This blog post contains graphic descriptions of obstetric surgery which you may find upsetting.
On Friday I lost a 27-year-old patient who had presented in a coma the night before.
She had progressively become more comatose throughout the day. The only unusual findings were jaundice and hypoglycemia, low blood sugar. I attributed the initial low blood sugar to the fact that she hadn’t eaten for over 24 hours. And I wasn’t sure what to make of the jaundice when her hepatitis screen came back negative. I thought the most likely diagnosis was fatty liver of pregnancy, a disease that used to have a high mortality in the U.S., over 80%. Aggressive management with early delivery has significantly lowered that death rate back home.
This patient was only five months pregnant. Her husband said that one night she just lapsed into a coma and never came back. That’s kind of unusual for fatty liver so it’s possible she had something else going on. It’s equally possible that she had had a progressive deterioration that he just hadn’t noticed. I discussed early delivery of the baby by C-section with the understanding that the baby was far too young to survive. They were in the process of making the decision when the mother died.
Later that same day a patient came in after pushing at home for over 24 hours after being in labor for two days. The baby was dead but the baby’s head was too large for her to push out. I could see it easily when she pushed. An ultrasound showed the chambers of the baby’s brain were filled with fluid, consistent with hydrocephalus. I inserted a large needled into the baby’s brain to remove as much of the fluid as I could but was surprised to find that it wasn’t brain fluid at all but blood. That mother had pushed so hard for so long that the baby had had massive brain bleeds. All in all I removed about 400 ml of blood, a little more than the amount of fluid in a 12 ounce can of Coke. As I was removing the last bit of fluid the mother gave a strong push and the baby practically delivered in my lap. I sent her home today, grateful that she hadn’t required a C-section.
That brings us to today, Saturday, but I’m going to save today for later. It has been grueling today and I’m ready to hit the sack. I also figure that you all didn’t sign on for a novel.
Just a little over two weeks to go!