A 35-year-old woman presents in an emergency department just as the day shift is coming on. She is in her 21st week of pregnancy and is carrying twins but is worried because she woke up with vague cramping sensations and noticed a bloody vaginal discharge. The ED attending performs a vaginal examination and determines that her cervix has dilated and that fetal membranes are bulging into the vaginal canal. The nurse straps a monitor to her abdomen, and all in the room stare at the screen pensively. The squiggly lines tell an ominous story—the uterus is contracting, and the fetuses, incapable of independent existence at this stage of their gestation, are slowly being expelled into the world.
Ramesh Raghavan. A Question of Faith. JAMA. 2007;297(13):1412. doi:10.1001/jama.297.13.1412