A Night on Call!

I had just fallen asleep, when I awoke to the ringing of the phone with a maternity nurse on the other end. She just called to inform me that a patient arrived who had delivered at home, and continued to have significant bleeding. I was tired as it had been a long weekend on call, and I was hoping for a good night of rest before the start of the week. Half asleep I reached for my scrubs and bag of random medical supplies and stumbled to the door to assess the situation. As I walked to the front gates of the hospital I noticed an anxious man standing next to a small cart with two large oxen attached to the front. This was an ox cart which was a common mode of transportation for many of the Shona people. I could only assume this was the husband of the lady I was about examine.

I proceeded to the maternity ward where I saw an elderly lady holding a small newborn right outside the delivery room. She was friendly, but nervous, and I also assumed she was the mother of the women I came to see. I arrived at the bedside to find and HIV positive mother who was completely pale, and barely responsive. I came to find out that she delivered at home which was 20km away. Evidently only a part of the placenta was delivered, and she had spent the next several hours with significant bleeding. They all loaded in the ox cart and initially drove 5km to a local clinic only to find no one available, and then turned and drove another 25 km to our hospital. All the while our young mother continued to bleed. As I examined her I knew  she needed several (3-4) units of blood. Unfortunately we had no blood in the hospital to give her. I asked one of our midwives how much she was still bleeding, and her response was "She has stopped...I do not think she has any blood left to bleed". Sadly, this was not much of an overstatement. The only option was to perform a D&C to remove the rest of the placenta and hope she would stop the bleeding, and we could keep her alive through the night.

We took her back to the theatre (operating room), and gave her some sedation. With some difficulty I was able to manually remove most of the placenta. Her placenta was firmly affixed to the uterus (placenta accreta). This made it quite difficult to remove. After removing most of it, I then used a curettage to remove the rest. Her bleeding slowly stopped, but the battle for her life will continue on through the night.

For now the night appears to be over. The rest of the hospital is quiet, and I'll try to get some sleep. This may be difficult, because I don't know if she will make it through the night. I know the best medicine I can give her at this point is prayer. I know our prayers have the power to move mountains (Mark 11:23-24). I'm also thankful Christ has removed the fear of death, and with him safe place to seek shelter (Prov. 18:10).