Umm Fulaan is a 26 year old mum of 2 who presented to the emergency department with tummy pain since last night. She is in the second trimester of her third baby…

Umm Fulaan: Doctor please help! I’m having pain in the right side of my tummy. It hurts so bad and I’m feeling feverish and nauseous too… What’s happening to me? Am I going to lose my baby?

Dr. Fulaanah: Calm down Umm Fulaan. Can you rate the pain from a scale of 1 to 10, where 1 is the least, and 10 is the worst pain ever?

Umm Fulaan: Ah, doc. It’s around 7, but I can feel that it’s getting worse. Can you please check my baby? She is only 20 weeks…

Dr. Fulaanah: (Does a quick ultrasound). Your baby is perfectly fine ma’am. Listen, that’s her heart sound…lobdob-lobdob-lobdob…

Umm Fulaan: (Smiling) AlhamduliLlaah. But what about this pain, what does it show in the ultrasound?

Dr. Fulaanah: We need to run some special tests and then refer you to the surgeons for further evaluation…

Umm Fulaan: Surgeons??? Am I going to need surgery? A’uudhubiLlaah!

Dr. Fulaanah: Not necessarily ma’am. From my assessment it looks like a surgical case but I’ll leave them to make the final diagnosis…

*45 minutes later*

Dr. Fuleen: Umm Fulaan, how is the pain now? Hope you feel better after the painkillers?

Umm Fulaan: Yes doc. Please, tell me I don’t need surgery…

Dr. Fuleen: Umm, I’m sorry to inform you that you need a urgent surgical procedure to remove your appendix. The appendix is a small finger-like structure that projects out of your (colon) large intestine. It has no function in particular but it can get blocked by swollen lymph nodes or faeces, then undergo inflammatory changes known as acute appendicitis. If the inflammation gets worse, the appendix can rupture and release toxic substances into your system, and this could be fatal.

Umm Fulaan: SubhaanaLlaah! So, why do I need to go for surgery? Are there no alternatives?

Dr. Fuleen: We will give you antibiotics and fluids to relieve the inflammation. But this doesn’t assure a total cure. It may get better, worse or the same, because the appendix is still there. Unfortunately, from the images of your abdomen, there seem to be a lot of inflammation going on there and we wouldn’t want to take chances on your life and that of your baby.

Umm Fulaan: Hmmm… Are you now saying that this surgery will not affect my baby at all?

Dr. Fuleen: According to the American College of Obstetricians and Gynaecologists, there is no evidence that exposure to anaesthesia has any effect on the developing baby’s brain; especially with limited exposures less than 3 hours in duration. The good thing is that we will be using a technique that is minimally invasive, not the regular open incisions. We call this Laparoscopy. Through some tiny holes on your tummy, we will insert the instruments and carry out the operation with the aid of a camera. You will be out of the hospital in no time and the healing is much faster!

Umm Fulaan: Maa shaa Allaah! That sounds reassuring. I’m just really worried about the baby…

Dr. Fuleen: It’s okay in shaa Allaah, your baby will be fine. Studies have shown that such simple surgical procedures like this one – whether laparoscopic or open – do not significantly increase the rate of miscarriage when handled by experts. We will take all precautions to ensure that there are no complications. We have done many appendectomies, cholecystectomies, etc. on pregnant women in this hospital and all went well, AlhamduliLlaah.

Umm Fulaan: Alright then. I’m ready. BismiLlaah…


PS: Umm Fulaan had a successful surgery, was discharged after 48 hours of the surgery and was delivered of a healthy baby boy through normal vaginal delivery 4 months later.



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