2 Rupture Uteri . . . and one live baby

About 10 days back, we had 2 rupture uteri. I had  written about it in an earlier post. 

SktD and NmnD . . . the patients. SktD's baby was not lucky as NmnD's baby. 

Couple of days back, I got the consent to publish the snaps of NmnD and her baby. 

By the grace of God, NmnD and her baby are doing fine. SktD was discharged couple of days back. 

Both of them benefited from the Maternity Charity Fund supported by one well-wisher. 

The snaps . . .

That is how NmnD's baby looked soon after delivery. The baby was in a face presentation.
I hope you remember UD whose baby also had a similar presentation

NmnD and her baby just before discharge . . . 

Saving a Mother

There was the amazing story of this husband who supposedly walked 40 kilometers through dense forests carrying his pregnant wife who appears to have had severe eclampsia. 

My thoughts turn to quite a lot of our patients who are not that lucky. 

We at NJH get quite a lot of such high risk obstetric patients who reach late. Not that we are the best centre to treat such patients. But, we are the most easily accessible and affordable to the communities around us.

The last month, I had been searching for the best story in Maternal and Child care that we had in the last financial year. And the below story is what I thought was the best. I had posted about this before. 

However, the snaps tell a great story. 

UD had been in labour since the last 24 hours. She had also received intramuscular injections at her house. She had gone to the district hospital as well as the private hospital in town. She reached NJH late evening yesterday. This was UD's first pregnancy. 

The diagnosis – Face presentation with obstructed labour and septicemia. She was posted for emergency surgery. The uterus was stinking. It was a surprise that the baby was alive although severely asphyxiated and sick.

UD and her baby took about 3 weeks to recover. 

That is UD and her child just before discharge

We were quite blessed that we would get them both healthy. Recently, we had a lady who came in labour (LD) who had a very similar history. And we ended up with a maternal death and an early neonatal death. 

Ayyappan's child did not make it. However, his wife, Sudha made it. Thanks to Ayyappan's heroics. 

I wish we have more menfolk all over the country who would go to any extent to save their women folk. 

Patient follow up .. . ..

Below is the snap of a mother and her baby which is quite a major encouragement for us at NJH.

This is UD and her baby. I hope you remember the baby with the gory face in the post. Yes, this is the same baby whose face was all lacerated. And she was quite sick when she was delivered.

We also thank the Lord for BD and GD, both of whom are recovering well. BD had a very bad rupture uterus which was neglected for long. And GD had come with severe eclampsia and pulmonary edema. We look forward to discharge both of them in a couple of days. I'm sure that I'll remember forever the sight of GD's uterus after we ended up B-Lynching it twice. 

Well, the stories of neglected pregnancies continue. I write this just after coming back from theatre after an unsuccessful attempt to save a baby whose hand prolapsed. The mother has never had antenatal check ups. There was no pain. However, I doubt the history as there was hardly any liquor inside the uterus. Rather is was quite dry. We ended up putting a inverted T shaped incision over the uterus to deliver the dead baby. It was a fresh still birth. In fact, we had got a heartbeat before the surgery.

As I mentioned in one of my previous posts, we are yet to explore the devastation of neonatal deaths. caused in our surrounding communities.

In addition, we also had 3 cases of eclampsia of some form or the other over the last 48 hours. However, all 3 mothers are doing fine. Although the babies dies. Well, one of them has been a diagnostic dilemma which I would narrate in my next post. 

Well, the final shot .. .. .. the patient RN, on whom we had done a repeat Cesarian. It turned out that the patient was registered in the hospital in the name of the first wife who is dead since 4 years. Our nurses realised it when RN did not respond to calling her name. In one sheet, she had accidentally told her original name. Someone thought about calling her that name. And she responded to the call. 

My friends in RSBY . . . I hope you have read this. It may be a odd case but has made a very interesting story on how we can be easily fooled.

(Consent has been obtained before taking the photograph. The patient has been given a concession of approximately 25,000 INR (The total bill for both mother and baby was approximately 40,000 INR). However, the family has been informed that there is no compulsion on her to allow us to take this snap and use it for field publicity efforts aimed at getting specialist healthcare staff with a heart for caring for the marginalised to join hospitals like NJH)

Maternal care . . . cont'd

(The snaps in the blog are of a repulsive nature to the general public. User discretion advised. Consent from family members have been obtained)

After the last update, there were couple of more cases which I thought would be worth mentioning.

Both happened last night.

UD had been in labour since the last 24 hours. She had also received intramuscular injections at her house. She had gone to the district hospital as well as the private hospital in town. She reached NJH late evening yesterday. This was UD's first pregnancy. 

The diagnosis – Face presentation with obstructed labour and septicemia. She was posted for emergency surgery. The uterus was stinking. It was a surprise that the baby was alive although severely asphyxiated and sick.

 

Bruised in labour . . . Neglected face presentation

MD came just before midnight. A G6P5L3D2. She had been in labour since early morning. It was only after a whole day of trial at home that the family decided that MD needs medical help.

Through the customary detour of the District Hospital and one of the private hospitals in town, she reached NJH. The diagnosis was obvious – Rupture Uterus. Investigations revealed that she was in sepsis as well as severely anemic.

We waited for blood which never came. By early morning, we decided to operate on her without blood. The surgery was uneventful. It was a rare type of rupture we saw. The uterus had ruptured in the posterior wall. The anterior wall was clean. One can only imagine the trauma MD went through till she reached us. 

The posterior rent . . . The baby was in the peritoneal cavity

The uterine tear was much beyond repair and our surgeon, Dr Nandamani had a tough time understanding the anatomy as he did the hysterectomy. 

I hope you remember about DD about whom I wrote in my previous post. DD's family was well off. Yesterday as I did my rounds in the evening, there were few of her relatives in the room. One of the ladies wanted to know about the condition DD had. I told them the name of the disease  - -  eclampsia. Then another of the ladies commented on how DD had high blood pressure during each of her pregnancies. In fact, she had seizures during her first delivery. 

And the family was well warned that she has a good chance of having high blood pressure during her second delivery. Therefore, they made all arrangements to have her second delivery at a tertiary centre in Ranchi. In fact, she had high blood pressure and underwent a Cesarian section. 

Fast forward to the third pregnancy. Nobody bothered to ask them about her previous pregnancies and only when she started having seizures did the family realise that it is serious. So poor an antenatal care did she have that in spite of being a high risk pregnancy (previous LSCS and history of eclampsia in the first pregnancy and pregnancy induced hypertension in the second pregnancy), nobody bothered to do an ultrasound abdomen. And nobody told her about ensuring a hospital delivery. 

Well, I don't think I need to give any further details to show on how much of a lackadaisical attitude most of us in health profession have towards our patients . . . Not only DD, even UD, who spent almost 8 hours at other health facilities and MD who spent almost 12 hours in health facilities before a decision was taken to intervene.