Today was a particularly exciting day, as I wound up doing four caesarean sections along with vaginal deliveries and rounds. About half way through rounds, a patient was brought in on the back of a small truck. She had been laboring out in the bush. She was obviously very pregnant and seizing. Her husband had used his cigarette lighter to place between her teeth, so she had a good airway; but she was seizing almost continuously. She looked very swollen and obviously had eclampia. The nurses told me this happens three to four times per year.
My nurses were quick to respond with an IV and we immediately gave her 6 grams of magnesium sulfate and valium. It took a total of 25 milligrams of IV valium to stop the seizures. Once she was stable, we took her straight to surgery. There was thick meconium, but the baby was fine.
After surgery, the patient continued to have problems. Although there were no more seizures, her blood pressure and urinary output gave me fits. By midnight of that day, she was only making 5 cc/hr of urine. I called the pharmacy to request some manitol, but was told none was available. They also did not have any plasma. I thought about using serum from the blood bank, but felt the risk of AIDS and Hepatitis was too high and I would try to do without. The following morning, I went over to the pharmacy and was finally able to find some German manitol, "osmofundin." After I gave the osmofundin and some lasix, her output was great and she seemed much better. Her blood pressure remained high and required hydralazine IV to keep it down for the next few days.
Around three hours later, a woman came in with rupture of membranes and she was breech. She had also had a previous C/S. Although we had been delivering v-backs and breeches, I discovered there were no Pipper forceps available and I did not feel good about a breech v-back, so we did c-section #2.
Later that same afternoon, one of the patients in labor ruptured her membranes and the umbilical cord washed out. The baby was in distress, but with oxygen, salbutamol, and knee chest position it soon sounded fine. A crash c-section around here takes one hour to get ready. We kept the mother in knee chest for that hour and the baby came out looking good.
I had just finished the third c-section, when another mother came in with ruptured water and another cord prolapse. This time the patient was not contracting and the baby did not sound distressed. We took our time and finished the fourth c-section of the day without incident. This baby was also fine.
Obstetrics around here is just like in Missouri - either feast or famine! Thankfully, there are not too many days like this one. We do around 30 deliveries a week in Kudjip and approximately 4-5 of these usually are c-sections. The section rate is slightly less than 15% and outcomes are good, unless the babies are too small. If you have read my other blog notes, you may recall the small babies I have told you about. The 1200 gram baby has survived and is now nearly ready for discharge, but the 1000 gram baby died of necrotizing enterocolitis.
No other exciting news to tell you and we are now just three weeks away from our departure to come back home. I hope to see you soon.
Dr. P
pictures can be viewed at:
http://www.facebook.com/media/set/fbx/?set=a.114240695317977.19428.100001961413037&l=a20582723c
http://www.facebook.com/media/set/fbx/?set=a.114388571969856.19532.100001961413037&l=0b5634e363
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