Thursday, November 15, 2012

Maternal care . . . cont'd


(The snaps in the blog are of a repulsive nature to the general public. User discretion advised. Consent from family members have been obtained)

After the last update, there were couple of more cases which I thought would be worth mentioning.

Both happened last night.

UD had been in labour since the last 24 hours. She had also received intramuscular injections at her house. She had gone to the district hospital as well as the private hospital in town. She reached NJH late evening yesterday. This was UD's first pregnancy. 

The diagnosis – Face presentation with obstructed labour and septicemia. She was posted for emergency surgery. The uterus was stinking. It was a surprise that the baby was alive although severely asphyxiated and sick.
 
Bruised in labour . . . Neglected face presentation

MD came just before midnight. A G6P5L3D2. She had been in labour since early morning. It was only after a whole day of trial at home that the family decided that MD needs medical help.

Through the customary detour of the District Hospital and one of the private hospitals in town, she reached NJH. The diagnosis was obvious – Rupture Uterus. Investigations revealed that she was in sepsis as well as severely anemic.

We waited for blood which never came. By early morning, we decided to operate on her without blood. The surgery was uneventful. It was a rare type of rupture we saw. The uterus had ruptured in the posterior wall. The anterior wall was clean. One can only imagine the trauma MD went through till she reached us. 

The posterior rent . . . The baby was in the peritoneal cavity
The uterine tear was much beyond repair and our surgeon, Dr Nandamani had a tough time understanding the anatomy as he did the hysterectomy. 

I hope you remember about DD about whom I wrote in my previous post. DD's family was well off. Yesterday as I did my rounds in the evening, there were few of her relatives in the room. One of the ladies wanted to know about the condition DD had. I told them the name of the disease  - -  eclampsia. Then another of the ladies commented on how DD had high blood pressure during each of her pregnancies. In fact, she had seizures during her first delivery. 

And the family was well warned that she has a good chance of having high blood pressure during her second delivery. Therefore, they made all arrangements to have her second delivery at a tertiary centre in Ranchi. In fact, she had high blood pressure and underwent a Cesarian section. 

Fast forward to the third pregnancy. Nobody bothered to ask them about her previous pregnancies and only when she started having seizures did the family realise that it is serious. So poor an antenatal care did she have that in spite of being a high risk pregnancy (previous LSCS and history of eclampsia in the first pregnancy and pregnancy induced hypertension in the second pregnancy), nobody bothered to do an ultrasound abdomen. And nobody told her about ensuring a hospital delivery. 

Well, I don't think I need to give any further details to show on how much of a lackadaisical attitude most of us in health profession have towards our patients . . . Not only DD, even UD, who spent almost 8 hours at other health facilities and MD who spent almost 12 hours in health facilities before a decision was taken to intervene. 

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