Re: 3rd World OB was Full dilatation
From: RModugno@aol.com
Tue Dec 2 16:07:49 2003
In a message dated 12/2/2003 3:13:12 PM Eastern Standard Time, eryl@intekom.co.za writes:
> How's this for the other side of the coin? Patient admitted in labour
> to a rural hospital near here - 20 year old primigravida at term.
> Progress not very good, but not arrested. Medical Officer who works
> only on weekends in hospital asked to see because of slow progress and
> head not descending. Finds she is fully dilated, but to everyone's
> surprise there is no fetal heart. Don't ask me how a patient can be in
> a hospital labour room for several hours and nobody notices that there
> is no fetal heart! Because there is now an IUD the doctor says "no
> caesar, allow to deliver vaginally" and disappears. 16 hours later, now
> Monday morning, the resident staff find her still in labour, and there
> is a swelling suprapubically which they assume to be bladder, as they
> can't get a catheter in because of the impacted head. No problem, they
> say, we'll empty it via a suprapubic needle. Rather to their
> consternation the needle releases not urine but gas! It is noticed that
> she has a fever of 38 degrees, and they decide, wisely to transfer her
> to the Obstetric Unit in this hospital. The urine on catheterisation
> here is wine coloured. A caesar is performed - now it is 19 hours since
> she was fully dilated. The lower segment is massively oedematous, the
> baby necrotic, and weighs 4000gm. 24 hours post C/S she is distended
> and pyrexic, so I performed a hysterectomy. The bowel looked fine, and
> there was a small amount of fluid in the pelvis, but the lower segment
> was avascular, pale and starting to necrose. The posterior wall of the
> bladder was intact still, but looking dead.
>
> Today, three days later, she is losing urine pv and the urine in the
> catheter is still very red. She has only occasional bowel sounds. The
> temperature is 37.7, and she is still producing large amounts of fluid
> through her nasogastric tube. How much necrosis of the tissues at the
> pelvic brim there will be, only time will tell. The catheter is
> destined to remain in for about 6 weeks I expect, and I only hope we
> don't have to re-open her for a colostomy because of
> sigmoid necrosis.
> Steve Raymond
Steve would a destructive operation( craniotomy) on the fetus have been an option?
Robert Modugno MD MBA FACOG
Marietta, GA
http://www.novaobgyn.yourmd.com
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