A tragedy revisted

It is after quite a lot of proding from one of my friends that I've restarted the blog. It has been almost a week since I had been trying to think about what I should start on. And then, today afternoon, something happened which I felt should be put in...

I remember the sultry afternoon almost one year back. I was in the office, sorting some matters related to taking responsibility of the hospital I give leadership to now. One of my medical officers called me and told of a lady in labour with a hand prolapse. Usually, when a hand prolapse occurs the baby is dead. But, she thought she heard a heart sound. I went to see the patient. It was one of the many gruesome scenes I had ever seen. The baby's hand was protruding out of the vagina - and it was bluish black and edematous. Since, she was in the OPD, I pushed in for a scan and lo the baby was alive.

We somehow got her posted for an emergency LSCS - the hemoglobin was 6 gm%. The baby was sick - the inside of the uterus was stinking. She was in labour since about 3 days and the hand had been sticking out for almost a day. Unfortunately, the baby succumbed after 12 hours of struggle. Now, the effort was to ensure that the mother did not go into sepsis. We were glad that she made a good recovery. Since, there was no more complications I did not get to hear much about her again.

Fast forward one year - Today, I was in the office, when Dr. Ango rushes in saying that there is a rupture uterus on a previous LSCS. So, what was the great thing? Rupture uteruses are the order of the day in NJH. We get about 20-30 of them every year. Well, the thing was that the subcuticular skin suture was still on the patient.

Dr. Nandamani operated on the patient. The baby was dead and the uterus was sown back. In the meantime, I made discreet enquiries on how it is possible for the skin suture to have remained. It seems that the patient had absconded before she could be discharged. And the skin suture remained on her.

I felt really bad. Here was a patient who ran off most probably because she could not afford the bill - and then later comes back with a rupture uterus within 1 year. Something needs to be done here. Now, the lady has already been twice pregnant and both the time she ended up with complications and dead babies. She would need to become pregnant again if she would want not to be abandoned by her husband.

I'm going to meet this family and talk to them tomorrow. They look really poor and illiterate. Will have to convince them to come for regular antenatal check ups and then if she gets pregnant - to plan for a early elective Cesarian Section.