Sunday, March 3, 2013

3 adverse maternal events . . .

Today, I'm on first call after quite a long long time. Necessitated as we are just 3 of us running the hospital from Friday last. Many a time, I wonder about how long I shall shout about adverse maternal events in this part of the country. And every time, I get an answer about what to do . . . Yes, continue to shout about it till something happens. 


We had 3 mothers today . . . all of them had gone through adverse events. Of the three mothers, one was already dead by the time she reached us. The second one was . . .  from a medical point of view . . . a gone case . . . it would need a miracle for her to live. The third one came to us on time . . . she should live. 

Their stories . . . 

The first patient, AA, was a known case of pregnancy induced hypertension. She was supposedly under treatment. However, I did not see any records. Therefore, not sure. She had started to have convulsions today early morning. They had taken her to some hospital in the nearby district headquarters. From where they were asked to go to NJH. It was too late for her. She was dead by the time she arrived. 

The second patient, BB, a primi mother had been having contractions since the last 3 days. When she did not deliver by today morning, they took her to a hospital nearby where she delivered a macerated baby. But, then her abdomen started to distend. She was given a letter to go to Ranchi. 

Her relatives brought her to us. The family was too poor. And her blood group was O Negative. She was putting out blood from her bladder. And then to our horror, found out that she was leaking urine. And on putting a nasogastric tube, there was pus coming out. Most probably, she had undergone abdominal massage when she was trying to deliver at home. 

My provisional diagnosis - Rupture uterus with bladder involvement and intestinal necrosis following abdominal massage. 

Thanks to a new fund we created following a donation from a well wisher in Australia, we paid for her travel to Ranchi. I can only pray that she survives. 

The last patient, CC. Into her 2nd pregnancy, she had a cord prolapse. And her baby was dead for almost 2 days. There was pus pouring out from the uterus. The last thing I wanted to do was a surgery to deliver a dead baby which was stuck in the uterus. But, that is what the doctor who first saw her elsewhere wanted us to do. 

I was not sure about how friable was the uterus. She was in full blown septicemia.

We took a decision to try to do a craniotomy and keep her ready for laparotomy if the uterus ruptures in the process. It's a difficult thing to do a craniotomy and I always pray that I do not end up doing one. 

As we were explaining to the relatives about all possible complications, the fortunate lady suddenly started to have contractions. And she miraculously delivered normally. It was a relief. 

It was very unfortunate . . . for the first two ladies . . . 

Next week, it is International Women's Day on the 8th. 

I pray that we would continue to make a difference in the lives of women in our surrounding communities especially when it comes to managing their pregnancies . . . 

1 comment:

  1. Hi Dr Jeevan,

    I am a medical student from Singapore and i happened to chance upon your blog. I just wanna thank you for sharing your experiences and thoughts. It really inspires me and i'm very heartened to see you helping the villagers and all. You're doing great work and thank you for remembering the deep human aspect and spirit of medicine. I'll be working hard now so that i can help more people when i go down to Cambodia the end of this year and also in the future. Thank you for the inspiration!

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