Monday, July 23, 2012

Marathon Cesarian sections . . . almost all MNMs

The start of the last weekend was quite hectic one. . . By standards of many big hospital, it may not be that hectic. . . But for us, it was quite a busy time. . . Not only for us, for each of the patients involved it was a close brush with death . . .  all of them mothers delivering babies. I thought I'll share each one of them. To make things easy, I've put it in a table. 

Time and date of surgery
Final management and comments
20th july, 11:00 am
Previous LSCS, had come for ANC on 20 june, Hb: 8 gm%, never bothered to arrange blood
Boy baby, apgar 9 and 10. Had waited almost a day for the blood
20th july, 12:36 pm
Obstructed labour since previous day 8 pm
Boy baby, apgar 6 and 10. Almost a rupture
20th july, 2 pm
Primi at 40+6 with labour pain since previous night. Later obtained history of leaking 4 days. Irregular fetal heart.
Girl baby apgar 8 and 10. Well off patient – did not go to Ranchi.
20th July, 3:14 pm
Labour Pains since yesterday afternoon and leaking, short 136 cm, obstructed labour
Sick girl baby, apgar 1 and 4. Died later, Almost a rupture
20th July, 5:24 pm
Prev LSCS  with  and Hb 8 gm%
Dead girl, Hysterectomy for placenta percreta
21st July, 2:17 am
G4P3L2D1, pedal edema 2 weeks, headache followed by seizures 2 pm, 20th july
Baby boy, apgar 6 and 10. IUGR
21st July, 3:30 am
Short primi, pedal edema > 2 weeks, was having labour pain since 12 pm on 20th July, BP 140/100. Urine alb 4+
Cervix edematous and head high, inadequate pelvis – lscs, boy baby apgar 3 and 7. Gr 3 Meconium Stained Amniotic Fluid

We lost 2 of the 7 babies. But we could have lost all the 7 as well as few of the mothers. The major challenges we faced - 

1. Availability of blood. 

2. Patients not following advice given during Antenatal Care. 

3. Ignorance of leaking per vagina as an indication for coming to hospital

4. Previous Cesarian section patients appears to be so ignorant about the fact that they need to have an institutional delivery

5. As we conversed with MD and AF's relatives, we realised that relatives have come to the conclusion that they have conceived girls. Especially, MD could have taken her easily to a higher centre. 

The weekend was thankfully not as busy as it threatened to become. . . 

However, do remember little GS, a little 6 year old girl who had come with a viper bite on her hand. Compartment syndrome has set in her hand very badly. 

I tried my best to refer the little girl, but without much response from the parents. We did a fasciotomy in the morning. Only tomorrow we shall know how much better it is going to be. . .

Then we had 4 kids who came in with accidental pesticide poisoning. 

After all the weekend rush, today was very quiet. Most probably on the occasion of a local festival . . .

And one more word of prayer for BD, who has delivered a baby at her home yesterday evening who came in with a retained placenta. On arrival, her hemoglobin was a paltry 2.4 gm%. The relatives have arranged blood just few minutes back. Shishir and Titus would be trying to do a manual removal of placenta within the next couple of hours. . . .Please pray that she will make it . . . It is almost similar to the case of SD who survived almost a identical history with a hemoglobin of 1 gm% ! ! !

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