Monday, December 12, 2011

Urban Legend

I've been working in delivery quite often lately. Some days are busy, some are fairly quiet, and there are those days when all hell breaks loose. One morning, I was working the day case list, IVF, D and C's (dilatation and curettage) and other sundries. During a lull, I was sent upstairs to delivery to perform an epidural because the anesthesiologist up there was preparing for a C-section. I told the midwife that I would do the epidural after my colleague induced anesthesia (since that is the stage when Murphy's Law invariably strikes and help is needed). She was visibly disappointed, but understood my reasoning. 
That epidural was not to be. From one of the rooms I heard a senior obstetrician yell, "We've got an abrupted placenta here, let's get her to the OR fast!". Placental abruption is when the placenta has separated from the uterus. This is a true emergency, because fetal oxygenation may be compromised and there may be significant bleeding. Both mother and child are in mortal danger.
The mother, an obese bedouin woman was indeed bleeding. Since the maternal airway, especially in an obese parturient is often problematic, I asked the other anesthesiologist to delay his C-section, and help me get this one underway.
Induction was no problem and I gave the obstetricians the go ahead. The operation was uneventful until they began the extraction of the baby. Often, the assistant must apply pressure to the upper abdomen thus pressuring the upper end of the womb to help the primary surgeon extract the child. At this point, the maternal heart rate dropped to below 40. I administered IV atropine and the rate rose and hovered around 50 while blood pressure was normal. I apprised the obstetricians of the situation. "I think that there's a lot of pressure on the vena cava, get that baby out quickly (please)!" The obstetricians were straining, but the kid wouldn't budge. 
The obstetricians, both female (very capable docs, with limited upper body strength, however) seemed to be tiring. Then, I had an idea.
"Rose (not her real name), move your hand please."
In place of the assistant, I pressed down on the upper abdomen through the sterile drape and leaned in. I'm no body builder, but I applied just enough leverage and the baby slid out, finally.
Looking at the monitor I noted with satisfaction that the heart rate was back up.
Ever since then, the OB/GYN's (with whom I have an excellent working relationship) have been approaching me with some measure of awe. 
The story has quickly become a local urban legend. Funny, I don't feel any different.

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