Tuesday, August 24, 2010

Retained Placenta.

Today one of my patients came in with her newborn boy. She delivered at home 6 days ago and “things weren’t quite right”.

When I uncovered her boy, he was tiny. My heart sank. Another preterm baby? Really LORD? Really??? But it was clear. He weighed exactly one kilo. But he was alive. I figure he was probably 7-8 months along but IUGR (Intrauterine Growth Retardation). He was breathing fine. His vitals were normal... except he was a bit on the cold side and lethargic.

But here’s the thing. This was her first baby. She had no husband and one kind (but exhausted) friend helping her. She didn’t know much about babies and as a result thought breastfeeding only 3 times a day was perfectly reasonable. (FYI: It’s not. Newborns need to breastfeed every 1-3 hrs minimum depending on their size and suck potential. :- ) I stressed the need for better feeding and she said no problem. Then we moved on to her.

She then explained that her placenta didn’t come out for 24 hours after her baby. When it did finally come, only half of it was there. The other half fell out all black and smelly just yesterday (5 days postpartum).

I was horrified.

When I did a speculum exam to find out more, it was not good. I’ll spare you the details. Suffice it to say, she needed a D & C quickly.

Part of me was hopeful to use our new Manual vacuum extraction machine. Dennis is going to teach me how to use it. But when I asked him if this would be a time to use it, he told me no. That once infection has set in, the risk of uterine perforation is too high. She needed a D & C.

My heart sank with the news. How is this little girl going to get the money to get to Wau? How is she going to afford a D & C? How?

When I explained the news to her and her friend... she just listened with her eyes averted. When I mentioned going to Wau... she just cuddled her baby closer and looked down. Her friend listened with tears rimming her eyes. They were scared.

They put on a brave face. One standing strong. The other in denial. But I didn’t detect much hope.

Here’s the thing. Had she come the day of her birth I could have gotten her placenta out any number of ways. Had she come on day one, two or three postpartum, perhaps it would have been possible to use the vacuum aspiration. But by waiting until sepsis set in, my hands were tied. My window of opportunity had passed. I had no choice but to refer her.

Perhaps I’m in a pessimistic mood, but I don’t think she’ll go. I think she’ll stay at home and die, along with her precious son.

Forgive me Lord. I don’t know what else to think. Save her. Make her whole again. By your strength and love, touch them. Heal them. Amen. Please pray with me.