13/09/2007.... First LSCS of the day..Uterine Rupture..

I was on call that very morning. Made my way to the delivery unit and met the consultant and my fellow colleague from the previous night. She looked exhausted. Probably a busy night I thought to myself. In room D, the room that we were all paying close attention to. A patient who had one previous cesarean section and a successful vaginal birth after was in labour.
'Progress has not been good' i heard one midwife commented. 'The CTG looks suspicious' my colleague said. 'I think she need a fetal blood sampling to assess further' she added. I waited no longer. It's all I needed to know prior to gathering the equipments for what is coming next. Fetal blood sampling. A very safe procedure done mainly to access the pH of fetal scalp blood obtained from a few superficial scratches.

The test revealed a pH of between 7.35 to 7.37 in three samples. That is absolutely normal for the baby. Nothing could be better. CTG at this time still remained suspicious. The plan was to see how she would progress in the next hour. I had examined her and she was still about 8 cm dilated. She had been 6 Cm dilated for the last 6 hours. I had requested for her to be catheterized to empty her bladder.

A minute later, it was chaos. The fetus was in obvious distress. The heart rate dropped to a mere 80 beats and remained there for the longest 5 minutes of my life. I decided it was not a good idea to carry on with the labour. I made several urgent phone calls, to the theatre staffs, the anaesthetist, and the consultant. I had wanted this baby out now.... right this moment.

The panic and confused patient was rushed to the theatre for a grade 1 LSCS. My heart rate almost invariably can be felt beating against my chest in cases as such. Patient was in theatre at 0918 and general anaesthesia commenced at around 0925. I had noticed the abnormal hump on the patient's abdomen. I have always called this the 'camel hump' as it looks like the baby's buttocks is raised high on the mother's anterior abdominal wall. Knife to skin at 0927. As I entered the abdomen, a sudden gush of fresh blood and I recognized the pale body of a fetus. 'The baby is out of the uterus! Call the consultant this instance! Start syntocinon 40 units please' I called out in sequence. Baby out in 2 minutes from skin incision.

As usual I had my trusty Paediatric colleagues to help with the resuscitation. I scanned the uterus for severity of the damage. Tears noted extended to the broad ligaments but fortunately no further than that. I had managed to achieve haemostasis. My consultant was there to give me a hand with the remainder of the surgery. We had avoided a possible uterine atony or hysterectomy. Blood loss was less than what I had expected. 500 mls. 'You do like excitement don't you? It only happens to you isn't it?' my consultant joked.

Half hour later, I was told the cord pH of the baby was 6.9. An acute drop. Too close for comfort. It could have been a perinatal mortality case in next month's meeting but thankfully not.

Patient remained stable post LSCS and baby is fine in SCBU.

I had another call few hours later from delivery unit. A patient who again with a previous scar now in the second stage of labour and had fresh bleed from the vagina. My thoughts 'If this is another scar rupture, i will be very very very surprise!'

Here we go again.