Magnesium Sulphate . . .

In this part of the world, we continue in the holiday season. Today and tomorrow is Chatt, a local festival where the Sun is worshipped. And therefore, the outpatient crowd was quite low. The inpatient is a bit busy as there are quite a number of sick patients. Mr. Loric Singh is out of ventilator, but continues to remain sick. Please pray that he'll be completely healed. 

After the quite busy obstetric crowd couple of days back, we've had a relatively free day yesterday. Although there were 2 patients with Eclampsia, one went to a higher centre and the other had a uneventful instrumental delivery

Just as I was coming out of the hospital, there was this primi lady, UD looking quite sick who was just wheeled into the labour room. With a Glasgow Coma Scale of 3 or 4 and laboured breathing with gurgling sounds, she does not look to stand a chance. She had been having seizures since daybreak. It's already crossed 12 hours. 

The only best part was that someone has managed to give her Injection Magnesium Sulphate. Injection MagSulf as it is known has become a life saver for patients with eclampsia and pre-eclampsia. There are quite a few of my friends who campaign for making Magsulf available with the ASHA workers (called Sahiyas/Mitanins etc).

Drugs given elsewhere. It is very rare that we get to know what was given elsewhere. 

I'm sure if it was not for Magsulf, UD might have had more than a dozen seizures. She's had only 3 episodes. 

However, after the Magsulf, she was not managed actively. Ideally, she should have got for a Cesarian section immediately. That did not come to pass. I think they were expecting her to deliver normally. 

She's already in severe sepsis with aspiration pneumonia.

With the customary death on the table consent, we took her for Cesarian section. 

The baby was sick . . . however, he should survive. Apgar was 5 and 8 at 1 and 5 minutes. And, UD was breathing without the ventilator after the surgery. . . quite an encouraging sign.  

The night is going to be crucial. Please pray that UD would do well. 

However, patients like UD remind us that Magsulf may only one part of the solution. Unless we have full fledged centres who are catered to deal with sick patients, we may not make much progress with controlling maternal morbidity and mortality.