Friday, December 20, 2013

Lost Pregnancies

Over the last 3 days there were 6 obstetric patients in the Acute Care Unit. All of them of course high risk. 

The first one was PrD, who had been on the ventilator for over 2 weeks. She recovered miraculously and has since been shifted out to the general ward. 

The second one was BaDe a twin pregnancy with eclampsia who had delivered normally. It is very rare for a mother and her twins to have come out alive after few episodes of seizures. Her blood pressure has since been controlled. 

MD was pregnant for the fourth time and had come to us after having been searching around hospitals who were ready to take up a previous Cesarian. When we operated, her previous scar was already giving way. The baby was lucky to have survived. For, MD has lost 2 of her previous babies to early neonatal illness.  

The fourth lady, SumD was delivered elsewhere. She had Post Partum Hemorrhage after the twin delivery. The bleeding was so much that the people where she had her delivered just packed her vagina tight with roller gauze and bandage. We removed that pack only after we got fresh blood. Thankfully, it was only an atonic PPH which had taken care of itself. 

The lady in the fourth bed was ManD. She also had delivered by Cesarian. And of her four pregnancies so far, this was only her second live child. The rest two had died during childbirth. She was also almost rupturing when we operated. She had been going around different hospitals in 2 districts, in labour, before she reached NJH.

The last patient of this story, MarB was the most unlucky. She had already lost 2 babies earlier. The present one was her fourth pregnancy and she had lost that too. As she had a Cesarian for the previous pregnancy elsewhere and there was scar tenderness, we had no option but to do a Cesarian section for the dead baby. Again, the uterus was just giving way. 

All the six ladies could have ended up dead. Some are alive because they were referred at the right time.

If you leave the two twin pregnancies . . . and look at the rest of the four families of PrD, MD, ManD, MarB . . .

Four families . . . 13 pregnancies and 8 dead babies . . . PrD (1 dead baby), MD (2 dead babies), ManD (2 dead babies), MarB (3 dead babies) . . .

Can you believe this? 

It was so difficult to comprehend that all these families had gone through so much of a heartbreak . . . 

At least 2 of the babies would have died if we had not intervened on time when they arrived this time. . .  And as I mentioned earlier, all the six mothers could have ended up as maternal mortality statistics . . .

We write in our consent forms . . . there is no obstetrician, pediatrician, anesthetist or a surgeon in this place . . . there is no blood bank in NJH . . . if we have to operate with a low hemoglobin, we give authorization to do the surgery without blood . . . the responsibility of getting blood is with us and not with the hospital . . . 

Most of our patients sign this without any second thought. Many of our patients are too poor to take a decision to move on to a higher centre . . .

I wish we had some more co-workers join us and be a part of NJH. Yes . . . consultants in all the above four specialties is something we would love. 

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