Sunday, November 25, 2012

Eclampsia with Pulmonary Edema

The ink had hardly dried in my pen that wrote the Death Review forms of the last maternal death. Today morning, I had another shocker of a patient. 

GD, another young mother-to-be at term pregnancy came to us with hardly any breathing, and putting forth pink frothy phlegm with each gasp and having seizures. GD had gone into labour at her home in the adjacent district yesterday evening. The family thought that everything was going on normal. 

Around midnight, GD started to have seizures and became unconscious. They could not arrange a vehicle till dawn. In between, she had 3 more episodes of seizures. 

They reached the first healthcare provider sometime around 5 am, who referred her to the adjacent district hospital. They went to 2 more hospitals, both of whom referred them to NJH. 

Something which was quite disturbing was that in none of the hospitals did a doctor examine the patient. Considering into fact that she had seizures and she was unconscious, it was quite pathetic that nobody took her blood pressure, leave alone give her a dose of Magsulf

Well, as soon as she reached NJH, which was around 10 am, we had to intubate her and hook her on to the ventilator. I clearly remember all the eclampsia patients who had come to us with pulmonary edema. We could only save one of them. SDe was her code name. And this is the fourth patient. The other two died. 

Accidentally, a technician from Medisys, our provider of ventilators had come down to service of ventilators. He was quite taken aback by the load which we were putting on our ventilators. He started explaining to us that we needed more high end Intensive Care Unit ventilators to deal with such patients. Well, that would cost us about 600,000 INR. 

Our basic ventilator was not enough to deal with GD's problem. We bagged her manually. And she was maintaining saturation. However, the pulmonary edema was worsening. With a huge dose of Lasix and a GTN drip, things appeared to have settled. 

However, we had more problems. The baby appeared dead and there was sepsis. Most probably a dead baby in the uterus for long. The per vagina finding was hardly encouraging. 

We discussed with the relatives and took a decision to do a Cesarian and take the baby out. I know I would have enough consultants contesting this decision. 

Per-operatively, there was pus inside the uterus. The baby was macerated. The uterus was so unhealthy that couple of times, the thought of doing a hysterectomy crossed my mind. Then after we sutured up the uterus, the uterus was not contracting. B-Lynch suturing was done. The uterus was so flabby that we had to do it twice over. 

GD continues to be on GTN drip and on ventilator. Please pray that she would make a smooth recovery . . . 

1 comment:

  1. Really a pity. The number of women who die in transit, now that emergency transport has improved is increasing in Karnataka. I hope GD is saved.