THIS CAN HAPPEN VOL XIV
THIS CAN HAPPEN VOL XIV
DR.GANGADHAR SAHOO.
I joined VSS medical college in1985 as clinical tutor. Clinical tutor was equivalent to the senior resident and lecturer in present time. There was no time scale promotion at that time. As per the vacancy available promotion was being made. I got my first promotion after 10 years. During that period we were working day and night
managing the routine works like OPD, OT, indoor patient care, academic activities and 24 hours labor room duty. There was a time when our OG department had only two clinical tutors. We had to do emergency duty on alternate days.
One day I was on emergency duty. My next senior on call was Dr. Sudhakar Rath , assistant professor. The labor room was full with critical cases. To help me I had given a call to Dr. Rath in the evening. Both of us managed a case of rupture of uterus, two cases of ECLAMPSIA apart from three vaginal deliveries. It was 10 pm by that time. As per our convenience Dr. Rath was to go for dinner and I was to look after the labor room. Once he returns, it will be my turn. He was on the verge of leaving the ward when an ambulance carrying a labor case from Sundargarh Dist. Head Quarters Hospital (about 150 km away from Burla) entered into the hospital
campus. As good sense prevailed Dr.Rath waited for a few minutes to know about the case.
I examined the case and told him that it was a case of two previous CS with 39 weeks pregnancy in 1st stage of labor. The case had labor pain for around 8 hours and discharge per viginum for 2 hours. Because of difficulty in transportation facility she was held up at the District headquarters hospital Sundargarh for more than 2 hours.
Dr. Rath also examined the case and advised to start first aid treatment and prepare the case for CS. Previous 2 CS is a definite indication for CS. Chances of scar rupture is high. So no obstetrician allowed these cases to go to labor. As a routine elective CS is the rule.
Dr. Rath called the attendants of the patient and explained them the risks of a 3rd operation(CS) and that too in emergency. Once labor starts there is every chance that the previous scar will give way and uterus will rupture which is lethal to the mother and the fetus. He explained them about all possible risks and advised them to arrange a bottle of blood and be prepared for the worst.
After counseling the patient party understood how much risky that pregnancy was. Uterus might rupture resulting in fatality to both the mother and baby. It might lead to severe blood loss. They all were ready to donate blood.
Some went to purchase medicine and some went to blood bank for collecting blood. It was a herculean task to get a cross matched blood at the dead of the night. The blood bank was located in the OPD block in an isolated corner. Night duty staffs usually were in the habit of locking the doors from inside to avoid being disturbed by
the drunk habitual donors. The veranda was the dream land of street dogs, beggars and miscreants. Patient attendants were facing a lot of problems to reach the blood bank and get a unit of cross matched blood. It was a regular phenomenon.
The attendants of the patient were desperately busy to arrange blood. Other group of attendants brought the whole list of medicines. By that time one valuable hour had passed. Anaesthesiologist on call had responded that he was busy in neuro surgery OT in a road accident head injury case. At the earliest he could be free by 12 mid
night. In the meantime I ordered my dinner from the hospital canteen and finished my rituals. I was waiting for the anaesthesiologist’s nod to shift the patient to OT. Dr. Rath through telephonic conversation told me to call him once the anaesthesiologist reached.
Patient was on the labor table. Myself, one PG student and one staff sister were monitoring the patient and the fetus. Fortunately there wa no other serious case. Intravenous fluid, oxygen supplementation and vocal analgesia and mood elevator was being supplemented to keep the patient in positive frame of mind. Pain was gradually increasing both in duration and intensity. After around half an hour the patient started bearing down. I did a thorough examination and found that she was in active 2nd stage of labor. Vaginal birth was eminent. I asked my team to get ready for this emergency battle. I asked the sister to give a pair of low obstetric forceps. In cases of previous CS forceps application is a recommended indication to cut short the second stage of labor so that maternal pushing efforts can be reduced and rupture of previous scar can be avoided.
An effortless forceps application with active management of 3rd stage of labor was performed successfully. A healthy matured female baby was delivered at 12.05 am . Baby cried immediately. It was an uneventful and effortless delivery. After the delivery was complete, I made a thorough examination. There was no suspicion of scar rupture nor any forceps inflicted injury in the lower genital track.
I was repairing the episiotomy wound when the anesthesiologist shouted to shift the case to OT immediately. Dr. Ratha directly went to OT to see and supervise preparedness to save delay.
Patient's attendant sprinted from blood bank to the labor room with the unit of blood in his hand as if running a relay race with a baton.
All concerned were seriously worried but God outscored others. Once God stands with someone, no power can do any harm.
I prayed Lord Jagannath for everything. Obstetrics is not only unpredictable, it is miraculously unpredictable.
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