Monday, 16 August 2010

Code blue

Miriam is a Nazarene meri pastor, or pastor's wife.  She was pregnant and just about due with her 5th child when she came to the hospital last week.  She was feeling some on and off contractions, the early signs of labor.  The nurses checked their patient and were concerned that her baby was not head down.  Dr. Scott did an ultrasound and diagnosed Miriam and her baby with a condition called "polyhydramnios," or too much amniotic fluid.  There was so much water in Miriam's uterus that the baby was doing hand stands and back flips!  

Sometimes polyhydramnios is due to a problem with the fetus, either a congenital or genetic defect.  Or it just happens and we never find a reason.  The condition has the potential to cause a several complications during labor, all of which are emergencies.  Because the fetus is so mobile, it is possible that he or she will turn sideways or bottom down during labor.  The baby may or may not be able to deliver vaginally depending on the actual presentation.  Another problem that can result from polyhydramnios is cord prolapse.  (Read about one of our other patients with cord prolapse in my blog "Giver of life.")  When the water breaks, a huge tsunami can sweep the umbilical cord into the birth canal along with the wave of fluid.  Pressure on the cord can cut off blood supply and the baby can die unless quickly delivered by c-section.  A third complication is called placenta abruption.  Rapid loss of the large volume of water causes the uterus to contract and the placenta can pull away from the wall of the uterus.  Again, the baby looses blood supply and will die unless an emergency c-section is done.  Finally, mothers with polyhydramnios have the potential of bleeding too much after a delivery.  Post partum hemorrhage occurs because the over stretched uterus fails to contract.

Because of these potential complications and our inability to do an emergency c-section if needed, Dr. Jim and I decided that the best course of action was to do a c-section before there was an emergency.  Or so we thought...

On Thursday morning, Miriam was taken to the operation theater.  She was given spinal anesthesia which is a medicine to make a patient numb from the waist down.  Dr. Jim and I scrubbed, gowned, and gloved.  We began to prep and drape the patient when we noticed that she was looking a little funny.  Suddenly she became unresponsive and stopped breathing.  Her pulse weakened and became undetectable.  Dr. Jim forgot about the prep and began doing CPR.  Our team of anesthetists intubated and secured the airway.  OT nurses started another IV to give more fluids.  Another nurse gave medicines to increase blood pressure and reverse the effects of the spinal anesthesia.  

Finally we detected a weak pulse.  Miriam's blood pressure began to rise.  She started to breathe on her own and then regained consciousness.  I did a quick ultrasound to confirm that the baby was still alive.  Praise God, there was a heart beat!

We re-gowned and gloved, prepped and draped for a second time.  An incision was made and a healthy baby girl was delivered a few minutes later.  The cry was music to my ears!  We sewed up the uterus and the bleeding stopped easily.  The surgery concluded without any further complications.  The baby was moved to the nursery and Miriam was taken to recovery.

Four days later, both mother and baby are doing great!  Miriam has done just about as well as any other post-op mother.  Look at her smile!  You would never know she almost died.  The baby is beautiful, and shows no signs of a congenital or genetic anomaly that would have caused the polyhydramnios.  They will likely be going home tomorrow.

Dr. Tom is an ENT doctor and one of our volunteers for the month.  I'm going to borrow the verse that he shared for this story, and for the many stories of Kudjip Hospital.  God has brought all each of us here--doctors and nurses, long termers and short timers, American and Australian and PNGian--to do good works and bring glory to His name!  Soli Deo Gloria.

"For We are God's workmanship, created in Christ Jesus to do good works, which God prepared in  advance for us to do."
~ Ephesians 2:10

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