Ruptured uterus — it could be avoided

In a busy labour-ward like the one where I work, there is always a lot of activity and no end of drama. The situation can really get out of hand as it happened this particular morning. The staff of a local Council had gone on strike over some issue or the other, and as a result, one of the largest maternity hospital in the region, was not receiving new patients. Even the patients admitted were having problems because there was no staff to look after them.

We received an alert that the patients were being diverted to a our hospital, the major referral, and we were on standby to receive them. One particular patient was wheeled in, we shall call her Betty. I will never forget what happened thereafter.

Betty was a single mother

Betty was a single mother of three, and she lived with her mother in Kawangware where she sold mitumba clothes and did casual jobs to provide for her children. All her children had been delivered by Caesarean Section. She was now expecting her fourth.

Betty had been in labour the whole night. After three operations, she was not supposed to get into labour!
Speaking to her mother who accompanied her, we were informed that they lived in a very insecure area in the depths of one the cities suburb, thus very’ difficult to get transport at night. When they had finally secured transport, they rushed to hospital, only to find that there was a strike, and so they could not be attended to. It took time for them to be sorted out.

She started screaming in pain!

Betty’s mother was determined that this would be Betty’s last baby, as she was, allegedly, taking care of the other three owing to Betty being irresponsible. She kept shouting, ‘Funga yeye. Lazima umfunge! (Sterilize her. You must permanently sterilize her!) Well, that was the last thing on our minds, we were more worried about the lives of Betty and her baby.

As we quickly prepared her for surgery, her condition suddenly changed. She started screaming in pain! Previously, she had been tolerating the labour well; quite confident in our service. But this pain was sudden, sustained and severe. Her vital signs started deteriorating, her pulse became weaker and she started to lose consciousness and slipped into shock. Going through the process of detecting the anomaly, my worst fear was confirmed. Her uterus had ruptured! We doubled our efforts to get her to surgery ASAP. In the meantime, urgent pleas for blood for our patient, Betty, were being sent all over. I said a silent prayer as we opened the abdomen, ‘Oh God. Please keep her alive for 5 minutes. We only need 5 more minutes.’

We found a sorry scenario

When we did the CS, we found a sorry scenario. The already dead baby was floating in the abdominal cavity immersed in her mother’s blood; the unnecessarily big pool of blood explaining the shock Betty was in. We tried very hard to stop the bleeding and replace the lost volume. However, time did not seem to be on our side; she was losing it faster than it was being replaced. Her blood pressure crashed, and Betty succumbed on the operating table, exactly 25 minutes after her arrival to the hospital. We were distraught for a few minutes, not believing what had just happened.

The baby was well built, weighing 3.5 kilos. The most difficult task was to break the news to Betty’s mother, who now, technically, had permanent custody over Betty’s three living children. When I left theatre, I found the lady waiting for me. ‘Umefunga yeye?’ (Have you sterilized her?) was her first question. Composing myself, I made her sit down and gently broke the news of her daughter’s demise. She broke down and started wailing and fainting, and wailing again after recovery. It took a while to calm her down.

This was an incident that could have been avoided in a number of ways. Betty was due for an elective Caesarean Section at 38 weeks gestation. The delays in getting her to a medical facility where she could be assisted, made the situation very difficult to handle, and the results unpleasant as described above.

END: PG 20/20