Monday, February 13, 2012

Tale of 2 pregnancies . . .

I had 2 ladies in the labour room yesterday (Sunday, the 12th February, 2012).

The first one was SD. . .  In fact, it was a bit funny. Dr Titus was on co-call with me. And I was just commenting about how long it had been since we had a patient with eclampsia. SD came in sometime around 2 pm. She has been in labor for quite a long time. . . In fact, almost 36 hours. She had initially tried to deliver at home. After which she was in the district hospital for almost a day before she decided to go to a nearby private hospital today early morning. By afternoon, as the relatives saw that nothing much was happening, they decided to bring her to NJH.

We saw SD walking in through emergency. In fact, we realized that she had a urinary catheter. And was it blood tinged? Yes, it was. . . We really scratched our grey cells on why this patient was kept in labor for quite a long time. We found out  - - more than an hour later.

After a detailed examination, we decided to keep her for normal delivery for another 2 hours. The baby seemed fine although the liquer was a bit meconium stained. She was about 8 cms dilated which prompted us to keep her for normal delivery. As the nurses were ordering the medicines, one of the relatives asked her if she could use some of the medicines which was purchased in the previous hospital. The nurse asked them to bring the lot . . . and along with the normal medicines used in the course of labor, there were half a dozen ampules of magnesium sulphate.

The nurse immediately informed Titus. We asked the history once again. Well, the lady had 2 episodes of seizures sometime during the time she was trying to deliver at home. They did not realise that the history was important. Somehow, it was almost couple of hours after she was admitted. And, we did a repeat per vaginal examination. Nothing much had changed. 

SD was posted for a Cesarian section. The baby was a bit sick, but after a good resuscitation, he's done well. SD was also sick during the post-operative period. However, overnight she has made a good recovery. 

The second one who we'll call RD . . .  It was RD's first baby. RD had been in labor since the last 3 days and she had been leaking since almost 36 hours. RD was trying for a home delivery with the help of a retired nurse. The interesting aspect was that RD had another 3 more weeks to go before her due date. On a detailed history, the pain with she started did not look like normal labor pains. I thought that it looked more like a urinary tract infection. But, she was put on intramuscular oxytocin injections - to speeden up the process. And there was no looking back. 

To complicate matters, she had started to leak. But, she did not take it seriously and did not report it to any of her relatives. The delivery having been planned at home - most probably, there was not much of a seriousness in the whole affair. However, sometime around Sunday afternoon, the relatives started to become concerned - which is when they brought her to NJH. 

With RD having been leaking since 36 hours, I had to explain to the bystanders about the possible complications of chorioamnionitis and a prolonged labour. They looked quite well off for our usual clientele and therefore, I gave them the option of taking to a higher center. They initially refused and allowed us to manage her. I was not much in favor of going in straightaway for a Cesarian section. 

She was about 3 cms dilated with full effacement. I explained to they relatives about us taking the risk of trying for a normal delivery. I decided to give it a try as long as there was no sign of a fetal distress. I was surprised that RD progressed textbook fashion. But then, she suddenly stopped contracting at full dilatation. I had to do a vacuum extraction of the baby. 

The mother and the baby are doing well. 

Both SD and RD could have ended up with severe complications endangering the lives of both mothers and babies. They are blessed to have had happy endings. We praise the Lord for the same. . . 

As I had mentioned in many of my posts, the solutions are not very difficult. SD need not have run from one hospital to the next, trying for a good management. RD should have been investigated for urinary tract infection, before a decision was taken to induce her. . .  And how was the induction done . . .Intramuscular Pitocin . . . It continues to be a scourge in maternal healthcare all over the country. And RD was quite unaware of the dangers involved when she started to leak . . . And the worst of all - especially when a patient comes from another healthcare provider - the lack of a proper referral letter . . . SD and RD could have been provided referral letters by their previous respective care providers . . . 

All these are not rocket science . . . We've been shooting off rockets with satellites into space, manufacturing supercomputers and contributing heavily into the information technology field and more interestingly developing into a medical tourist destination . . . But, what a paradox - when it comes to providing safe delivery facilities for our sisters and mothers, we come up a cropper . . . 

1 comment:

  1. Your blog has in a way revived all my memories. Its now six log years that I left Lasalgaon a small town in Rural Maharashtra and even left Gynac.
    Now I am in HIV field sleeping every night.
    All these CD and RD are familiar faces to me.
    I shiver.
    And all those senseless academic discussions about reducing maternal mortality!