15.04.2020 Busy continues

Good morning we need you immediately are the words I’m greeted with as my phone wakes me once again.  This time it’s a patient, Volatiana, that came during the night with a rupture of membranes.  Contractions and dilation had been progressing continuously without any signs of worry.  In the early morning hours though the water turned meconial and green which was soon followed by signs of fetal distress in the CTG.  The inability to do micro blood analysis (MBU) but even more a suspicion for fetal infection is the reason the decision to deliver via C-section is quickly made.  We soon find out that this was the right decision.  The baby is born with APGAR 0-2-7 and has clear signs of infection.  The midwife team have to resuscitate and administer CPAP.  My nurse anesthesia leaves my patient on the table in the hands of the non-medical assistant to monitor the machines while he puts in the i.v line for antibiotics and I continue the surgery.  After an hour our little one is in intensive care with antibiotics and glucose running.  Thank goodness we have this operating room and staff to run it, that certainly saved this babies life today.  I don’t think there would have been time for a transfer and the equipment for the standard of care that this baby needed post-partum anywhere else around here.

Case #19  Baby Finoana 2934g with infection in the ICU (This picture is from day 2 on which CPAP was no longer required but if you look closely we have a little opaque tube running just under the mourth to provide additional oxygen to keep the oxygen saturation up)

After this I’m back to ultrasound scans.  The first patient I see is homeless and has not been to any pregnancy checks her whole pregnancy.  Here is the ultrasound picture I find:

Not hard to guess right? Twins!

And I have no idea what week of pregnancy they are.  The patient Louisette tells us her last menstruation and we calculate that given that date she would be at term today.  Echographic measurements suggest the babies are around 33 weeks (based on femur length).  We keep her here for CTG observation on three consecutive days and repeat the scan next week to have a growth comparison and decide on when to operate because both babies are in breech oblique position!

My last patient is one from labor and delivery.  She just had her fourth baby with the midwives who called me regarding the suture.  Normally they have been doing the first and second degree tears on their own, I only help if they ask.  In this case it was a higher degree tear.  The trouble was there was no external sphincter muscle palpable.  I found out this had already been like this post partum since the second delivery.  So far she had no issues with continence.  I wasn’t sure how to fix this. There were no muscle remnants to be found!  I carefully adapted the perineum as usual and checked if there was any tear in the mucus membrane of the anus.  This thankfully was not the case.  Conclusion:  Third degree tear without a third degree?