The past two weeks have been pretty hard weeks in the hospital for both of us. Tim had previously admitted a woman who was pregnant with bleeding. He did an ultrasound and saw that she had a placenta previa, the placenta covers the cervix and won’t allow the baby to deliver vaginally. He also saw something unusual and was unsure what it meant. He came home and thought there was a possibility that it was a placenta accreta, where the placenta has actually grown into the wall of the uterus. If this was what he saw, this can be very dangerous for the patient. They continued to monitor her for several days, as her bleeding slowed to occasional streaks on the pads placed underneath her. On Tuesday last week, Tim was on call and rounding in the different wards as usual and I was preparing to come to the hospital, as this was my morning to work at the hospital for the week. Tim received an urgent call from maternity, asking him to come evaluate the patient as she had begun to bleed more rapidly. I arrived at the hospital just after Tim realized that this mother needed to have a Cesarean Section right then. He asked me to come to the OR, so that I could help resuscitate the baby. At this time, the mother was only 29 weeks pregnant. Although she had been able to receive steroids to help the baby’s lungs to develop faster, this baby would likely need as much help as we could give her. Tim did the C-section rapidly, attempting to get the baby out and stop the bleeding as quickly as possible. He handed the pale bluish, lifeless small baby to me, as he continued to work quickly to save the mother’s life. As I placed the new little girl on the cold hard table, her chest caved in as she tried to gasp for air. There was no sound made and only a slow heartbeat. We quickly dried her off and began CPR, as Tim was working on removing the placenta. As Tim was removing the placenta, he realized that what he had seen on ultrasound was a placenta accreta and this mother was in great danger of bleeding to death. He was able to remove most of the placental tissue in pieces, but the patient continued to bleed a lot. This is the sort of case that only OB/GYN trained doctors do in the US, because it is rare, and dangerous complications are associated. Tim was considering performing a Cesarean hysterectomy (taking out the uterus after doing a Cesarean section), when a Ghanaian physician poked his head in the OR room. He had previously seen a couple of placenta accreta patients in his housemanship training, where they placed a special balloon to stop the bleeding from the placenta accreta. They gathered together the tools needed and placed the balloon. Meanwhile, a midwife and I continued CPR on the little girl, also giving her epinephrine and an IV fluid bolus. Her chest would occasionally cave in as she tried to gasp for air, and her coloring improved only a little as we continued CPR. After a while, the little girl stopped trying to breathe and eventually we decided that the CPR was futile. This little girl, who was just born into this world, died before she was able to experience being lovingly and warmly held by her mother, who was also fighting for her own life. As Tim and Dr. Yakubu worked to place the balloon in the mother’s uterus, her bleeding began to slow. The doctors finished the operation, were cleaning up and noticed that the balloon had fallen out. They tried to place a new balloon but it would not stay in place. Thankfully, God had slowed the woman’s bleeding to only a slow trickle. We were still nervous that Tim may have to do a hysterectomy over the next day or two, but the bleeding stopped and the mother continued to improve. She was able to return home a few days later, but sadly leaving without her little girl. Tim did see her again in clinic this past week, and she was doing well (had no more bleeding, her blood count was stable, and the ultrasound did not show any retained tissue in the uterus). Praise God for preserving this woman’s life!
Later that same day, Tim was also called for another C-section. Mother and baby did well. Then, he was called to evaluate a possible ruptured ectopic (pregnancy outside of the uterus). He performed an ultrasound and confirmed that she did indeed have an ectopic pregnancy with lots of blood in the abdomen. The patient ended up having the ectopic where the Fallopian tube connects to the uterus, a rare location. Again, God guided Tim’s steps as he quickly rushed her to the OR to remove the ectopic and give her back some of the blood that she had lost into her abdomen. The patient improved, and several days later, she was able to go home. Tim will follow up with her next week.
This week also came with its own challenges. Tim was on call on Wednesday and had to perform a C-section in the middle of the night (Thursday morning) for another lady with a bleeding placenta previa. He had only had a few hours of sleep, so he had hoped to finish rounds quickly that morning and return home for a nap. This also happened to be my morning to work at the hospital. I went to maternity to see if I could help Tim round on the patients there. As we were finishing rounds, one of the midwives approached Tim. She was concerned about a patient who had just arrived. The Kakumba woman had been in labor and pushing since daybreak and it was now 10:30am and she had not delivered. Her contractions had stopped and the midwife thought the patient’s stomach felt unusual, like a possible uterine rupture (where the uterus tears open). Tim quickly examined the patient and agreed that it was likely a uterine rupture. He grabbed the ultrasound to confirm and to see if the baby was still alive. Sadly, the baby, that she had carried for 9 months and had been trying to bring into this world, had bled to death inside her abdomen. However, this tired, frightened mother was pale, cold, and internally bleeding. We had to rush her to the OR or she would bleed to death as well. We asked for anyone who could communicate with this woman and finally found someone just before taking her to the OR, and they confirmed that she did not desire another pregnancy (she had 7 children at home). Tim and a volunteer, Charlie, worked hard and were able to stop the bleeding by repairing the badly rent uterus and tied her tubes. She required a couple units of blood during and after the surgery, but currently she is in maternity ward and doing well.
Even early this morning (despite the fact that Tim’s day off was to begin 1 hour later), Tim was called in to see a pregnant woman. She had delivered her seven previous babies too early, and she had no living children. This pregnancy, she had a cerclage placed (helps an incompetent cervix hold the baby in the uterus) in hopes that she could carry this baby to term. She had gone to a clinic in her town, Bunkpurugu, early this morning in labor. They realized that she still had a cerclage and needed to go to a hospital. They referred her to Tamale Teaching Hospital, but as she passed by Nalerigu she decided to stop at BMC (God’s divine guidance). The midwife called Tim to come quickly, as the patient was bleeding profusely. Because of the cerclage and the patient being in labor, she was at risk of a cervical laceration A cervical laceration can cause severe bleeding, putting the mother at risk of bleeding to death. Tim ran to the hospital, was able to remove the cerclage, and fortunately, there were no cervical lacerations. Because of her poor obstetric history, current bleeding, and history of one previous C-section, Tim took her to the OR for a repeat C-section. Praise God that the baby and mother are doing well after the procedure.