Friday, August 6, 2010

Premature.

After lunch, I was quickly called back to the clinic because a woman had delivered prematurely and her placenta was ‘stuck’ inside. My translator looked worried and so I rushed. I told the rest of the staff (who had started lunch a bit later due to other emergencies) about it and they agreed to come soon.

However, Jessica (volunteer/Nurse) hurried after me, eager to learn as much as she could. I wasn’t told anything more than that the baby was preterm and the mom had a ‘stuck’ placenta.

The last time this happened the placenta was sitting in the vaginal vault and needed the slightest tug to come out. Today was a much different case.

When I walked into the room, the mom was covered in blood and motionless on the bed. A family member was holding her baby, wrapped in a blanket and gasping for air. The baby girl only breathed every 15 seconds or so and her heart rate was a cool 60 bpm. (It should have been in the 130 range). She was dying.

I started to resuscitate and Jessica was quick to help with chest compressions. The Ambu-bag we had was much to large (due to her prematurity). She had lots of secretions and was pale.

Caleb and Maggie came in shortly afterward. Caleb took over my job in resuscitation and Maggie helped me assess the mom.

All the while, I kept calling out for more information. When was the baby born? How long has she been bleeding? How much blood has she lost? How long was her labor? How many babies has she had? Which ones of them are alive? Has this happened before?

The story unfolded for me question by question as I continued to assess the young girl. This was her forth pregnancy. Each of her babies were born premature. Each of them died.

I remember looking over to the table where Caleb and Jessica worked tirelessly on the baby girl. She wasn’t breathing spontaneously. Her heart rate would jump from 30 to 100 depending on resuscitation efforts. It didn’t look good.

Meanwhile, Maggie was getting an IV started as we could see the young mom was in hypovolemic shock. Her blood pressure was bottoming out. Her pulse was through the roof. She had been bleeding non-stop since birth (which was 3 1/2 hrs earlier).

I could see her heart beating in her chest. I didn’t need to take a pulse to count it.

When I evaluated her placenta, it was partially detached (the reason for all the bleeding). What’s more, is it was very determined to stay that way. I had to do a number of maneuvers to knock it loose. But when it came out, all the membranes were still inside.

My only option then was to do a manual exploration for the membranes. This is not comfortable but it was the only way I could be sure the membranes wouldn’t continue to cause bleeding. Fortunately it worked. Her bleeding stopped.

A second IV line was started, as we flooded her with fluids. She got 5 liters before her blood pressure even remotely stabilized. She was pale as a sheet, desperately needing the one thing we couldn’t give her; blood. 

The baby died but she didn’t. I think the baby could have survived if she was born in the clinic. But even then, I’m not sure. Maggie tells me that babies born that early here rarely survive.

The young mom, turned her head from me in sorrow when I told her but she didn’t cry. So I cried for her. I cannot begin to fathom her pain. Four time pregnant. Four time heartbroken.

The only reason I can think of her premature labor is an incompetent cervix. I told her how to fix this problem next time she gets pregnant. But I’m not sure she believed me. I think she’s lost hope of every having a baby live.

Pray for her. She’s in desperate need of blood but her family doesn’t have the resources to get her to the hospital for treatment. I think she will recover. It might take months without the blood but it’s still possible.