Just prior to my two weeks annual leave to be a personal tour guide to my parents here in the UK, i was on-call. And during that hot saturday afternoon, I had a patient who is into her term plus 13 days of pregnancy. Erm... thats what we think she is..because we have absolutely no antenatal records whatsoever from her country of origin, Zambia. She left Zambia to be in this country when she was about 35-37 weeks pregnant and i have no idea how it was possible for her to escape the flight restriction.
Anyways, she was induced for post term and planned for an artificial rupture of membranes (i.e. erm...breaking the membrane at the neck of the womb/cervix to release some yucky 'pandan smell' of fluid to release some chemical substance which would then start the contraction... yada yada yada).
Problem!! We (midwife and myself) noted that she didnt had any antenatal booking blood results of HIV/RUBELLA/HEpatitis B or C!!!
That sort of makes things more complicated as Zambia, since the mid 1980s has been compounded by one of the world's most devastating HIV and AIDS epidemics. The statistics alone are shocking:
one in every six adults is living with HIV
98,000 people died of AIDS in 2005
life expectancy at birth has fallen below 40 years
710,000 children are AIDS orphans
The prevalence of HIV infection in women giving birth in London was 0.38%,compared with
0.06% in both the rest of England and in Scotland (RCOG).
and, and..... fetal heart rate is not the best as well.... BUT,
I dont want to cross infect her baby iatrogenically.
I dont want to risk myself or my staffs to possible infection by not knowing her status.
Heck, i dont even want her not knowing her status and then not getting any possible treatment...
We then manage to get an URGENT HIV testing (courtesy of the oncall consultant microbiologist) and got the results within 3 hours (how efficient!). IT WAS NEGATIVE. Phew.... what a relief. I did what needed to be done... i ruptured the membranes........yucks...
*Any women diagnosed HIV positive during pregnancy should be informed that interventions (such as anti-
retroviral therapy, caesarean section and avoidance of breastfeeding) can reduce the risk of mother-to-
child HIV transmission from 25–30% to less than 2% (RCOG).
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3 comments:
Not an uncommon scenario in certain parts of Malaysia...G10P9 turns up in labour not having any antenatal records and the baby pops out with nary a sneeze. O+G's too stressful for me!
fibrate: well...i sometimes feel that i am an adrenaline junky... getting all those stressful days when oncall... gee..i think i may need a physician's advice soon on possible heart failure.. hehhe
Then you're in luck coz I might take up cardiology :)
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