A TERRIBLE EXPERIENCE
Prof. Gangadhar Sahoo, President Elect ISOPARB
Dean, IMS & SUM Hospital & Pro. Vice Chancellor, SOADU,
Bhubaneswar
It was in 1990s. One pregnant mother, elder sister of an MBBS student carrying 30 weeks of pregnancy came to my OPD with history of two bouts of painless bleeding per vaginum within last fifteen days. She was admitted for evaluation and management. The ultrasound report showed a living foetus of 31 weeks with PLACENTA occupying the lower part of the uterus. This type of placenta at times bleeds so profusely that it may risk the life of mother and fetus. Timely intervention is the only way out to save both the lives.
Decision was taken for conservative treatment with bed rest and "wait and watch policy". Our objective was to prolong the pregnancy as long as possible for the fetal maturity unless there's recurrent life threatening bleeding. Therefore two units of blood were kept ready for emergency purpose. Blood bank was kept on alert . On the bed head ticket it was boldly written in red ink " A SENIOR CONSULTANT ON DUTY IS TO BE INFORMED IF THE PATIENT FURTHER BLEEDS . Liberal decision for CS may be taken keeping in view of the life of the mother. If required l may be informed. “The younger sister of the patient was asked to keep at least two volunteers of same blood group ready for emergency situations. Every hour passing was adding dividend to the fortune of the mother and intra uterine baby. In this way one week passed. It was a Sunday Morning. The patient complained of slight bleeding in the bathroom at about 10 am. The staff sister in charge shifted the mother to the labor room for further management.
Mother was kept for observation with full preparedness to go to the war once bleeding threatens the life of the mother. The senior ANAESTHESIOLOGIST on duty was informed. I got the information and took charge of the situation. Another bout of bleeding started at around 3 pm . One unit of blood was started. Requisition for two more units of blood was given. Emergency call was sent to all concerned specially to the senior anesthesiologist and pediatrician. Role of pediatrician was to manage the premature risk neonate. OT started at around 4 pm. The placenta which was occupying the lower segment of the uterus was obstructing my entry to approach the fetus. Anyhow tactfully and skillfully I overcame the first obstruction. With all my experience and skill the premature baby was delivered and handed over to the pediatrician. Then the placenta was delivered. All precautionary medical and surgical procedures were taken to minimize the blood loss. Uterus was closed and the CS was almost over. At that point of time suddenly the electric supply was cutoff. OT was almost dark. There was no alternative power supply to the OT. We arranged two torch lights, one from the OT and other from the patient. With that we closed the abdomen.
I always followed my Guru’s teaching, “Never leave the OT, before the patient is transferred from the OT to the ward and never leave the department before you are satisfied with the immediate postoperative conditions.” I stayed to examine the patient on the OT table fortunately in the presence of the anesthesiologist with the torch light. To my utter surprise she was having profuse bleeding , which is very common in low lying placenta. So I instructed the OT sister to prepare OT trolley for reopening and if required for removal of the uterus.
A message came from the maintenance department that there was least chance of supply of electricity because of a major break down at the main turbine. An interesting thing happened. A group of monkies were playing on the Hirakud dam. By chance one monkey slipped and fell on the live cable coming from the turbine to the main supply room. Following that all the 4 monkies jumped to save their friend and all were charred to death in a horrible situation. It was an unprecedented accident which occurred disrupting the power supply.
Our team accepted the challenge. We were in a huddle to pray God to save us from this situation. Those two torch lights were our hope. OT sister took half an hour to arrange the trolley. During that interval one of my reliable PG student gave bimanual compression of the uterus to minimize the blood loss. It's really a herculean tax , most pain staking and highly skilled maneuver where one has to stay in one position as a statue till the abdomen is opened. Special training was being given to all the post graduates to practice this procedure to boost their confidence at the time of emergency. In the mean time two units of blood reached the OT. Then general anesthesia was administered for the procedure.
After opening the abdomen it looked quite normal. No internal bleeding, but when re examined vaginally, she was bleeding profusely. Prompt decision was to be taken to save the mother from exsanguation and death. The choice of procedure to tackle the situation depends on the general condition of the patient, availability of blood, experience of the surgeon, the logistics, environmental factors and most importantly mother's future fertility.
At that point of time every factor appeared adverse to me . I felt as if the sky is falling on me . A young lady who had just achieved her motherhood hardly two hours back , yet to recover from anesthesia had landed in a life threatening bleeding which might deny her to hug and breastfeed her daughter. The monkies couldn't find a better time than this to commit suicide and creat a total blackout in the region. With two torch lights I have to fight one of the most difficult and challenging battles of my career. No more blood was available in the blood bank nor any more donor. I was on a cross road whether to go for sacrificing the uterus and save life there by, finishing her Obstetric career or trying for other methods to preserve the uterus. The condition of the patient and the situation was against the latter procedure. At that time my Guru's teachings reminded me, “There’s no place of heroism in emergency. Never experiment in dying situations. Practice the best method; you have mastered to save the life. Don't listen to what the world says behind you. “I regained courage and vigor and proceeded with removal of uterus to save the life of the mother. Everything was finished within two hours. The mother was saved but lost her fertility forever.
The electric supply was restored after three days. The premature baby started breast feeding after five days. The young mother drawn from the jaws of death, getting a rebirth was so happy. Till the day of discharge she wasn't aware of the critical period through which she had passed. She didn't know that she can't be a mother again. Her family members were reluctant to reveal her all the facts. They were of the opinion that they would reveal her everything at a later period once the child became at least two years old. But for me it was too heavy a burden to carry for two years without any valid reason. I wanted to tell the truth before the mother is being discharged from the hospital with proper documentation. "Who is to bell the cat? Who will break the news? “I volunteered to do so without any hesitation. I called her family members including her husband and her younger sister.
With all composure I detailed the situation through which we had passed on that fateful day and we had no other way to stop bleeding and save the life of the mother. The mother listened to me and showed the best reaction totally unexpected, “Thank you doctor for saving my life and gifting this cute doll to me. Bless my baby. I will stay indebted to you forever."
Prof Gangadhar Sahoo is a well-known Gynaecologist. He is a columnist and an astute Academician. He was the Professor and HOD of O&G Department of VSS MEDICAL COLLEGE, Burla.He is at present occupying the prestigious post of DEAN, IMS & SUM HOSPITAL, BHUBANESWAR and the National Vice President of ISOPARB (INDIAN SOCIETY OF PERINATOLOGY AND REPRODUCTIVE BIOLOGY). He has been awarded the BEST TEACHER AWARD of VSS MEDICAL COLLEGE,BURLA in 2013. He has contributed CHAPTERS in 13 books and more than 100 Scientific Articles in State, National and International Journals of high repute. He is a National Faculty in National Level and delivered more than 200 Lectures in Scientific Conventions.He was adjudged the BEST NATIONAL SPEAKER in ISOPARB NATIONAL CONVENTION in 2016.
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