I feel like this is such a stupid question, but it’s been bugging me for ages. In drawings of the female reproductive system, the fallopian tubes are shown with connections at the top of the uterus, with ovaries on the ends of the tubes. I am familiar with where the ovaries are in the abdominal cavity under non-pregnant conditions (as I’ve got a set myself, and the very kind obgyn that did my first pelvic lo those many years ago pointed them out to me).
By the end of a full term pregnancy, the fundus (top of the uterus) has managed to stretch and cram itself up near the rib cage. At this point, where are the fallopian tubes and ovaries? I don’t recall seeing them indicated on the standard pregnancy literature. (of course they’re around there somewhere) I assume the uterus stretches over its whole volume, maybe this is an incorrect assumption. I can’t figure how the tubes and ovaries would not be shifted out of their customary positions. Do they manage to stay low in the abdominal cavity? Is their attachment point lower on the uterus than I think? All I could find via Googling was a lot of very uncomfortable sounding bits about fallopian torsion and the badness thereof.
In this illustration you can see where the fallopian tubes and ovaries arise. Here, you can see that the fundus, or top part of the uterus stretches and rises, while the areas of the falopian tubes and ovaries remain essentially the same.
They move a bit, but not as much as the body of the uterus. The whole thing is basicly free floating, so mobility isn’t a problem.
Thanks. So all that increase in volume is coming from the portions of the uterus above the fallopian tube connection - even more reason to be in awe of the amazing stretching organ.
There was a doctor on Oprah when I was home on maternity leave after having my first daughter. He was showing actual body parts, and had a uterus sitting on the table all by itself. It looked like a really ugly coin purse. The thought of something that small managing to not only encompass an infant but still work effectively enough to push it out just made me boggle.
The uterus stretches throughout pregnancy, of course, and the top part (the fundus) stretches quite a bit before the bottom part stretches notably.
You know how women get “bikini cut” c-sections most of the time these days? It’s a horizontal cut low on the abdomen and uterus (about where that fetus is staring, actually, Maybe he’s looking for the scalpel!), which heals better, with less scarring and more muscle integrity - it’s most often possible to have a vaginal childbirth after a bikini cut c-section without more than a slight increase in risk of uterine rupture.
Anyway, the point is, when I had my c-section at 23 weeks of pregnancy, it had to be the old fashioned midline kind, because the bottom part of my uterus wasn’t stretched out enough for them to get her out down that low. They had to cut into the stretched out fundus and pull her out up high.
Nope. 23 weeks 6 days and a lot of luck. There was a big thread on in in 2005. 23 weeks 0 days at a Level III NICU has about a 30% of survival these days; 24 weeks 0 days has a 70% chance. We were lucky to be in a Level III.
They saved a 21 week 6 dayer in Florida in 2006 (Amillia Taylor), on accident (they thought she was 23 weeks), but I think she’s got some developmental issues.
ETA: Actually, I take it back. They saved her because the mother lied about her gestational age - later investigation into her IVF records showed the actual date of implantation. And the latest article I can find mentions no disabilities, so I may have been conflating my micropreemie stories. 'Miracle' baby born two weeks before legal abortion limit | Daily Mail Online
I remember your story, WhyNot, and that article you linked was interesting. I knew about the “24 weeks viability” standard, but didn’t realise there was a law about it (at least in some places). I always assumed (hoped?) it would be a bit of a case-by-case basis, in that early signs, such as trying to breathe, or moving or whatever would indicate making an effort to save the baby or not. But I guess had they thought she was at 22 weeks, they wouldn’t have done a Caesarian, or wouldn’t have handled the delivery the same way. I’m uncomfortable with the 24-weeks line drawn in the sand like that… I hope most doctors are willing to push the boundaries occasionally!
Depends on the state. Planned Parenthood v. Casey did away with trimester restrictions in favor of viability standards. Some states declare viability to be at X weeks (27 is common, as that’s when 90% of fetuses are viable, 24 less so, last I checked). Illinois does it on a case by case basis - to have a legal abortion, two doctors must examine the woman and declare the fetus nonviable. I’m not sure how that works, logistically, at 10 weeks when no one would argue it’s viable, but in later stages it’s very literal and you will be seeing two docs before you can get an abortion. They use not only gestational age but size on ultrasound, amniotic fluid level and I’m not sure what else to determine viability.
Like you, I prefer that method to the X weeks method, ethically and biologically.
That makes me feel better, thanks for that information! I’d hate to think that a number in a bit of law would be the difference between hooking up an oxygen line or not (I know it’s much more complex than that, but you know what I mean!)
One of the criteria that can be used to determine foetal viability is weight- foetuses under 500 grammes generally being considered non-viable.
You can get a pretty good estimate of weight prior to delivery using modern ultrasound scanning techniques.
Obviously, parental choice would be a factor too. If someone didn’t want aggressive resuscitation of their 24 week 506 gramme baby, one would hope that their choice was respected.
At most c-sections I’ve been at the surgeon used the fundus of the uterus as a guide, moved to the edges, felt down the length of the fallopian tubes and felt for the ovaries, before bringing them out of the incision to check they looked healthy.
Think of the uterus as a triangle with the point downwards. The fallopian tubes are attached to the top two corners of the triangle, the ovaries are on little stalks attached about halfway down on each side. As the pregnancy advances the ovaries stay more or less where they are, and the fallopian tubes move up and out.
That’s the part I find most amazing about little Amilla. She was 283 grams! 2.8.3.!!! :eek: And odder yet, one eye was open at birth! (WhyBaby’s eyelids didn’t open until a couple of weeks after her birth, which is much more normal.) Amilla self extubated (pulled out her own breathing tube) 6 times before she was 4 pounds. That is one *strong *little baby girl. I know her case has caused an uproar about viability, but people should really understand that she is a very odd little duck, and 99.9% of babies at her gestational age just wouldn’t make it at all with our current medical technology, nevermind without apparent disabilities at her second birthday. THAT is a miracle baby, folks. Using her as our model for viability would be like using Verne Troyer as our model for countertop height.
