Unlucky Thursday Night going into Friday the 13th

Did a c-section for twins yesterday and maybe its my 'mulut celupar'....as i have told the patient and partner that i fear she may have uterine atony (womb lembik like dough!). That's because she has been in labour for hours and although relatively pain free with the epidural in situ, and on maximum doses of syntocinon...she wasn't really progressing or dilating her cervix. 8 hours into her labour...i had a look at the partogram ( graph showing labour progress) and decided i would throw in the 'white towel' and call it quits with any chance for vaginal delivery.

Had a chat with patient...and i strongly advise against her wishes to carry on another two hours. Everything she did was perfect...its just one of those cases where her uterus just wouldn't contract efficiently. So..brought her to theatre about 3 am. C-section was straight forward... no complications until...the uterus starts to relax. I generally ordered prophylactic doses of syntocinon (erm..hormonal drip to enhance womb contraction) but in this particular case...the uterus just refused to budge. Doses after doses of carboprost as well as per rectal misoprostol did not make any difference.

So, she bleed and bleed and although given other medications to stop the bleeding...she continued to bleed. Had to call the consultant in and .....after hours of massaging her uterus (another means of trying to contract the uterus), we ended up opening her abdomen and performed a B-lynch suture (will show illustration below). Well that kinda stop her bleeding after losing nearly 2/3 of her body's volume.


(BJOG)

She was later send to the HDU for further monitoring. Sigh..what a night .... oh did i mention that half way through the re-laparotomy i had to rush to delivery suite to perform one ventouse delivery and assess a lady for manual removal of placenta, as well as another patient with thick meconium stained liquor (pooh in the fluid surrounding the baby in the womb) with pathological CTG.

That was how busy it can be on my calls. It has been busy calls for me ever since October 2006. It doesn't help when its Friday the 13Th.

one more night of on call to go....