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.
