THE COSTLY DELAY – 2

This is a continuation of the post THE COSTLY DELAY – 1 (http://jeevankuruvilla.blogspot.com/2011/09/costly-delay-1.html) Unfortunately, the protagonist of the this post was not as lucky as LR.

RD was in labor pains since the last evening.  It was her first baby. She was just about 8 kms away from our hospital – she had never been to an antenatal check up.

Dr Nandamani saw RD as soon as she came into our labour room the following day morning. RD was in terrible pain. On cursory examination, it was evident that there were enough complications in store. Obviously pale, RD was in obstructed labour.

Per vaginally, the baby was stuck at the outlet – the baby wedged so tight that Nandamani knew that a Cesarian Section also could be traumatic. The Fetal Heart Rate was about 100 per minute and was going down. There was thick gravy like meconium coming out from the vaginal opening during each contraction. The baby’s head which had formed quite a big caput had become a pulpy mass by now.

There was no other way. We had to take out the baby by forceps. Once we decided, Dr Nandamani was in action. The baby came out with only the heartbeat. Leaving the mother with the attending nurse – the baby was promptly intubated. He had aspirated too much of the meconium. I came in at this point. On laryngoscopy, there was too much of meconium coming out from the airways. I knew that we did not have much of chance. After sucking out quite a lot of the muck, we intubated him and started mechanical bagging.

The initial response was good – but it was only a matter of time before pneumonitis and respiratory distress syndrome could set in. He was not at all responding. There was hardly any respiratory effort although the heartbeat was going strong. We decided to continue bagging. That was when I thought about trying out our new ventilator (http://jeevankuruvilla.blogspot.com/2011/08/new-ventilator.html) on the baby – however, it could not perform well.

The hospital was quite busy and we had manually ventilated the child for quite long. And we had to attend to other patients. We had to find out a way out – I wish we had a neonatal ventilator. We decided to teach the relatives to bag the baby. There have been quite a number of occasions before when we asked relatives to mechanically ventilate a patient. The most vivid one I could recollect was a young man with cobra bite whom we ventilated manually for about 6 days – before he made a recovery – we had run out of Anti-snake Venom.

But, RD’s child was more challenging. There was much meconium clogging the lung tissue and considering that there was evidence of fetal distress for quite long – I knew that we had very little chance. There was nothing more we could offer. After a 15 minute session of educating 3 members of the family to mechanically ventilate the baby – we set off for the rest of the day’s work. The nurses were keeping a tab on the baby.

At around one in the afternoon, the nurse called me and informed the baby had started to desaturate. I took some time to reach the nursery. When I reached the nursery I had the shock of my life. The relative who was supposed to bag was sitting on the floor. I rushed in started bagging the baby. The saturation was 55%. On questioning the bystander, he told me that he thought of taking a break as he was quite tired. He also gave a excuse that since the oxygen chamber was bubbling, anyway oxygen was going to the baby – and so he concluded that nothing will go wrong. I did not know what to tell him.

Any more of intervention was of no use. The pupils were already dilated. It was only a matter of time. The baby was declared dead at around 3:00 in the afternoon.

The delay to come to hospital has cost KD her baby. One can only wish that patients like KD and LR teach their neighbours on how valuable time is when it comes to taking the right treatment at the right time and the right place. There is more in store for KD - her Hb was only 7 before the delivery. We have already asked for blood. But, the relatives are hardly bothered. Today, I saw KD - she looks quite puffed up. Considering that she had quite a long time of labour, and should have lost some amount of blood during the delivery and a very big episiotomy wound, having couple of pints of blood is essential for her to return to routine work.

However, she is luckier than SD who died following delivery today morning. But more of that in the next post.