20th February - Dead Baby and Mother on a Knife's Edge
I was dropped at the hospital at 9.00am after taking the car back to Johnny at Sodwana. I did a ward round whilst Lyn was in labour ward with a lady with a placental abruption. The baby had died in utero and she was making no effort to deliver it, with her cervix dilated to three centimeters of a number of hours.
She was eventually taken to theatre for a caesarean section under general anaesthesia. She was initially haemodynamically stable with good saturations and blood pressure but as soon as the uterus was cut open blood stained fluid poured into the abdomen and the lady’s blood pressure plummeted.
The dead baby was removed and handed to me to hold and do nothing else until it was taken form me, at which point I ran down to the fridge to grab units of blood. Whilst this was happening, Guy – our anesthetist – was frantically trying to place a second line in the external jugular vein as one of the large bore cannulae had been lost.
As Lyn and Lili worked to control the bleeding the patient received two litres of crystalloid, two bags of blood and two bottles of freeze dried plasma before her blood pressure picked up (from a systolic of 55) and remained stable.
The patient was then monitored by Guy for a short while before being transferred to recovery and back to the ward. Everything had happened so quickly that it hasn’t been until now, writing everything down, that I quite appreciated how much was being done.
I hated not being able to do anything with the baby except wrap it up in a blanket. The experience and specifically that feeling of uselessness will stay with me for a long time. It makes you feel very small to just have a dead patient given to you without any attempt to resuscitate expected from you.