lifted her chin. ‘I beg your pardon?’
‘Last night. I was at your fundraiser.’ She’d caught his eye. Several times. So she knew he’d been there. ‘Your voice is gorgeous.’
‘Thank you.’
She still wasn’t smiling. Maybe she was just tired from last night. He had no idea what time it had finished because he hadn’t been able to stay until the end. Tess had started getting anxious about Charlie and, although Rosemary had reassured her on the phone, Tess had wanted to see her son for herself. No way would Kieran let his sister go home on her own, so he’d left with her. And every step away from Judith had torn at his heart.
‘The guy who sang with you—he was good, too.’ Kieran hoped he didn’t sound as jealous as he felt.
‘Brad? Yeah, he’s cool.’
‘Your boyfriend?’ Oh, for goodness’ sake! He had no right to quiz her like this. It was none of his business.
He just wanted it to be his business.
She frowned. ‘Hardly. He’s my best friend’s husband.’
Good.
When her frown deepened, Kieran had a nasty feeling that he’d just spoken aloud. ‘Good that he helps in the fundraiser, I mean.’
‘Of course he would. His wife started them, about eighteen months ago.’
From her clipped tone, he was aware that he’d said something very wrong, but what? Hopefully he’d be able to smooth things over during their shift, otherwise, it would be a waste of time asking her out tonight. She’d refuse flatly and it would only make things worse between them. ‘I’d better do my rounds.’
‘And I’m due at the antenatal clinic.’
‘See you later, then.’
Her gaze most definitely said, I’d rather not. But what on earth had he done to upset her?
He was still none the wiser at the end of Judith’s clinic, when she knocked on his door. ‘Got a moment?’
Still not as warm and friendly as she’d been on the day they’d met, but maybe if he responded as a professional, she might relax with him again. ‘Sure. Come and sit down. What’s the problem?’
‘One of my mums—Rhiannon Morgan. She missed her eight-week dating scan and now she’s thirteen weeks. But she says she’s had trouble going to the loo. She’s getting cramping and abdominal pains which have been getting worse over the last couple of days.’
‘Could be a UTI.’ Urinary tract infections were very common during pregnancy.
‘I wasn’t happy about the scan. And she’s had some spotting.’
‘Threatened miscarriage?’
Judith shook her head. ‘I can’t put my finger on it, but something’s not right. The angles on the screen were…’ she waved a hand, as if searching for a word ‘…odd.’
‘Have you done a pelvic exam?’
‘No.’
Kieran frowned. ‘It could be a retroverted uterus.’ He drew a quick sketch to show her. ‘You know the uterus is fixed at the cervix but it’s partially mobile, and it’s more likely to move during pregnancy.’
She nodded.
‘Around one in five women have a retroverted uterus—where it’s tipped back instead of forward.’
‘It’s linked with infertility, isn’t it?’
‘Not necessarily. Sometimes it’s associated with endometriosis, pelvic adhesions or ovarian tumours.’ He tapped his pen on the pad. ‘Is this her first baby?’
‘Her second,’ Judith said.
‘It’s more common in women who’ve had a baby before. In pregnancy, the uterus can be tipped back, though it normally returns to its normal position again. If it stays tipped back in the second trimester, there’s a risk that the uterus will get trapped—known as incarceration—though it’s not that common.’ He shrugged. ‘About one in three thousand pregnancies, roughly. You’ll need to do a pelvic exam and check the ultrasound—retroversion sometimes mimics other problems. If you can rule out a UTI or a threatened miscarriage, it might be a malformation of the uterus.’
‘Right.’
Again, that flicker of worry in her eyes. Her instincts had been spot on in the near fortnight he’d been working with her. Why didn’t she trust herself?
Maybe he could do something about that. ‘OK. If it’s a retroverted uterus, what will you expect to find in a pelvic exam?’
Judith concentrated for a moment. ‘Her cervix will be positioned well behind the pubic symphysis, there’ll be a soft, smooth non-tender mass filling the cul-de-sac, and the uterine fundus will be in a posterior position, behind the sacral promontory.’
He nodded. ‘It’s pretty unmistakable. What management would you suggest?’
‘Give her a catheter for twenty-four hours or so, so we can decompress her bladder, and get her to do intermittent knee-chest exercises—that might put the uterus back into the right position by itself.’
‘And if that doesn’t work?’
‘Manipulation.’ She grimaced. ‘Though if you use too much force, there’s a risk of injury to her cervix, or it might distort the uterus or affect the blood flow from the uterus, so it could damage the baby.’
‘Mild to moderate force is fine. She’ll be in the knee-chest position and you’ll need a long Allis clamp—grasp the posterior lip of the cervix.’
She frowned. ‘The anterior lip, surely?’
He raised an eyebrow. Just as he’d expected, she’d picked up his deliberate mistake. ‘Exactly. It’s not a common procedure, Jude. You really know your stuff.’
Her eyes narrowed. ‘So that was a trick question?’
‘No. It was an experiment, to prove to you that you know more than you think. Trust yourself, Jude.’
She scowled. ‘I’m not a child.’
‘I know you’re not. What I’ve seen of your work is good, and your instincts are spot on. But you come across—to me, that is, not to the patients—as lacking confidence.’ Which was probably why she’d only recently been promoted to registrar.
Her chin came up. ‘I’m fine.’
‘I know,’ he said, as gently as he could. ‘Look, if you want to talk to me about anything, I’m very good at keeping things secret.’
Oh, yes. She knew that. Like his wife. And his baby. Any other proud father would be showing photographs to the midwives, the doctors and even their new mums. Swapping stories about broken nights and nappies
