Saturday, August 6, 2011

Weekend Diary 2

Sorry, for all those who may think that this is the second day of the last weekend diary that I wrote ( I was too tired that I slept through the next day. Dr Ango was on duty. She mentioned about an eclampsia patient whom she had to operate. By God's grace, both mother and baby are doing fine. Then, there were the umpteen number of fever and couple of snake bites. Almost all of them went home healed.

For a change, this weekend, I am handicapped by the absence of Dr Nandamani and Dr Ango. They are off to a time of rest and retreat for 3 days. The should be back by Monday evening. And I find myself taking the call for another weekend. And as expected, I've got some time to come to my office as I wait for the results of MD who just came in. She claims she is at term. However, she has a discharge summary from us dated about 6 weeks back saying that she has a complete placenta praevia. It also says that her Hemoglobin is 7 gms%. She has been having pains since morning. It was good that someone remembered that we told her that it was dangerous to try a normal delivery. MD has other problems too. She had been pregnant 4 times before and everytime the baby had died sometime around 1 or 2 years of age. She has also disclosed that she is taking some treatment for convulsions. Her husband has shown me some tablets wrapped in a piece of paper.

By God's grace, she has brought along with her a hoard of male relatives. So, all of them have gone to the laboratory trying to find out if any of them is fit to donate blood. As soon as the blood comes, I'll operate.

Morning has also been busy. We had couple of Cesarian sections, one hysterotomy and one curretage of the uterus for incomplete abortion. Basically, after rounds, I was closeted inside the cool environs of the theatre.

LD, for whom I had do a Cesarian Section had her first baby by Cesarian section. It is not very wise to try to do a normal delivery in places like ours for quite a lot of reason. I was almost deciding on trying out for a normal delivery, but it was quite risky considering the technical and manpower backup that I had - and that too on a weekend when things really hot up. The second Cesarian was for a lady who was supposedly having a precious baby. Belonging to quite a rich family, she had gone in for infertility treatment as she did not conceive within the first year of her marriage. She conceived within 6 months into the infertility treatment and had come to us for delivery. Now, the problem was that she was a bit on the plump side and was not able to percieve fetal movements regularly since the last couple of days.

In addition, she had an ultrasound which showed lesser liquor volume. On clinical examination, the baby looked fine although the liquor volume was on the lower side. I asked for a repeat ultrasound, which showed even lesser liquor volume that the previous scan. The relatives were really petrified. I calmly told them that we would try to induce and try for a normal delivery. But, I knew this was going to be tough. Within couple of hours the nurse from labour room called me saying that the lady was creating a scene saying that she could not percieve fetal movements and the relatives were intrusively anxious.

Well, I needed to have an indication - nowadays, there is a good one - Non-reassuring Fetal Status. Off she went to the theatre and she delivered a girl baby. On the table I found out the reason for the absent fetal movements - the liquer was actually very low and in addition, the umblical cord was tightly wound around the fetus. Maybe she would have ended up with the Cesarian ultimately.

Well, they are calling me to the labour room. There is one more new patient... Shall write more if I get time... There was one more new thing we tried today.... And a patient with really bad falciparum malaria.... That would be after I see what's cooking new in the LR...

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