Hiding the horror

I’m sure that the sad story of SS is quite fresh in your minds. However, you’ll be stunned when you hear the story of RD who came to us few days back.

RD arrived sometime in the midnight. As is the protocol, the nurse on duty took the history which looked quite innocuous. RD, a primi was quite regular with her antenatal care check ups at NJH. The last time she came to NJH, she was already 5 days past her Expected Date of Delivery. 

The doctor in outpatient had asked for admission so that we could induce her. The family left with a promise to come back the next day. They did not turn up the next day, but arrived at midnight of this particular day which was about five days after her last visit to outpatient department.

According to the family, RD had started to have contractions from 6 pm – about 6 hours before she arrived at midnight. On per-vaginal examination, she was already 8-9 cms dilated. A perfect progress if not a fast progress of labour. The plan was put up for a re-assessment at around 3 am in the morning. There was only one thing which worried the team. The head was a bit higher than usual and a small caput had formed.

At around 2 am, the doctor on duty received a call to attend to another emergency. After that was settled, he decided to take a look at RD before it turned 3. Per abdomen, the head was still palpable. A repeat pervaginal examination showed that the head was still quite high and the caput had increased in size. During this pervaginal examination, there was a foul smell coming out from her vagina. The staff asked the patient once again about any leaking which started earlier.

The patient had been quite positive that there was no leaking. However, a new relative who had just come blurted out that she had been leaking for 3 days.

The family was conveyed the decision to take her up for Cesarian. And of course, the high chance of having a sick baby and septicemia in the mother.

Per-operative, the uterus appeared quite edematous and the liquer was stained with meconium. The baby was quite sick. Something was amiss.

The doctor closed the uterus and as is the usual protocol checked the posterior wall of the uterus. And what he got was the shock of his life. There was a hole in the posterior wall. Below is the snap of the posterior wall.

The patient was wide awake to talk. The team told her what has happened. The doctor told them that he suspected that she had been subject to abdominal massage and longer period in labour.

The story she told us unbelievable. After she returned from outpatient 5 days back, RD had gone gone to a quack who gave her some injections to increase pain. Nothing happened for the first two days. On the third day, she was again given injections and a massage of the uterus was done. She started to have contractions on the fourth day. When the contractions were quite good for about 6 hours, the quack did more vigorous massage with the intention to push the baby out. But, nothing happened.

One of the relatives realized that it may be better to go to hospital.

They had concealed the original history.

RD is lucky. The baby had very bad birth asphyxia and meconium aspiration. It was a baby boy. They have rushed the baby to a tertiary centre in Ranchi.

We pray that RD would recover without any problems. She was in florid sepsis when blood tests were done. And also remember the baby in your prayers. 

Living on the edge

It's sometime that I've written about the high risk obstetric patients that we continue to have at NJH. Of course, winter is considered to be off-season for obstetric care. 

The first one was TB. TB was into her fourth pregnancy. Her first 2 deliveries were at home. The third one was a Cesarian section done 5 years back. She had no clue on why the surgery was done. 

She came in with labour pains since about 12 hours. They were trying to deliver her at home when someone thought that something was amiss. On arrival, we were quite convinced that she had ruptured the uterus. 

On opening, there was something funny. The rupture was not along the previous suture line. The rupture had happened along the lateral aspect of the body of the uterus.

There can be only one diagnosis. The gravid uterus was massaged and thus the rupture happened. On finishing the surgery we asked the relatives whether some sort of massage was done. They were quite surprised that we found that out without their telling it to us. 

TB's 3 children are lucky to have their mother alive. 

The next patient, whose story I am going to narrate is not yet out of danger. SD, a young mother of a one year child came around the 8th month of her pregnancy. The problem was she was bleeding. 

We could tell that clinically, her hemoglobin did not look beyond 3 gm%. She had a complete placenta praevia. It was horrifying to note that she had spotting on and off and her relatives never thought that the condition could be life-threatening. 

More on SD in my next post . . .