Cord Prolapse

Just had a cord prolapse about an hour ago. Received a call from patient who had informed us that she had just ruptured her membranes and noted 'something' in between her legs. We had 'blue lights' up to her and i had given specific instructions to the paramedics what to expect and what to do. Midwife was in her car, stepping on the accelerator trying in vain to reach the patient.

Got a confirmation from midwife...'Its definitely cord!' ..as she made her way in with the ambulance.

I have assembled the theatre staffs, anaesthetist, paeds as well as SCBU. Scrubbed up at 0745 waiting anxiously for the patient to be pushed through the two operating theatre doors. The consultant on call was making her way in. It might take a while before she arrives.

In the next 5 minutes, the two wooden doors opened and in came two paramedics in their green uniform..and the midwife on the trolley with the patient in the semi recumbent position, her hand in the vagina. I can feel all the adrenaline rushing through my blood vessels. My heart was beating up to a 120 beats per minute. I can literally hear my own palpitations. The staffs were frantically getting her onto the table. I rushed them.

'Were there two heart rates?' i called out. 'How's the pulsation on the cord?' i asked again. 'It seems to have stopped about 4-5 minutes ago' the midwife replied underneath the surgical drape i threw over her and the patient after i had cleaned the patient's abdomen. I didn't had the chance to say hello to the patient or even looked at her face. She was under general anaesthetic the next minute. My surgical blade just inches above the area where i would make the incision. I performed the fastest c-section i can the very moment the anaesthetic reg says 'go'.

Patient was in the theatre 0755.

She was anaesthetised before 0800.

First twin came out at 0800.

Second twin was at 0801.

Twin one had the cord prolapsed. Pale and lifeless at birth, it took a while before the paeds got the heart rate and continued with their resuscitation. Twin two was crying nearby within the resuscitaire trolley.

I saw my consultant through the small window of the doors. She gave a 'thumbs up' as though asking if everything was alright. I managed a nod whilst closing up the bleeding uterus. She acknowledged.

The theatre was bustling with activities. Nurses running in and out to SCBU. Consultant Paediatrician making orders and registrars setting up lines. I did not hear a single whimper from twin one. I heard somebody in the theatre said 'she's got a heart rate and looking pink now'. I gave out a sigh of relief. At least its not a still birth. We are still to know how extensive the damage was. It would take some time before i get that answer.

I walked out from the theatre after about half an hour. Wrote my surgical notes and handed over to the next registrar on call. Tired. I changed and made my way out from the hospital. 'Were you on last night?' C asked. 'Yes' i answered. 'Hm mm i supposed that's the reason for the mayhem in the theatre, eh?' she teased. I laughed and said 'Well, you know me. Whenever i am on call, things do certainly happened and its almost always busy.'

Its bright and sunny outside. I can feel the warm summer sunshine on my face. 'I hope its going to be quiet tonight' i whispered to myself.