Tuesday, October 15, 2013

The Short Lady

Today early morning, we had a lady who came with a neglected previous Cesarian. She was brought in quite late. SwrD had started to contract sometime late evening yesterday. They lived quite away from a place where a Cesarian section could be done. It was midnight by the time she reached a place in our nearest town. Being Dussehra, there was no doctor there. They reached NJH today dawn (15th October, 2013).

SwrD, about 25 years old was 125 cm tall. It was quite obvious that the labour was obstructed. Her haemoglobin was only 8 gm%. Titus send off the relatives to get blood. He also got consent to operate without blood. It may look very foolish but that was the only option considering that she was fully dilated, the baby was stuck and very much alive.

The problems started after he opened up the uterus. Till the delivery of the baby, there were no obvious problems. However, as soon as Titus started to suture the uterine opening, he realised that there was a problem. There was torrential bleeding from below the uterine incision. That was when he realised that the previous Cesarian scar was quite low and it had given way.

With a hemoglobin of 8 gm%, it was only a matter of minutes before she got drained of her blood. We acted quite fast. I realised that the prolonged labour had made the proximal part of the uterine opening quite friable. We somehow got her sutured up and achieved hemostasis. However, there were very much evident signs of shock.

We were blessed to have the relatives come quite fast from Daltonganj with one pint of blood. We had asked for two. 

By God's grace, she responded well to whatever we offered her. It's midnight now as I write this. She has been shifted to the general ward from acute care. 

This is a typical case where a UDBT would have helped the patient and given a peace of mind for the doctors involved in her treatment. If the relatives were not that forthcoming, only a UDBT would have saved her. I later found out that the relatives had someone known within the blood bank . . . and that was the reason they got a blood bag fast. They had also taken someone to donate.

I understand that the government is considering to legalise UDBT. Hospitals like us would definitely benefit . . .

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