Three for one

05 July 2017

As we say in Jahun, expect the unexpected.

It had been a busy morning, like most. It is difficult for patients coming from remote villages to travel during the night hours, so many have to wait until sunrise to start their journey to the hospital.

Sea of children heading to school along the main road

I was just finishing a review of the patients in the pre-delivery unit when a new patient was wheeled in by family members. The patient was a young girl, pregnant and semi conscious. I motioned to the family and we aided her from the wheelchair to the hospital bed. I looked around for a midwife to help me with translation. “Jujuga?” I asked as I quickly assessed the patient. They nodded.

Jujuga means convulsion or eclampsia in the Hausa language. Eclampsia comes from the Greek “eklapsis” – a sudden flashing or lightning. Eclampsia is a condition in pregnancy whereby a woman has seizures (convulsions) that are associated with abnormally high blood pressures. I wish I could say that this was the unexpected aspect of my day – in my nearly eight years of training and practice in Canada, I’ve never seen a case of eclampsia. But in Jahun, we see upwards of 5 eclamptic patients everyday.

Together with the midwife we obtained a better history from the family. The patient was 16 and this was her first pregnancy. She did not have any prenatal care. She had 3 seizures at home and one on the way to hospital. She came from a village about an hour away but was not able to present sooner as her husband was not around. On examination she became more alert but was confused, her blood pressure was extremely elevated at 210/125 (normal upper limit being 140/90), she was breathing normally and on ultrasound had a live baby of about 8 months. We made a plan geared towards preventing further seizures, lowering her blood pressure and the ultimate treatment - expediting the delivery of her baby within the next 12 hours.

A rare moment when the pre-delivery area was nearly empty – I’ve seen this only once

I’m then called to the delivery room. A patient has just arrived, she was 38 years old with a history of 8 home deliveries and 7 living children. Earlier that morning she delivered a small but healthy baby girl at home and eventually presented to the hospital as the placenta (the afterbirth) had not yet come.

The midwife astutely observed that the woman’s belly still seemed large and suspected maybe she had a twin still inside. I scanned the woman’s belly with the ultrasound machine. Lo and behold, I saw not one but two heads still inside! Surprise! She had triplets! Reaching for the feet, I delivered the two remaining babies – also healthy decent sized girls – and reunited them with their slightly older sister. Triplets alone are relatively rare. To deliver them normally (ie not via caesarean section) – now that is something you don’t see everyday!

Shaded area for patients’ families on the hospital grounds

By evening when I did my final patient round before heading back to the base, I checked on the young patient with eclampsia. She was alert, her blood pressure was under control, she had not had any further seizures, and was well on her way to delivery. When I saw her the next morning she was proudly breastfeeding her baby boy.

Healthy mom, healthy baby

At times it’s difficult to work in an environment like northern Nigeria, where poor maternal and fetal outcomes are all too common. At the same time, it is motivating to witness how emergency obstetrical care can bring us one step closer to reaching the ultimate goal in obstetrics: a healthy mom and a healthy baby. Every good outcome is a victory.

 

 

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