Location
Suwanee, GA
Start Date
7-5-2024 1:00 PM
End Date
7-5-2024 4:00 PM
Description
Introduction: People experiencing homelessness can struggle to have basic healthcare needs met due to a variety of factors, potentially resulting in the progression of untreated health issues and development of complications. Since the COVID19 pandemic, rates of homelessness have increased and women are the fastest growing subgroup. Women have a higher need for preventative care, especially when considering reproductive health and gynecologic issues. Health education and treatment, even for seemingly benign conditions, is imperative for improving health outcomes of women experiencing homelessness.
Case description: A 38-year-old woman experiencing homelessness becomes unresponsive, and an onlooker calls 9-1-1. No medical history is known except the patient is suspected to be around 40 weeks pregnant. EMS notes the patient is in asystole, and they begin chest compressions and oxygen en route to the hospital. Neither fetal heart rate nor fetal movement were detected by the paramedic. Upon ED arrival, two OB/GYN physicians boarded the ambulance and began an immediate postmortem cesarean section. Access into the abdominal cavity was obtained with a vertical surgical incision. As the physician lifted the enlarged uterus, the patient regained consciousness and a pulse. Surprised at the unexpected turn of events, the OB/GYN lost grip of the uterus and the patient returned into asystole. Upon further assessment, it was determined that a large fibroid tumor, not a fetus, had resulted in the patient to suffer an extreme supine hypotensive event. She was promptly transported to the operating room for an emergency hysterectomy, and encountered no further complications. However, lacking understanding of the situation, she demanded to see her baby when she awoke in the postanesthesia recovery unit.
Discussion: Uterine fibroids, or leiomyomas, are the most common tumors of the pelvis in reproductive-aged women. While vastly benign, patients may develop symptoms depending on tumor location or size. Giant fibroids can grow up to 11.4kg and increase risk for supine hypotensive syndrome, causing decreased cardiac output and loss of consciousness due to compression of the inferior vena cava. In the case of our patient, adequate access to medical care would have likely led to early diagnosis and management of the fibroid. This would have also given an opportunity to educate the patient, thus limiting potential mental and emotional repercussions caused by her mistaking her symptoms for pregnancy.
Conclusion: This case illustrates the struggles faced by an unhoused woman lacking healthcare. Barriers to healthcare access include cost, transportation, low health literacy, and perceived stigma from healthcare providers. Current efforts to improve health outcomes for low socioeconomic groups, including the Affordable Care Act, free health clinics, and targeted health education for underserved populations, are beneficial yet often underutilized. Increasing health literacy and breaking the cycle of mistrust of the medical system may help encourage utilization of available programs, but bridging the gaps in healthcare for houseless women will take a continued multifactorial effort from several entities.
Embargo Period
6-25-2024
Included in
Where is the baby?
Suwanee, GA
Introduction: People experiencing homelessness can struggle to have basic healthcare needs met due to a variety of factors, potentially resulting in the progression of untreated health issues and development of complications. Since the COVID19 pandemic, rates of homelessness have increased and women are the fastest growing subgroup. Women have a higher need for preventative care, especially when considering reproductive health and gynecologic issues. Health education and treatment, even for seemingly benign conditions, is imperative for improving health outcomes of women experiencing homelessness.
Case description: A 38-year-old woman experiencing homelessness becomes unresponsive, and an onlooker calls 9-1-1. No medical history is known except the patient is suspected to be around 40 weeks pregnant. EMS notes the patient is in asystole, and they begin chest compressions and oxygen en route to the hospital. Neither fetal heart rate nor fetal movement were detected by the paramedic. Upon ED arrival, two OB/GYN physicians boarded the ambulance and began an immediate postmortem cesarean section. Access into the abdominal cavity was obtained with a vertical surgical incision. As the physician lifted the enlarged uterus, the patient regained consciousness and a pulse. Surprised at the unexpected turn of events, the OB/GYN lost grip of the uterus and the patient returned into asystole. Upon further assessment, it was determined that a large fibroid tumor, not a fetus, had resulted in the patient to suffer an extreme supine hypotensive event. She was promptly transported to the operating room for an emergency hysterectomy, and encountered no further complications. However, lacking understanding of the situation, she demanded to see her baby when she awoke in the postanesthesia recovery unit.
Discussion: Uterine fibroids, or leiomyomas, are the most common tumors of the pelvis in reproductive-aged women. While vastly benign, patients may develop symptoms depending on tumor location or size. Giant fibroids can grow up to 11.4kg and increase risk for supine hypotensive syndrome, causing decreased cardiac output and loss of consciousness due to compression of the inferior vena cava. In the case of our patient, adequate access to medical care would have likely led to early diagnosis and management of the fibroid. This would have also given an opportunity to educate the patient, thus limiting potential mental and emotional repercussions caused by her mistaking her symptoms for pregnancy.
Conclusion: This case illustrates the struggles faced by an unhoused woman lacking healthcare. Barriers to healthcare access include cost, transportation, low health literacy, and perceived stigma from healthcare providers. Current efforts to improve health outcomes for low socioeconomic groups, including the Affordable Care Act, free health clinics, and targeted health education for underserved populations, are beneficial yet often underutilized. Increasing health literacy and breaking the cycle of mistrust of the medical system may help encourage utilization of available programs, but bridging the gaps in healthcare for houseless women will take a continued multifactorial effort from several entities.
Comments
Presented by Rohit Karnati.