AN ACTION PLAN FOR PREGNANT PEOPLE EXPOSED TO SMOKE

 

Full transparency: This blog was originally written in 2021 in response to the California wildfires. I never imagined I would be writing to warn the citizens of my birth state about the very same issues.

Do these wildfires affect an unborn baby and its mother? The answer is a resounding yes, in the same manner as cigarette smoke. There are toxins in the air called PM2.5 that adversely affect our lungs and heart. Pregnant women exposed to PM2.5 and other toxins associated with wildfires are at risk for

  • Small babies
  • Growth-restricted babies
  • Preterm labor
  • Gestational Diabetes
  • Preeclampsia

 

Here are the action steps a pregnant woman should take if exposed to wildfires:

  • Request an ultrasound to document the proper size and weight of your unborn baby
  • Ask your OB provider about your fundal height to document appropriate growth
  • Be vigilant regarding monitoring the fetal movement per your OB provider’s recommendation, and do not hesitate to contact them if you are not comfortable with the level of activity or movement

Perhaps we need to bring Smokey the Bear out of retirement, but until then, please be safe and share this post to help pregnant mothers do the same.

HGTV Celebrity Couple Lost Cousin in Childbirth

Every time I write one of these posts, it breaks my heart, but these women’s deaths would go unnoticed without raising public awareness.

If you are interested in receiving information about the Black Ob-Gyn Directory that will drop in February 2023, please contact me at DoctorLindaOnline@gmail.com or https://www.thesmartmothersguide.com/contact/

 

You Saved My Baby’s Life

As Preeclampsia Awareness Month comes to a close, I want to share a blog post I wrote on 2/28/2011 that provides a better description of my former patient’s birth that resulted in her amazing son. If nothing else, please pay attention to what her blood pressures were and how the resident physicians had a false sense of security that almost led to her baby’s death. 

I was greeted by those words during a patient’s recent postpartum exam and was both gratified and humbled.  A potential disaster was avoided and her pregnancy had a happy ending.

Katina* (name changed) had registered for prenatal care early so when her blood pressure was a little “different” at 32 weeks, the change was duly noted. She wasn’t complaining of a headache, her feet weren’t swollen but this was her first pregnancy which placed her at an increased risk of developing pre-eclampsia.  A blood pressure of 120/82 would seem normal to most people but in Katina’s case it wasn’t. She was sent to the hospital and then discharged home with instructions to monitor her blood pressure daily and I asked her to return in one week for closer scrutiny.

Upon Katina’s return, her blood pressure was 140/90 so off she went to the hospital’s labor and delivery triage department for further evaluation. Upon her arrival, her blood pressure appeared to have improved. The resident physicians on duty made snide remarks, insinuating that she was referred inappropriately.  As she was about to be discharged, the baby’s heartbeat dropped precipitously. Before Katina could blink, a team of physicians and nurses descended upon her with full force. They shoved papers in her face requesting a signature for an emergency c/section and informed her that it was possible she could die as well as her baby. Her blood pressure had escalated through the roof and her heart raced dramatically. She was quickly put to sleep, a “stat” c. section was done,  and her baby was born alive. For the next four days, the hospital staff had difficulty controlling her blood pressure and her heart continued to pound at rates above 150 beats per minute. It was one of the most harrowing experiences of her life however, in the end, both mother and baby were discharged home and are now fine. Katina experienced what we in medicine call a “diagnostic save.” A life was saved because the proper diagnosis was made in a timely manner. How often does that happen? Not often enough. If you can “see it” then you can treat it. Pregnant moms must be empowered to help their healthcare providers “see” the problem before it spins out of control.

 

The Deadly 17 Minute Cesarean Section: In Memory of Kira Johnson

The public should be wary of certain physicians, and the late Kira Johnson’s physician is one of them.

According to Case No. 800-2016-021723, the California Board of Medicine received six complaints of medical negligence against Dr. Arjang Naim, who is a board-certified obstetrician-gynecologist who practices in Los Angeles and Beverly Hills, California.

On April 12, 2016, Johnson entered Cesar Sinai Hospital for an elective C-Section accompanied by her family but left the hospital without her.

I attended medical school and did my internship with men like Arlang Naim and know them well. Cowboys is what we called them back in the day. They took pride in whizzing through operative surgeries like they were in a race against time. Safety rules did not apply to them. They breached standards of medical care, and no one held them accountable.

In cases of emergency C-sections, the expected length of time is thirty minutes. Kira Johnson had no emergency conditions, and her C-section was an elective procedure. Naim had two medical practices in Hollywood and Beverly Hills and was probably multi-tasking.

Johnson’s procedure began at 2:31 p.m. and ended at 2:48 p.m., 17 minutes, including her delivery. Unfortunately, in Naim’s haste, he failed to close the bladder flap. Shortly after that, he left the hospital, leaving Johnson’s care to the resident physicians who were in training.

At 4:40 p.m., Johnson developed abnormal bleeding in the bag that collects urine (known as the Foley catheter). Then, at 5:45 p.m., a massive blood clot could be felt through her skin incision. Her pulse then increased dramatically, and is a classic sign of impending shock.

Johnson received multiple blood transfusions and exhibited signs of a dangerous condition called DIC (disseminated intravascular clotting) which meant her blood was not clotting properly. Naim did not arrive at Johnson’s bedside until 8:47 p.m. Despite Johnson’s unstable condition, he wrote orders, including a CT scan and then LEFT THE HOSPITAL.

Johnson’s condition deteriorated further, and the resident physicians called Naim again. He arrived at the hospital at 11:45 p.m. but only wanted to continue to merely observe. However, the resident physicians convinced him to return to the operating room to determine the site of her bleeding.

At 12:25 a.m., Johnson was taken back to the operating room, and at 1:15 a.m., the resident physicians scrambled to find a general surgeon to assist Naim with the procedure. Unfortunately, Kira Johnson’s heart stopped beating.

Further evidence from the California Board of Medicine reported that Johnson was not the only patient who experienced medical neglect.

  1. On August 21, 2015, a patient had a ruptured tubal pregnancy. Naim performed her surgery but failed to achieve any follow-up hospital care for three days despite her requiring a blood transfusion
  2. On March 14, 2016, a patient had a ruptured uterus after experiencing a 16-week pregnancy loss. The uterus was repaired, the patient required a blood transfusion, and Naim did not see the patient during her entire hospital stay.
  3. On May 31, 2016 (approximately one month after Kira Johnson expired), Naim performed a C-section on his patient with a placenta previa (placenta covering the baby). Unfortunately, the placenta could not be removed, and the patient required a hysterectomy performed by Naim and a GYN oncologist. Although it was Naim’s patient, he failed to see her daily during her hospital course.

The California Board of Medicine placed Naim on probation in 2018 for two years, but he is practicing medicine again, including delivering

Would you want him to be your physician?

The U.K. Approves an Early Preeclampsia Diagnostic Test. Will the U.S. Follow?

A decision made by the British version of our NIH, the National Institute of Care and Excellence (NICE), sheds a flicker of light onto a very dark landscape regarding maternal mortality. They are authorizing the use of a blood test that will diagnose preeclampsia as early as 20 weeks. This decision is groundbreaking news and will change the landscape of how preeclampsia is currently diagnosed, treated, and hopefully save lives.

NICE is developing a draft of clinical guidelines and believes that African, Caribbean, and Asian women will benefit the most based on their history of adverse birth outcomes.

Here’s what you need to know in plain English about the test:

  • It measures Placenta Growth Factor (PIGF), which is a protein that plays a role in the development of blood vessels in the placenta
  • Women who have preeclampsia have low levels of PIGF. Low levels of PIGF means that the placenta blood vessels do not grow well

Can these tests diagnose as well as exclude preeclampsia?

Yes, according to published literature cited in the article.

Who makes these tests?

Four independent labs: one in San Diego, two in Germany, and a lab in Finland

What are the benefits of using this test for pregnant women?

The tests will make it easier for healthcare providers to diagnose preeclampsia and make fewer mistakes regarding clinical management.

Are there any economic benefits of using this test?

According to NICE literature, the saving was between 26 pounds ($34.06) to 2,896 pounds ($3,793.76) per patient.

Are there any other early diagnostic tests for preeclampsia?

Yes, there is a test using different technology that measures cell-free RNA as a means of early preeclampsia detection, according to an article published by Nature.com. However, healthcare providers do not currently use this test because it has not been approved as part of clinical guidelines.

I anxiously await the use of PIGF in mainstream obstetrics. We once thought that the adverse effects of preeclampsia stopped when the baby and placenta were delivered. However, we now know that reasoning was wrong based on the number of women who died during the postpartum period. Hopefully, with the future use of this test, women will no longer be discharged from hospitals or emergency departments prematurely. Anything that decreases maternal mortality gives me a glimmer of hope.