THURSDAYS 9|8c

Meredith’s Labor and Delivery

  • By Meg Marinis, Director of Medical Research
Meredithâs Labor and Delivery
Which character will you worry about the most this summer?

There’s April, who recently accepted Matthew’s proposal, yet we can see that she still may harbor feelings for Jackson (watching someone almost blow up in a bus can do that). Meanwhile, despite Owen’s protests, Cristina walked away from him, knowing that she can never fulfill his dreams of having children. The last conversation between Callie and Arizona broke my heart so completely that I don’t even know how to approach it. And Richard… Goodness, what the heck is going to happen to poor Richard Webber?

At least the lights came back on, right? Can you believe we performed surgery on Meredith… In the DARK?!

Why did Meredith need a C-section again?

Meredith needed a C-section due to her baby’s presentation – the way that the baby was coming down through the birth canal. Typically, babies present head-first, specifically with the crown of the head leading and therefore resting their chin on their chest. However, in Meredith’s case, Dr. Ryan detected a “face presentation” – the baby’s head extended backward, so that his head rested on his upper back.

Face presentation can be diagnosed during labor when the doctor, while examining the mother, can feel the baby’s eyes, nose, mouth, or chin. Depending on the severity of the flexion of the neck, the baby can still be delivered vaginally. However, Meredith’s baby specifically had a mento-posterior face presentation, which means that his chin pointed further back and his neck could not extend any further without additional complications.

After McBaby was delivered and whisked away, why did Meredith suddenly start to bleed uncontrollably?

As Shane worked to close up Meredith’s uterus, he and Heather saw additional bleeding in the abdomen. As they explored further, Meredith looked over and noticed that blood had started to come from her IV sites – a frightening sign that she was in DIC, or disseminated intravascular coagulation. DIC means that small blood clots have formed throughout the entire body’s blood vessels. These clots can impede blood flow to organs and cause them to malfunction, but the even bigger problem is that since the clotting factors have been used up, the blood starts flowing uncontrollably. All of this bleeding becomes extremely serious and life-threatening.

When Meredith fell down the stairs in Episode 923, she sustained an injury to her spleen, which began to actively bleed once she started the labor and delivery process, which then caused the DIC process to start. However, a variety of conditions can lead to overactive clotting factors and DIC such as:

• Some types of snakebites.
• Some types of bacterial, viral, or fungal infection.
• Surgery and trauma.
• Cancer.
• Serious complications of pregnancy and childbirth.

Treatment for DIC varies according to the specific cause, but in Meredith’s case, Shane and Heather needed to replenish the depleted fluids, immediately find the source of the bleeding and quickly control it.

After making an incision into the abdomen, Shane isolated the spleen as the source of the bleeding. How are these injuries repaired?

In the past, doctors handled splenic injuries by always performing splenectomies, or surgeries to remove the spleen. Doctors felt that assessing the injuries remained difficult and did not believe that the spleen healed well. However now, due to better diagnostic technologies, the treatment differs depending on the grade of the splenic injury. For example, Grades I and II may only involve minor tears to the organ and only require a brief hospitalization and observation. In these situations, the patients typically stay in the Intensive Care Unit while their blood and fluid levels are closely monitored and replaced.

But Grades III and IV, which could be characterized by more serious lacerations or complete rupture, would necessitate surgery. Surgeons have the option of accessing the spleen by creating several small incisions in the abdomen (laparoscopic surgery) and inserting a camera to help excise the spleen. However, due to the emergent nature of Meredith’s splenic injury, Shane completely opened her abdomen in order to gain immediate visualization.

In several cases, surgeons try to avoid removing the entire spleen and will only do a partial splenectomy. But when the patient’s bleeding cannot be controlled, such as Meredith, the safer decision remains to be a complete splenectomy. Studies have found that people can survive without the spleen, but doctors know that the spleen does play a role in fighting infection and therefore may recommend certain protective measures in the future, such as certain vaccinations.

For more information on Disseminated Intravascular Coagulation, please visit the following link:

http://www.nhlbi.nih.gov/health/health-topics/topics/dic/
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