10 Bere 2024
At the end of another long day Audrey is called about 9PM for a mother at maternity what is at term and the nurse says the contractions are to hard and she thinks the belly has changed shape. The patient is about mid twenties and has had 4 children and none of them living. Audrey goes into evaluate. She does an ultrasound and sees a baby with a very slow heart rate- fetal distress. She needs an emergency C-section. She calls me and I call the anesthetist and surgical assistant. The abdomen is an unusual shape, signifying likely uterine rupture. While Phillipe and David come in we get the patient to the OR and get some blood out of the fridge to start warming it up. We each stick a pack of blood under our armpits to start warming it as we race around the room preparing things. We start pouring in the fluids as the nurse starts another IV. A few student nurses from maternity are standing around not knowing what to do. We have way to many nursing students in the OR each day. Mostly in the way, however they do provide translation that is useful as someone usually can speak the language of the patient if we ask around to them. I get the C-section OR pack. All are wrapped in two layers of cloth and since we have the sterility indicators that I brought in them- I know this pack is sterile.
Phillipe and David show up and I start scrubbing. Phillipe is going to use Ketamine because she’s lost blood internally and because it’s faster. After scrubbing and putting on my cloth gown and sterile gloves, I gown Audrey. They’ve prepped the patient with betadine. I go in quickly not taking time for cautery and stopping bleeding. Its been about 45 minutes since we last ultrasounded the baby. It’s as fast as it gets here. I cut through the abdominal wall in a low transverse incision. Go through the muscles vertically, then down to the uterus. Release the bladder and push it down out of the way then cut into the uterus. I can tell it has a hematoma on the side and rupture there. I pull the baby out and it’s floppy an no sign of life. Audrey takes it off to the side and tries CPR for a while. I put clamps on the uterus to stop the bleeding and then start closing it. I can’t get the rupture closed by myself and after trying for a while to get the baby back to life, she gives up and joins me after scrubbing again. The tear is down the side again and we are able to stop the bleeding and repair the side. We saved moms life and are sad we didn’t make it to the baby in time, I think we went as fast as possible in this situation.
We go back home to the heat (97 deg) and decompress before getting tired enough to sleep.
Greg
