Thursday, February 16, 2012

Feverish.


Ajer showed up at 3:30 pm saying she was having a bit of bleeding on and off and was worried. She insisted there were no contractions, but as I checked her I noticed several mild ones in short succession.

“But Ajer... that is a contraction right there,” I argued, “Isn’t that painful?”
“Yes, but I’ve been having those for a few days now...,” she explained.
“Oh...”

When I touched her belly to palpate position, I was surprised by how hot she felt --even for such a blistering summer day. It could be simple dehydration... or it could be something worse.

“Have you had any fevers recently?” I queried, trying to pinpoint her diagnosis.
“Yes. I had one last night, but it went away this morning.”

This felt like more than simple dehydration, so I got out my thermometer. She was burning up with a temperature of 38.0 C.

Her baby’s heart tones were also high (168, 172). Not good. Perhaps the fever was causing the contractions, but I doubted it was the other way around.

She was sick... but with what?

She tested negative for malaria and complained of no other symptoms except contractions.
    --Humm....

The vaginal exam showed she was dilating; but with such mild contractions, I didn’t expect her to deliver any time soon. (For any midwives out there: she was 2 cm, 80%, 0 station, IBOW.)

So I started her on prophylactic malaria medicines and antibiotics --just in case-- then hung some IV fluids. The minute I hydrated her though, her contractions picked up speed.... and strength.

I had barely finished giving her IV antibiotics when she started getting grunty. Her fever soared higher (38.8 C), and her baby’s heart tones raced even faster (176).
    -- What was going on?

She felt something come out from between her legs, and I looked down to see water.
    -- Humm.... strange that she’d have rupture at 2 cm. Very strange, but okay.

I started counting contractions and measuring their strength. They were strong now, lasting 45 seconds... and happening like clock-work every 2 minutes.
    -- Seriously.... something was up.

Then she started pushing.

“Ajer... please don’t push. You are only 2 cm dilated. It’s not time now.”
“But I’m not doing it on purpose,” she promised. “I just can’t help it.”
“Please don’t push...” I continued. “Don’t...”

Then I looked down.

Her bag of waters was bulging, and the baby’s head was right behind.

“It’s coming,” she half grunted, half pushed.
        --Yes. It most definitely was.

My helper moved lightening fast to prepare the room for the birth, and I slipped a pad under her butt. The next push he was born.

She went from 2 cm to baby out in 43 minutes with a fever of 38.8 C!

Unfortunately my story does not end there. Even before the placenta was born, she started dumping blood. And by the time I got it out (15 minutes postpartum), she had lost over 1500 cc. Fortunately, oxytocin helped stop the bleeding, and she slept through the night.

This morning everything looked normal and I was about to discharge her when she reminded me about the tear.
    -- The tear? Which tear...? She didn’t tear during the birth.

She went on to remind me of how she got a severe 4th degree vaginal tear after her last birth at home. She came to us initially for help, but we referred her to Wau for an operation. She went but never got it fixed; she didn’t have the money.

However a few months later she got pregnant again, and was told she could not get the surgery until after she delivered.

As she explained, I remembered running into her in town a few weeks back. Yes, of course I remembered her. We had discussed the option of her getting surgery with our surgeon instead.

Dr. Mike reviewed her and said she was a good candidate for surgery; he wants to schedule her back for the beginning of April.
         --What a blessing!

It’s strange that she neglected to say anything during prenatals, or even during the birth. But I’m glad she reminded me of it this morning!

Her previous tear helps explains the unusual fever and lightening fast birth though. It helps explains a lot.

Praise God she got to us in time for a safe birth and quick antibiotics for both her and her new son! Thank God that she can now get the surgery in town! Please pray for them to heal quickly, and for her to have a successful surgery. Thanks.