Monday, April 30, 2012

The hidden pregnancy . . .

(All the pictures in this post are per-operative pictures which could look gory - kindly view with caution)

Well, here is the first of the interesting cases that we had last Saturday

GD, had come to us with a history of abdominal pain after having been pregnant for about 4 months. She was pale, tachycardic and had been diagnosed elsewhere to have an intrauterine death. 

She had been sick for the last 4 days. We did an ultrasound. Surprisingly, the dead fetus was outside the uterus. Well, the possibilities - 

1. The family was not giving us the full picture. She could have gone for a septic abortion using a stick. The stick could have caused an injury pushing the fetus into the abdominal cavity. 

2. It could be an abdominal pregnancy . . . 

We once again confirmed the history. They were very definite about not being in the former scheme of things. 

Well, what was she doing for the last 4 days. For the first 2 days, she was in our adjacent district headquarters trying to get a diagnosis. They had treated her anemia. Investigations elsewhere showed a hemoglobin of 5 gm%. She had already recieved 2 pints of blood. She was referred to the nearest district headquarters as nothing was happening. The family informed us that they were waiting for the dead fetus to be expelled. 

At the adjacent district hospital, they went ahead and induced her for delivering the dead fetus. The lady was there for more than a day. 

Since, 'nothing' much was happening, they decided to come down here. 

We told the family that she needs to be operated on. The family was well off. And as Nandamani and the rest of the team discussed the case, possibilities of intestinal involvement etc. weighed on us. We gave them the option of going to a higher centre. The family was tired after having visited quite a number of hospitals. 

The next problem was the availability of blood. The family had already arranged 2 pints of blood. They tried their best and arranged one more. One of our staff volunteered to donate so that we could start the surgery soon. We were already looking at the possibility of septicemia as she had been sick since the last 4 days. 

Below are the snaps from the surgery - 

As we opened the abdomen

The pregnancy in the broad ligament. The uterus and the right ovary can be clearly seen

Placental adhesions to the intestines . . . 
The diagnosis - Left broad ligament pregnancy ruptured with adhesions of the placenta to the sigmoid colon and the small intestine. . . 

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