Around 7:00 pm yesterday, I was called into the emergency to attend to a patient with a viper bite. As I finished writing up the orders for the patient, the screech of tyres outside indicated that I had one more patient to attend to. I walked upto the gate and asked the driver what sort of patient he has just brought in. Delivery patient - was the reply.
I told the chowkidar (security guard) at the gate to shift the patient to labour room. Just as I turned to walk back towards labour room, one old lady ran behind me yelling, 'doctor, doctor - have a look at my daughter before you ask her to be taken to labour room. The baby's hand is coming out and my daughter has been in severe pain since morning.' 'The hand coming out' statement woke me into my senses. I asked the patient to be rolled straight to ultrasound.
AB was a G4P3L3 who had an uneventful antenatal period and presented to the adjacent district hospital at around 10 in the morning for normal delivery. At around 5 pm, the nurses who was monitoring her informed the family that there was a problem and she needed to be rushed to a higher centre. The hand was coming out first rather than the head. They told the family that the baby was alive.
I watched with trepidation as I scanned her abdomen. The heart rate of the baby was about 40 per minute and it was very sluggish. I told the bystanders that there was no point in doing a cesarian section as the baby was highly bound to be moribund. They were quite resigned to whatever we could do to save the mother.
I took the patient to the labour room straightaway and did a per vaginal examination. It was a compound presentation with the right arm coming in front of the head. The head was also quite descended. I weighed my options. I asked the nurse to look for the fetal heart rate which she could not find.
Using all the force I had, I pushed the head back into the uterus and slipped the hand back into the uterus behind the head. I was quite surprised at how easy the hand slipped behind the head. However, having seen a poor fetal heart in the ultrasound, I knew that there was hardly anything we could do for the baby.
Meanwhile I got a call from the Acute Care Unit. Leaving the delivery to be conducted by the nurses, I rushed to the ACU. As soon as I reached the ACU, I recieved a call back from Labour Room saying that the AB delivered and the baby was gasping. I rushed back to LR. The baby was quite sick - I got into the routine of resuscitation of the baby - but with quite a resigned attitude.
To my surprise, the baby responded quite well. There was poor respiratory effort with quite a lot of secretions. So, I had to intubate and do direct suctioning of the trachea. I ventilated the child for about 10 minutes when I noticed that the child was trying to cry. I removed the endotracheal tube and to my surprise the child started crying.
|The cyanosed right forelimb of the baby which was the initial presenting part.|
I could not believe it. Even the female relative, who was inside the labour room could not believe what had happened.
Now, what is interesting is events which happened after this. The next thing, the lady relative wanted to know was the sex of the child. The child was a girl. She was quite crest-fallen. AB started to weep.
I looked like a villian to the family for having rescued this baby. However, after some amount of talking, they were fairly convinced that the baby whatever be the gender is a gift from God and it is upto them to bring her up well.
Today morning, I was quite glad to find AB tenderly caressing the baby as I called on the family to see things were going. It was a close call for the baby. Even for AB, if she had kept on contracting, she may have ended up with a rupture uterus.
But, the saddest part of the story is that AB was referred from a district hospital and there was not even one doctor to attend to her and take a decision about her management. We thank God that we could avert a perinatal adverse event.