Palmo Anest

Effects of hungry ghost month?

There may be something very wrong in my hospital especially to the O&G department. Why? We have had 3 rupture uteruses in a year and 2 of it in this month!

The latest one happen on my oncall day. Coincidentally it was also the 15th day of the chinese lunar month (hungry ghost month). I don't believe there is any connection to this but our O&G colleagues seems to belive it does! There are awfully way too many major bleeding cases in this month for them (their LSCS and ERPOC).

This is a case of a young G3P2 term mother came to Labour room for delivery. No previous surgery done before. Os was 6 cm on admission and labour progressed well. Case book with OT for prolonged 2nd stage after os full for 45 minutes, CTG reactive. As it was 4 am in the morning, and there's no case going on in OT at the moment, we called the case imidiately for LSCS.

On booking, vital signs claimed to be normal and stable. However, on arrival to OT, patient was very tachycardic (> 160 bpm), BP lowish at 80+/40+ mmHg, mildly pallor.

We sets 2 large bore branulla and run fluid, however SBP was just minimally improved to 90-100 mmHg. Still very tachycardic >160 bpm and became very pallor and drowsy.

On palpation, can easilly felt the feotal parts per abdominally and unable to get a feotal heart sound. Brought the ultra sound scan machine to OT and there was no foetal heart, called in their consultant oncall and a diagnosis of uterine rupture was made.

By this time we had inserted 4 branulars to the patient and called for blood and blood products from the blood bank. I called in my consultant oncall and GA the patient, induced with ketamine and suxamethonium.

Upon opening up the patient's peritonium, a fresh IUD baby gushed out together with lots of haemoperitonial blood. We have no choice but to replace the volume with colloid while waiting for the blood. By the time the blood and blood products came to us, my clinical judgement of the Hb was arround 4-5g%.

They had to proceed with hysterectemy and latar ligation of bilateral internal illiac artery. Abdominal packing done too. Total blood lost about 7.5L. We transfused 12 units of blood and 2+ sets of DIVC regime.

Intraoperatively patients vital sign was resonably stable and MAP was all the while above 60mmHg.

She was later admitted to ICU for post operative care. Removal of abdominal packing done after 48hr. Luckily she didn't developed any Acute Renal Failure or Acute lung injury/ARDS secondary to massive transfusion.

I've just discharged her from ICU early this morning after 5 days stay in ICU. hope she was well.

Currently my general ICU still have 2 Obstetric cases. As I said, I really wonder what's going on with them nowadays with such high incidence of critically ill cases.

Hope she will be discharged well from hospital ASAP.

posted by LT @ 5:04 PM