The teenager didn't realise she was pregnant until she went to the hospital with stomach pains. (Photo credit: Jamie Grill via Getty Images)
Patient: A 15-year-old girl from Lesotho, South Africa.
Symptoms: In 1988, a young woman came to the hospital with intermittent, sharp abdominal pain. An examination revealed that she was about nine months pregnant – but she claimed to have been unaware of her condition. Her uterus was contracting at regular intervals, and her fetus was positioned head down in the birth canal.
What happened next: When doctors in the emergency room examined the patient’s vulva, they found no vaginal opening. Instead, there was a shallow, skin-covered dent between her labia minora and under the urethral opening, which drains urine from the bladder. This rare condition, where the vaginal opening is missing or closed, is called distal vaginal atresia and affects about 1 in 4,000 to 10,000 newborn girls.
Doctors gave the patient a spinal anesthesia and performed an emergency Caesarean section (C-section), resulting in the birth of a healthy baby boy weighing 6.2 pounds (2.8 kilograms), according to a case report.
After the birth, an examination revealed that the patient's uterus ended in a vagina that was only 0.8 inches (2 centimeters) deep, according to the report. (The vagina is usually 2 to 4 inches (5 to 10 cm) deep, but can increase to 8 inches (20 cm) during arousal.)
Diagnosis: The patient had previously presented to the same emergency room 278 days, or just over nine months, earlier after a man stabbed her in the upper abdomen. The knife penetrated her abdominal wall and caused two wounds. At that time, doctors treated her injuries and discharged her from the hospital.
Months later, while the patient was recovering from a C-section, she told a nurse that the attack had occurred when her ex-partner caught her performing fellatio on a new boyfriend. Doctors concluded that after the stabbing, semen she had swallowed had entered her reproductive organs through tears in her digestive tract, causing her pregnancy.
Treatment: The patient's recovery was uneventful, and she and her partner eventually came to terms with the circumstances of the child's conception, the report says. Several years later, the boy began to resemble his father, the man she was having sex with at the time of the attack, which the doctor says “rules out an even more miraculous conception.”
What makes the case unique: Fertilization usually occurs after sperm enters the female reproductive system through the vagina. Acidic environments, such as the gastrointestinal tract, are unfavorable for sperm. However, saliva is less acidic than other parts of the digestive system.
Acidity is measured on the pH scale, which ranges from 0 to 14 — the lower the number, the more acidic. The stomach is acidic, with a pH of 1.5 to 3.5. Saliva typically has an average pH of 6.7, which is close to neutral. This may explain why the sperm in this case remained viable after being swallowed, according to the report.
Moreover, when people are deprived of food, their digestive systems become less acidic and more alkaline, the doctor noted. The patient was malnourished at the time of the stabbing, which may have created more favorable conditions for the ingested sperm as it exited her digestive system and passed through the stab wounds in her abdomen to reach her uterus, the doctor suggested in the report.
Disclaimer
This article is for informational purposes only and does not constitute medical advice.
TOPICS Diagnostic Dilemma
Sourse: www.livescience.com
