Saturday, February 9, 2013

Just in the nick of time

She was on the OR table ready for her spinal to be put in her back, when I got called to the ER.  I asked anesthesia to wait, until I knew what was out there.  I found a young man who was chopped in his R foot and R leg, just below his knee.  The foot chop was significant, his foot was almost amputated, and we were going to have to finish the amputation in surgery.  Loretta, a volunteer doc from the US, called Jim to let him know what we had, and then we had a discussion about who should go first – the lady for Csection on the OT table, or this guy who is stable, but needs an amputation.  We elected for the Csection, since she was ready and he wasn’t and proceeded accordingly.

As I cut through her skin and got to her uterus, I saw, what looked like, a small white bubble on one side of the uterus.  As I was preparing to cut into her uterus to get her baby out, this white area was getting bigger – her uterus was rupturing right in front of my eyes.   Thankfully, I was cutting into it as it was opening, so it made my job easier and I quickly got the baby out and sutured up mom.  

If we had chosen to take the foot chop instead of the Csection first, this lady and her unborn child would most likely have died.  A ruptured uterus is a common complication in patients who have had a prior Csection and who are now pregnant again.  Many women have regular pregnancies after having a Csection, but it is a known risk that uteruses can rupture.  A ruptured uterus causes massive bleeding for mom and then for the baby as well.  If you don’t get in there right away, both can die.  We only have one operating room, if we were doing that chop, she would have just been waiting and we wouldn’t have been able to help her when it happened.  Thankfully, God knew this and let us do her first, and in just the right time.