One too early, another too late-both dangerous
I was doing one of my final rounds to make sure my patients were okay before I signed out. In the last bed lay Monica, an obviously happy thirty-five-year-old house-help and now a single mother of three contentedly suckling the youngest. She motioned that I sit as she needed to tell me her story. I sat on the visitor’s seat and listened to what had transpired before I met her earlier with a placenta that would not budge.
Monica told me, the eagerly suckling baby was unexpected and totally unplanned for, but had a mother who was determined to manage—somehow. She, therefore, worked a day job and an evening job—all in a bid to save a decent amount of money for her children; knowing well that after the baby came she would not be in the capacity to toil for some time.
‘Now, that evening I came…’ narrated Monica. ‘After working particularly hard, I went to bed with lower abdominal pains that were increasing in intensity.’ She went on to explain that the pain charged on despite her resting and taking painkillers. Hours into the relentless anguish, it dawned on her that she could be having a miscarriage at 30 weeks. She was alone in the house with her two older children, who were not old enough to be by themselves. She called her sister who lived close by, but for some reason, she did not come as quickly as the situation called for. This saw her roughing awake her children and pleading with the taxi to fly over to her house.
In no time, she felt a gush of warm liquid… her waters had broken. Her panic was taken to another level. The sophisticated hospital delivery was never to be as she felt a great urge to bear down. She could not hold it any more and after two pushes, a brand new little baby girl was screaming out her lungs!
Thankfully, Monica’s sister arrived at this juncture. Just in time to cut the cord, clean and wrap up the baby. Monica tells me she burst into tears as soon as her eyes roved over the new born, ‘She was so tiny!’ She recalls sounding like the figure was stuck vivid before her eyes.
As they fumbled with the baby, Monica noticed that she was bleeding heavily! More panic! The taxi, finally, arrived at the panicky atmosphere. Monica, her baby and her sister made for the hospital at death speed; leaving the other two dear children with a cooperative neighbour.
Then I met her. When I reviewed Monica, she was in obvious shock. She was cold and shivering, with a dry mouth. She complained of thirst and feeling faint. On examining her abdomen, her uterus was poorly contracted and her belly was still quite large. Sure enough, the cord was still hanging, meaning the placenta had not been delivered.
The first thing to do was to restore her fluid volume. We fixed two wide bore cannulas or lines, and started running fluids, while we looked for blood urgently. Thankfully, there was some screened blood, which we did not hesitate transfusing into her. We also gave an injection of the hormone oxytocin that helps the uterus to contract. With a technique called controlled cord traction, the doctor was finally able to expel the placenta.
With the placenta out the bleeding stopped, and within a few hours Monica had settled.
Meanwhile, the paediatricians were examining the baby. She weighed 1800g and was immediately started on fluids and kept in the incubator. Glad to say she steadily gained weight and both mother and baby were discharged after three weeks.
That was a good ending to a potentially disastrous situation.
END: PG19/20