I just wonder . .. .

It has been quite a long time since I posted something about the maternal and child health care we do at this place. We do quite high risk obstetric care in spite of all the limitations we have. And it has been some time since we got any sort of high risk patients. 

However, today we had two bad cases. 

The first lady, RB - a primi at term with regular antenatal check ups had been trying to deliver at home since the last 24 hours. The reason for trying to deliver at home - 'she's had a normal antenatal check up' - according to her brother. 

Dr. Johnson was on duty. RB's was dead and was in a face presentation. And she was running a fever. Blood investigations showed sepsis. It was a tough call. Mother in sepsis and a dead baby with a very difficult presentation. We called up Dr. Shalini who is in charge of Obstetric Care in EHA. A craniotomy was the best option. 

I had never done one for a face presentation. However, Dr. Shishir had experience of doing couple of them on a face presentation. I have never liked doing these destructive procedures and to do one for a face presentation was all the more unthinkable. Thankfully, the procedure went well. 

Late evening, we had another of our routine eclampsia patients. With a twin pregnancy and having been having fits since more than 12 hours, CD was a very high risk patient. And being quite well off, it was quite surprising that the family did not want to take her to a higher centre. 

Again, Dr. Titus, our doctor on duty got in touch with Dr. Shalini and she advised to go in for a Cesarian section. The surgery went off uneventfully. The babies needed active resuscitation - but they are doing well for the time being, although both are around 1.5 kilograms. 

Well, what did I wonder? 

As you can see, both the women had received sub-standard care. RB should not have been in labour at home for over 24 hours and CD should have gone ahead to a higher centre. It was quite risky for CD to have given a high risk consent for us to go ahead with the surgery. . . however lengthy the consent was . . . the family even accepted that CD could die on the table. 

All the 3 babies born were G I R L S. I find it difficult to accept that neither RB nor CD's did not know that the babies were girls . . . although I may be wrong . . . Dear Lord, I pray that my hunch is absolutely wrong . . .