Saturday, March 28, 2009

Julie and her son

2 weeks ago I was Csection backup. This means that I don't get to round or do any patient care stuff, unless there is a Csection, then I get to work. Well, that Saturday, I got to work a lot (3 Csections and one 4th degree repair). I had admitted Julie, late Friday afternoon, with placenta previa at term. She wasn't from our area, but I was concerned that if we didn't admit her and do her Csection, that she might not get the care she needs elsewhere, so I admitted her. It took a while for family to come in order for us to do the section, so we did it Saturday afternoon.
I have only done 1 placenta previa, which was with my sister, almost a year ago, so I asked Jim if he wouldn't mind being in there in case I needed him. Niles Batdorf, a surgery resident from Mayo, was with us and he and I started the case. When we got to the uterus, it didn't look like anything I had seen before, but I figured well this must be what previa's look like. It was all vascular, and darker color. Jim walks in at this time and says WOW, what do we have here. It was good timing to say the least. We ended up cutting above this placenta in the upper segment and getting the baby out. When it came time to remove the placenta, it was quite adherent to the rest of the uterus, and it made up the lower segment of the uterus. She didn't just have placenta previa, she also had placenta percreta.
Thankfully, Jim was able to sew the pieces back together into a uterus again. We wanted to do a tubal ligation on her, but her husband was in Port Moresby, and the family couldn't consent to it. So we just finished the Csection. In the days she was here in the hospital, I had numerous discussions with her about her needing a repeat CSection, and should even consider a BTL now, as she is at risk of having the same thing happen next time. She seemed to understand. This week, I got to see her and her son in followup. It was neat to see them and know that they are both doing well. She will stay up in the are for a few more weeks before heading back to POM with her husband.