Mar 17, 2009

at your 'cervix'

grateful to: Bayer's Yee Ling for the little guide on all the latest contraceptives of the world.

It was a busy day. Diving down to help out my colleagues who are really busy and practically (probably) seeing her world turned upside down or other way round.

I was called to help out as the 2nd call colleague stuck with C-Section.

I was told there was this massive PPH secondary to ? cervical tear happening in the ward and sending to OT for EUA and proceed. EUA is just another fancy term meaning examination under anaesthesia, meaning we try to knock out the pain maximally in order we could position this lady for a better view of the problem.

This was the same lady that gone through ventouse earlier this morning by my junior colleague supervised by me. I was really stumped because there was not much bleeding after the ventouse and there was definitely only small first degree tear.

My junior colleague told me it was probably a cervical tear and she had bled 750cc so far, by pad and gauze calculation. Gauze nowadays are getting thinner and thinner (probably thanks to CSSD earning kopi duit from taking those ciplak stuff in), I guess she may have overcalculated. But still the bleeding was real.

I cleaned and did a simple digital vaginal examination.

Hmm. It looked like the cervix, bled like the cervix, torn like a cervix, but it definitely doesn't feel like cervix. It was somehow less fibrous and less firm. Anyway, post partum cervix may have felt that way. But still not that bulky.

With simple strength, I try to pull out that piece in the vagina. It got torn off.

Bright light in OT.

This is definitely no cervix.

It's the placenta and I proceed to grab another big chunk of 500mg of it out.

Ta daaa...

Bleeding stopped.

Reexplored by ERPOC and did some simple suturing of minor vaginal wall tear.

Re-re-re-re-re-re-re-re-re-re-reviewed the post delivery notes: placenta and membrane complete.

Most probably diagnosis: Succenturiate lobe. In layman term, it's another satellite lobe from the main lobe. Not an everyday diagnosis of PPH.


Arth Akal said...

oh, wow. you're a gynaecologist, no?

Anonymous said...

u could probably be retained placenta as well, right?

pilocarpine said...

no, arth, still a miserably paid gov servant, i juz aim to be one... how far i can go, yet to be known...

anon: not really, i re-examined the placenta dat was removed earlier. it looks absolutely complete to me.