26.01.2020 Sunday on-call

While attending the local church for service, Tanja and I were notified by our midwives at the hospital of a patient who came in with strong vaginal bleeding near term.  This patient was not seen in our hospital before so we had no previous history.  Because of the strong bleeding and the fact that we do not have a blood bank here we transferred this patient by ambulance nearly 2 hours away to a larger clinic in hopes that she remained stable and makes it and that the staff and equipment necessary were present at that hospital today (this can be a hit or miss situation).  Hours later we got a message: it had been a placenta previa (not previously diagnosed) with a placenta accreta.  The patient received blood transfusions and required many working hands.  Our team was relieved knowing we had made the right decision and thankful that the blood bank had blood and the staff there were not out sick (they don’t always have replacements, there is simply no one there).

The rest of the afternoon was for resting, I had a chance to take some time to sit in the garden and relax.  By late evening it was back to work. 

The night has been pretty normal so far. I've got two IG 0P, one at 36+1 and one at 37+1 weeks of pregnancy. The patient at 36+1 had dysuria and pain associated with early contractions. She is here for observation and received antibiotic treatment. The other has been having steady contractions and dilating normally. There was no sign of fetal-maternal disproportion and no indication of any troubles according to CTG. As the pushing continued, troubles arose. The baby's heart rate was starting to drop and the CTG was pathologic showing signs of fetal distress resulting in the need for a secondary C-section in the early morning hours. This one was not easy as the baby had already progressed far. Finally delivery of a not so little but relatively fit baby boy! The bleeding stayed in the norm and the surgery finished without further surgical complications. The team was tired and relieved. Mom and baby are both doing well. Our other patient was able to catch some sleep while we were busy.

C-section #3: baby Misaina 3144g