She had been 3 days in labor at home. Then she went to the clinic. They recognized that she needed to be at the hospital, so she was sent to us. As I walked into the room a putrid odor hit me in the nose. The smell of rotting flesh mixed with pus. So infection was clear. I did an exam and discovered a macerated head. The abdomen had a bizarre contour making me worry about uterine rupture. I attempted to pas a urinary catheter without success. It felt like it only went into the vagina. So I decided to place it as we performed a Caesarean section in the operating room.
Knowing the baby as dead I used Ketamine for anesthesia instead of a spinal, Ganava administered the anesthesia. Jacques and I performed the operation. Suspecting the uterine rupture, I made a vertical abdominal skin incision. The uterus was somewhat contracted and had a large hematoma all around the base where the bladder is. I opened the uterus in with a classical incision and pulled out a macerated child. As I inspected what was left, I could see that the uterus had ruptured completely at the base and was not attached to the cervix as usual. Also as I inspected why I had been unable to pass the urine catheter, I discovered that the bladder had necrosed the entire posterior wall. This occurs from pressure from the child’s head against the pelvis, where the bladder lies between them. This pressure of three days had caused her bladder wall to necrose entirely, leaving only part of the sidewalls and nothing down to the urethra (the normal area to urinate). We placed a catheter and attempted to reconstruct a bladder from the remaining tissue. I also removed the Uterus that was not attached any longer.
We are now three days after the surgery. I praise God! First, because she is overcoming the infection she has. Second, because her intestines are starting to function again. Third, as of yet she has had no urine leakage. May God be glorified in His healing of this woman and in all the patients we see.
Another I praise God for directly healing is a thirty-year-old man with tetanus. For about a week he appeared like it was likely he would die of spasms at any moment. Yesterday he was up and walking around, eating, and having almost no spasms. Glory be to God! Greg
#164 Shanksteps