THIS CAN HAPPEN VOL X
Dr. Gangadhar Sahoo
It was an incidence of 1995 . I was just promoted to the post of Assistant Professor, ObGy after a rigorous dedicated work of 10 years as Senior Resident in VSS MEDICAL COLLEGE BURLA. In Burla there was a special rule for faculties. Question of transfer to other two medical colleges was a rarity even after promotion. If by chance one is transferred , he/she can not be relieved without a substitute joins . It was the statutory rule. Those who were posted to other city based medical colleges get their transfer and posting order canceled by hooks or by crooks . So I was continuing there for more than 10 years even after my promotion. I was used to be familiar with my patients. There, the doctor-patient relationship was intimate and something special. In one of my OPD days came a couple whose appearance and voice was familiar . But exactly I couldn't remember the incidence why they were so familiar. Both of them touched my feet with tears rolling on their cheeks and their look expressing both hope and apprehensions. The husband told , " Sir ! six months back we had a dead born child of eight months pregnancy delivered in your unit. You had advised us to come for check up and if required for hospitalization once pregnancy test comes to be positive. "
It was their 13th pregnancy without a living issue. They were in their early thirties married for around 13 years. There was no problem in conceiving. Immediately after marriage Mandakini, the wife conceived .She was under the care of the most experienced and respected Village Dai Mini . Who did not know Mini Mausi (Aunty)? There was no couple in that locality who was not being treated by her? First information report of pregnancy of any mother was received by her. She was giving a long list of advice to every pregnant woman. It included the advice regarding diet, lifestyle, exercise, yoga, easy delivery medicine etc. Mandakini was under her treatment. After around 40 weeks she delivered a matured male baby following prolonged labor of two days. That baby did not cry after birth even with all efforts made by Mini Aunty and after few hours the ill fated baby breathed his last. That was her only live baby delivered by her. After that she had a few miscarriages, intrauterine deaths. But she had only visited a hospital that too our hospital in her last pregnancy. During that pregnancy all necessary investigations were done to find out the cause of the recurrent pregnancy loss. But no definite cause was found. At the time of discharge we had advised her to take folic acid tablet daily and with that medicine to try for pregnancy after three months. Once she conceives, she must get admitted so that we can investigate and follow up her pregnancy under our direct supervision. Therefore they had come after the pregnancy test came to be positive.
Really this type of decision and advice sounds absurd. But why did we take such an absurd decision? Is it evidence based? No. It might be the 1st evidence in medical history.
While taking history it was revealed that the couple moved from pillar to post except the specialist consultation after the fifth pregnancy loss. They started different alternative therapies like yagyans to satisfy the dissatisfied souls, chanting of mantras, practicing meditation so on and so forth. Those practices added more insult to injury. During the previous mishap we assessed all possible aspects and decided that we have to address their psychological factors because both had developed severe depression.
Once she was admitted, she was given a bed in the 3 bedded sharing observation cabin in front of the antenatal ward duty room. We had made a plan to engage the patient mentally and physically as far as practicable. We were allowing them for morning walk and evening walk. We engaged our staff sisters on duty to spend time with the patient to give moral boosting. Our faculty members and post graduate students also were trained to give psychotherapy. The other patients after delivery both normal and critical cases were allowed to interact with her to share their experiences. Gradually as the days were passing she was developing self confidence and the negative thoughts started disappearing.
We were monitoring her health and fetal growth as per the routine protocol of our hospital. With crossing of each milestone she was becoming more confident. During each ultrasound examination when she was seeing her baby's movements and heart beats she was becoming more confident, comfortable, relaxed and ecstatic. After 28th week she became assured that she will definitely be a mother this time. That positive mental makeup helped our team a lot to tackle the situation. Every day passing was appearing as if a month was passing not only for the mother but also for the whole team. After 32 weeks we gave her a home tax in the form of maintaining the daily fetal movement count chart. Daily a chart was supplied to her in the morning round, methods of filling the chart was explained to her. In the evening round we were analyzing the chart. She will be anxiously waiting for our remarks. After getting our positive response the changes of expression on her face was worth observing.
In this way days were passing. Countdown started after completion of 34 weeks. Once it crossed 37 weeks we were losing our patience. We were not in favor of allowing for a vaginal delivery as the horror of her first pregnancy was haunting us. It was decided to deliver by Caeserian section after completion of 39 weeks. Everything went smoothly. Mandakini became the mother of a healthy, beautiful girl child. She kept her name Gouri for obvious reasons. Her husband, the father of the most precious girl child came to the hospital at the time of admission without any beards but when Mandakini was discharged with Gouri from the hospital his beards had grown proportionately with pregnancy and crossed the xiphisternum level.
In our study of recurrent pregnancy loss (RPL) this particular case had a record breaking 12 pregnancy losses.
A single pregnancy loss is painful not only to the parents but also to the treating Obstetrician.
Each case of RPL is different. In 95% cases one definite cause cannot be found out. Therefore while dealing with such sensitive cases the Obstetrician should be careful, cautious and hopeful. The approach should be such that the victim i.e. the mother should feel positive, relaxed, confident and de-stressed. At no point of time she should feel taxed. Then God will bless the Obstetrician and her/his patients.
IT'S RIGHTLY SAID ONE AND ONLY ONE TREATMENT IS REQUIRED FOR SUCH COUPLES WITH RPL IS “TENDER LOVING CARE.”
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