uterus and plop it on her stomach stitch it up and plop it back in.
I'm interested to see if this becomes old had seeing C-sections and how much I enjoy gyn surgery. This is the one field I thought may pull me from my passion for family medicine. Even though it's only been 2 days - I don't know. I just don't know. Only time will tell if it's so exciting and interesting because it's new or because this is IT.