Tuesday, 19 October 2010

Obs Gyn Posting..

Obstetric and Gynaecology..

Salam sejahtera semua..
Dah lama tak update blog ni..kebetulan hari ni, esok dan lusa aA cuti..boleh la update..
Sambung tentang O&G Posting..teringat pula masa aA 3rd call (Ho yang kena bersedia if ada operation eg: caesarean, etc) pada satu hari.

23 years old, Indonesian Gravida 2 Para 1 (with no living child). The first baby died just after birth around 3 years ago..admitted for labour pain at 40 weeks of gestation. Around an overnight stay at ward. The next morning, she was sent to labour room with OS 3 cm. The progression of the labour quite slow initially..from 3cm to 8 cm take about almost 7 hours..

A healthy 2.9kg baby girl was born around 5.30pm..however, the complication goes to the mother. She suddenly had tachycardia (increase the heart rate) with massive per vaginal bleed..diagnosed as primary PPH secondary to extended tear of vaginal wall..estimated blood loss around 1 litre.

She was push to the OT immediately and I was call to get ready to assist the MO in the OT.
In the OT, the patient was put under GA (general anaesthesia)..repair of the vaginal wall went uneventful. The tears were very large…until it’s like u can put ur hold hand in the tear..

When we about to finish, noted blood gushing out from the birth canal..very thin (cair)..and maroon in colour.. we searched and explore the source of the bleed..it’s from the uterus..is it the uterus became atonic??i massaged the uterus, well contracted..
And the BP started to drop, the pulse rate raised..the anaesth trying to insert the central venous line using ultrasound guided. Failed..
Then we unscrubed..patient currently in DIVC (disseminated intravascular coagulopathy)with hypovolaemic shock..because of too much bleeding, the coagulation component already been used up and end up with the blood unable to clot.

We infused 3 cycle of DIVC regime (FFP,Cryoprecipitate and Platelet). My friend who in-charge labour room that night also got bz with that case. She has to run from the labour room to Blood Bank and to OT. It’s very tiring..and us who were in the OT, need to compress the DIVC regime packs with our own hand..with both of our hand rasied up..at least 30 bags..
At that time, the blood still pouring out from the uterus..Hysterectomy cannot be carried out because of the coagulopathy. ABG at that time shows severe metabolic acidosis..
After the BP have been stabilized, the patient was transferred to ICU around 12am.

At 2am, I had another call for another caesaerean that night. Uneventful..around 3.45am, only 5 minutes after I finished my job at OT, again, I was call to ICU.. that patient actually already in asystole..my friend do the CPR and I help the Anaesth specialist to infuse 4th cycle of DIVC regime.

As the patient’s condition is very bad, I was asked by my specialist to explain the condition to the husband.. it’s the hardest task for me..

I explained the condition slowly and the husband cried in front of me..

Not even reached 5 minutes after the explanation, I was informed that the patient already gone.

Itu lah oncall yang paling saya akan ingat..the patient is only 23 years old..and this case went to Maternal Mortality audit..which was carried out around 6 weeks ago..where I’m already in Medical Posting.