Rupture Uteri . . . and the luckiest of them

Over the last 1 week, we’ve had 4 patients with rupture uterus.

Two of them were previous Cesarian sections who tried to deliver normally elsewhere. One of them continues to be very sick. Today we found out that she has developed a vesicovaginal fistula too.

However, the luckiest of the lot seems to be Kanti Devi, a 28 year old lady who had a twin pregnancy after 2 previous successful pregnancies, both of whom needed Cesarian sections.

Now, for the present twin pregnancy which she was not aware about (as she did not have any sort of antenatal care), she started to have pains since about 3 pm on Friday afternoon. 

The kept her for some time at home after which by around 8 pm, they took her to a nearby private clinic.

At the private clinic, she delivered a baby by normal vaginal delivery. However, after that the people in the private clinic waited as they most probably diagnosed a second baby.

They waited for almost couple of hours after which they realised that something was amiss.

The relatives brought her to NJH with a diagnosis of undelivered second twin.

Dr. Shishir, who was on duty did not need to ponder much to diagnose a rupture uterus. 

The surgery was uneventful.

I’m sure that this would be a very rare presentation of a rupture uterus - a patient with 2 previous Cesarian sections who in her third pregnancy conceives twins. She delivers a live baby by normal vaginal delivery and then ruptures her uterus and loses the second baby. 

And here is Kanti Devi with the surviving twin . . . 

The snap has been taken after obtaining consent from the family including the patient. 

Bizarre Obstetric Care . . .

As I write up about the different patients to come to us for care, I always pray that things get better as each day passes. Unfortunately, it does not seem so. The number of patients with rupture uterus and eclampsia continue unabated. Of course, on and off, we get patients who were saved from certain death because of timely intervention . . . 

But, one lady who came yesterday broke all limits of imagination on how careless and ignorant can people be when it comes to obstetric care. . . 

I was in Out Patient yesterday (13th April, 2012) when at around 2 pm, a lady with a distended abdomen was wheeled in. The history was that she had a normal delivery on 10th April elsewhere following when the abdomen got progressively distended. They also told me that somebody had diagnosed her to have a rupture uterus following the delivery . . . 

The lady has been married for 12 years. . .  and the family did not have children for about 8 years. The first delivery was a tragedy. For reasons unknown, she ended up with a Cesarian section, but lost the baby. . . The next two deliveries were normal . . . and one done at home and the other in hospital ! ! ! In between, she had 2 abortions. 

Then came the fourth one, they tried a home delivery . . . but started to have difficulties, for which they came to the district hospital. She ultimately delivered normally. The baby was dead but she started to become sick. She was brought to us in a terrible shape on 11th April, 2012. So, she was P4L2D2A2. 

It was obvious . . . the uterus had ruptured. Her Hemoglobin was 4 gm%. We asked the relatives to get blood. She had about half a dozen male relatives but nobody was ready to give blood. 

It was fine, if there were no relatives to donate blood or if all the relatives got their blood group checked and then none of them matched. In such a situation, many of us from among staff have donated blood to patients. 

We told the relatives that they better take the patient to Ranchi. They did not hesitate to take her away. 

We had forgotten about her. 

And then they came back yesterday. We shall call her AD. Now, it took some time for me to discover that AD was the same patient who came to us on 11th April, 2012 and was supposedly taken to Ranchi. 

So, I was quite inquisitive to find out what happened after the relatives took her from here on the 11th. It seems they took her to the district hospital in the adjacent district. They told her everything will be fine once blood is transfused. And they managed to get hold of 3 units of blood. . . Nothing else was done. 

It was obvious that the patient was deteriorating. Later, someone told them that this sort of patient can only be managed at NJH or Apollo. And, therefore, she was brought here a second time. 

The patient was obviously sick. The hemoglobin was 10 gm%. She was dehydrated. We were sure that we will operate only if we had at least one pint of blood. Unfortunately, the relatives were not relenting. It required quite a lot of counselling from our side. I'm glad that they arranged one pint of blood today morning (14th April). As I write this, Dr Nandamani would have started operating. 

We pray that she will do well . . . 

Now, major lesson learnt here - lack of adequate medical facilities within the country. I had written quite a mouthful on a new act which is going to be implemented soon. What will patients like AD do when such a act is implemented?