Aug 21, 2009

privileging praevia

I had really interesting EOD (every other day) on call with Dr. C recently. I got really really, seriously busy and tired, but in the midst of all this tiredness and jonahness, I had several new experiences.

Thanks to Dr Haznita, covering specialist from Penang, I was given the chance to fly solo in knifing down a bleeding posterior type III praevia while she was completing the rounds. So far, I had never been going all surgical unto praevia, except for that one time I accidental operated on that lady with praevia, which was missed antenatally. My heart was beating so fast prior to the op that the thoughts of popping a beta blocker crossed my mind. I kept her number on top of the list for speedy contact, just in case.

I went in all calm and focus, while all the scrub nurses around the OT were hilariously making comments about how lucky I am to have a pretty assisting intern that day. It was a bad moment for jokes. After wading through the abdomen, finally, I reached the uterus. Dr Haz’s words crossed my mind, “Don’t cut the uterus if there’s a nest of vessels on it.” There were only 2 vessels on it, the calibers of Aedan’s little fingers, both on the far left, which doesn’t really fit the definition of a nest of vessels.

Imkansiz Ask

And so, hands on blade 20, waltzed through the lower segment in the locus of smiley and incision on the uterus widen with the tissue scissors. It wasn’t the baby’s head. It was the placenta, probably nearing its anterior edge. With blunt force, I scrapped through the placenta with my right index finger and searched wildly for the baby’s head. And with my left index finger, I widen the exit for the baby as I scooped the baby’s out with a little help of fundal pressure from my assisting intern. Everything just happened in a split second. That split second. I reconfirmed intraoperatively – it was posterolateral type III praevia. I removed the placenta and sutured like crazy. I was lucky, the bleeders were secured and I was truly relieved I did not paint the house red that day.

The baby went all crying and good, thanks to my wonderful Paed colleague.


The second new experience would be to operate for an unfortunate mother with intrauterine death. She was devastated with the news 3 days ago, gone through 3 days of induction and finally went to labour room with 4cm os and though on maximum pitocin augmentation, her os remained stubbornly unchanged from sunrise to sunset. To make things worse, the soft bodied body of the fetus turned from cephalic to tranverse. Factor in the stubborn cervix, with informed consent, the mother insisted for surgical delivery.


I delivered the baby by breech extraction via the uterine incision. The baby was expected to be soft and floppy. I made small incision, contemplating some cosmetic compensation for the traumatic mother, but somehow I regretted it later when it was kinda difficult to extract the baby – all soft and you know, very soft. I was worried.


The idea of as I pulled the body out, the head might just get detached. How scary that thought was.

Luckily that gory scene didn’t materialize.

That lifeless baby boy came out in one piece and in the most solemn atmosphere, the maternity nurse let the unfortunate mother kissed him for the first and last time. Not one sound in the room, except for the ECG bleep on the machine.

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