Abortion pathology

Discussion in 'Pathology' started by LADoc00, May 11, 2006.

  1. LADoc00

    LADoc00 Gen X, the last great generation
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    Anyone get tripped on these? Im talking especially the big ones, where you can actually make out facial expressions like they knew they were being hacked the hell up (im serious). I almost went bonkers once over one, that is some scary crap. Am I the only pathologist who freaks when a 0.5cm eye ball comes rolling out of bag and stares right at you.....I know we are thinking this, just no one in pathology is talking about it.
     
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  2. Poety

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    omg that would send me into the psych ward QUICKLY :eek: :scared: :(
     
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  3. b&ierstiefel

    b&ierstiefel Guest

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    Totally trippy man. We get a fair number of fragmented fetuses from abortion procedures and they come in a container with formalin. The fact that they're all hacked up is disturbing to begin with. Of course, there is the whole eyeball issue which freaks me out as well. Echoing in my mind is the sound effects from the movie Psycho...

    Reeee Reeee Reeee Reeee Reeee Reeee!
     
  4. OP
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    LADoc00

    LADoc00 Gen X, the last great generation
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    One incident really freaked me, it was a boy fetus, at least 3+ pounds, around 24+ weeks. It sat decomposing because the rest of the staff was AFRAID of it, Im not joking. Then the chief of staff told me to deal with it because I was the FNG (f-kcin new guy) so I went to work. Pulled out 2 well formed arms and then the torso, headless. The head was at the bottom of the container, when I pulled it, he had this expression of such utter horror it flipped me wayyyy out, my PA saw it and ran, literally left work and went on disability (Im serious here). It was like a headless screaming baby, like it had been born at least for a split second to realize it was screwed and let out one agonal yelp. The story of this reverberated around the department, someone actually accused me of doing what should have been a ME case and threatened to call the medical board! Im not joking, I woke up once shortly after that in a cold sweat with piss running down my leg....not pretty.

    feel free to post your scary abortion pathology story here...
     
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  5. b&ierstiefel

    b&ierstiefel Guest

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    I personally see very little value in doing these kind of autopsies. Fragmentation of the fetus really compromises the ability of getting any useful information. Most of the info that will be useful to the parents will come from ancillary studies done before the procedure and cytogenetics studies. Sure, you might see a transverse palmar crease if you're lucky...or an extra digit...or a rocker bottom foot (if the stars are aligned correctly). Otherwise, it's pretty much a waste of time. Not really a scary story...more of a rant, if you ask me.
     
  6. OP
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    LADoc00

    LADoc00 Gen X, the last great generation
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    well yeah but I like the idea of a scary pathology post because all my other threads sound so whiny....oh and I saw Silent Hill last week, made me think of that story again.
     
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  7. b&ierstiefel

    b&ierstiefel Guest

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    Well, certainly this thread is a departure from your norm...yeah, some of your threads make you look like a rageful beast, whereas others make you out to be a whiny bitch. Oh well...I'm trying hard to conjure up memories of a scary fetopsy and can only think of a case that a fellow resident had. One of the fragments was the upper half of the baby's head and it was a cyclops with a proboscis! That was really freaky for the others but the whole time, all I could think of was the scene in Austin Powers where Dr. Evil refers to Number Two as "my cycloptic colleague."
     
  8. djmd

    djmd an Antediluvian
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    I guess you have to try an identify an abnormalities, but like AM says, it would be prety hard to do.

    Whats the SO dx, just products of conception?

    I used to hate getting 19 weekstill borns, because at my program 20wk is the cut off for autopsy, so 19 weekers you have to do at the desk like it is just a regular surgical, but you still have to document all sorts of info, really slows you down..
     
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  9. b&ierstiefel

    b&ierstiefel Guest

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    Well, all you can say in a lot of these final diagnosis reports are that the fetus is fragmented, you don't know what the sex is (unless you've found the gonads and histologically they're confirmed as balls or babymakers), you've identified some organs, and you give the estimaged gestational age based on foot length. I dunno what else really...I haven't had too many of these cases but all of these reports with my name on it are pretty simple writeups.\

    Yeah man, same here. Having these specimens as regular surgicals can be quite a chore if you have a lot of other things to cut. Whereas, if you get this on autopsy, that's probably the only thing you have to deal with at the moment. In any case, these dissections are really easy and once you've documented various things and taken pictures/x-rays, these cases can be finished in a snap!
     
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    LADoc00

    LADoc00 Gen X, the last great generation
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    in the real world, private prac docs rarely have contracts where they are compensated for post mortems, they are pro bono for holding an exclusive hospital contract. Insurance companies dont pay either, sooooooo you never post these cases if you can, they are always surgicals. And thus bottom lined: products of conception, fetal parts identified.
     
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  11. yaah

    yaah Boring
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    Most of my abortion-path anecdotes come from my PSF. Here one of the residents grosses most of them in as part of some project he is doing, and we are more than happy to let him.

    1) Anencephalic baby, otherwise intact. Those are disturbing to look at. Saw quite a few and they never really get comfortable to look at.

    2) When doing one POC that was about 12-15 weeks, somewhere around there, I put through the entire hand into a histology block, so that I could see what a developing hand looked like. The histotech freaked out when she saw it and I wasn't allowed to do that again. So I stuck later to doing things that weren't recognizable, such as the full cross section of the 8 week fetus anencephalic head, and the full larynx, etc.

    3) The strangest are when you get the macerated contents, and you are able to recognize a few parts here and there - usually a leg or an arm, sometimes the heart. But it's odd when you can't find a large portion of it.

    4) There was a stillborn birth at about 12 weeks or so and it was sent to the morgue for some reason, and never claimed. A couple of months later the family decided they wanted an autopsy. So I had to do an autopsy on a mummified 12 week fetus. They had bothered to put the little bonnet on its head, but otherwise it was shriveled and brown.

    5) 16 week or so fetus, the POC is sent down as one specimen, and there is a second specimen labeled "heart." They wanted us to identify if there were any clear cardiac anomalies. It was about the size of a marble. I took it to the dissecting scope and found the PFO but that was about all I could tell.

    6) about a 12 week fetus, sent down POC and wanted to know if it was an imperforate anus.

    On a related note though, eyeballs are the specimen that freaks me out the most. Cutting into an eye makes me squeal. I remember doing it the first time in anatomy lab and I felt like I was sticking a knife into my own eye.
     
  12. OP
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    LADoc00

    LADoc00 Gen X, the last great generation
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    Hmmm I specifically DO use baby hands and feet because I can eyeball in a hurry without using a full scope and instead a spare loop I carry if I really need to.

    On a related note: There was a urban myth or in fact a true story of a group of lesbian UCSF trainees that would always submit the penises, as some sort of sick manhating ritual...Ripley's believe or not type crap!
     
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  13. Gut Shot

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    I had a huge string of 20+ week abortions to gross/autopsy in January-February. Capped them all off with a QPWC at the hospital McDonald's (which, oddly enough, is right down the hall from the morgue).

    You guys are a bunch of pooswahs.
     
  14. OP
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    LADoc00

    LADoc00 Gen X, the last great generation
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    I usually like chow down on White Castle while my trusty lab assistant has to stack all the baby body parts, limb amputations and reduction mastectomies into the incinerator. It has almost a Nazi concentration camp feel it all sometimes, one of my assistants today tried to joke about this leg and aborted fetus we were transporting, I snapped "have some f-ing respect!!" then started laughing too, you cant help it. Its so unbelievably insane. Nothing med school prepares you for.

    PS-Anyone else hear the story about the 1200 aborted fetuses that were found during a siemic refit underneath a California hospital?? Turned out the company they were hiring to incinerate them was just stuffing em under the foundation. When the hospital admin found out they got pissed and had the pathology staff yanking molded abortions out for days...
     
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  15. Gut Shot

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    I presume that's a taste you acquired in St. Louis, although you can buy those little suckers frozen nowadays.

    In any case, no, abortions don't freak me out whatsoever. Maybe if a twin IUFD case showed up and one was giving the other a Dirty Sanchez, well, perhaps then I would take pause. Until then, no amount of googly eyeballs or tiny jaws dislocated "mid-scream" does anything to humanize the little sacks of neverweres for me.

    There are quite a few things that I find disturbing, but few of them spill directly out of the womb.
     
  16. deschutes

    deschutes Thing
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    Only the secondmost oddest place, right behind the coronary care unit. Subtlety isn't a lost art!
     
  17. stormjen

    stormjen Path PGY
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    I had a holoprosencephaly case too, with the proboscis. I handle the aborted fetuses okay; the only thing I really dislike is having to stick my finger in the mouth to check for cleft palate. That gives me the willies.
     
  18. augmel

    augmel Senior Member
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    Before med school I worked as a autopsy tech/path lackey and one of my jobs was dumping the old surg path specimens to drain off the formalin and then bag the specs for incineration. Sounds unpleasant but I actually enjoyed it cause I could listen to NPR and not be bugged. Anyhow, I would get going fast just dumping specimen after specimen in the sink, until one day I dumped a whole intact fetus, ~ 25 weeks old into the sink. Closest I ever came to fainting. So completely unexpected after seeing gallbladders and colons day after day.
     
  19. fomites

    fomites Senior Member
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    oh mah farking gawd. This is what I get for invading the path threads. Just read all this abortion stuff and I think I need major therapy!!!!! (+ versed cocktail)
     
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  20. djmd

    djmd an Antediluvian
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    What excatly did you expect when you saw a topic labeled "Abortion pathology", a tread where we all talk about all the secrets of pathology because on one else will read it...
    Nothing to see here....


    So dark the con of man, my brothern...
    We have thwarted the outsider...
     
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  21. OP
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    LADoc00

    LADoc00 Gen X, the last great generation
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    Welcome to our world, now kindly get the f- out.
     
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  22. fomites

    fomites Senior Member
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    play nice. down boy.
     
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  23. OP
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    LADoc00

    LADoc00 Gen X, the last great generation
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    Hehehe Always wanted to say that, nothing personal.
     
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  24. njac

    njac Senior Member
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    now I'm curious - why would surgical abortions get autopsies?

    I worked in a vet path lab for awhile and we got all sorts of cool stillborn stuff (and all sorts of nasty the farmer found it 2 days after it was "born" and still sent it in...) but as we don't really do surgical abortions in animals other than pinching off a twin or something it was just a non-issue.

    I guess if I had an abortion I don't think I would really want an autopsy report on it.
     
  25. OP
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    LADoc00

    LADoc00 Gen X, the last great generation
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    Its based on state laws and hospital guidelines, but most commonly past the age of viability, an autopsy is performed rather than billing for a surgical. If the abortion was elective then obviously an autopsy makes no flippin sense! But I dont make the rules I follow em.

    And as side note, pathologists rarely do anything based on what a patient "wants". In my own practice people get skin lesions taken off all the time, then are pissed that a pathologist will examine it and they will get a separate bill from the derm visit. But that is the law.

    You would almost never see anything related to an elective abortion in terms of pathology, except the bill!
     
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  26. PathOne

    PathOne Derminatrix
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    Actually, I've never personally had a problem with those kinds of autopsies, but then again, I've done tons of forensic - and sometimes really, really weird - stuff. Still, I really don't see the point, except in spontaneous abortions, where parents would be naturally concerned about what went wrong. But unless it's something really obvious, the pathologist can rarely come up with a good explanation.

    Frankly, the thing that bugs me the most, is that they're so darn small, so it takes a long time to do a proper autopsy.
     
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