Dec 10, 2010

of triplets and bandl's ring

today is a good day to rejoice.

been pretty tied up for the past 1 week, having to be on call 5 days in a week.
Saturday, Sunday, Tuesday, Thursday and Friday (Yesterday).

Some days were busier than the others as required to cover for my junior colleagues who are still at their infancy of training. Tired as it was, I was glad to help out, because all I could think about is how slow, stupid and pathetic I was when I first started my journey.

I could remember vividly what my senior specialist told me.

"Pilo, you came in at a wrong time."

I do not wish to indulge further in the details of how my initial training would have been better.

I was called upon twice on Thursday.

First, it was my colleague's suspicion of an abnormal uterus and did not dare to proceed further. In a C-section for fetal distress, to stop and pause when the uterine field of lower segment is wide enough to deliver the baby is probably frowned upon. Nevertheless, to proceed when you're not in control is definitely worse. I applauded his wise decision to go back to the first rule of primum non nocere.

I scrubbed in subsequently and noted the thick plastering adhesion between the anterior wall of upper segment of uterus and the anterior abdominal wall. I copped a feel of the gravid uterus from the sides and ruled out any fibroid or didelphy. The clear deepening line between the upper and lower segment was smiling at me. The thought of Bandl's ring struck me. All done in a few quick seconds before I knife in and got the little one out. That little fellow sang a lovely tune as I passed him over to the maternity nurse - pure rock and roll.
(credit: airahospital)

Bandl's ring is a constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine segment that is associated with obstructed labor.

Later that night, after midnight, my phone rang.

"Triplets in labor, os 5cm, sending over to General Hospital as ventilators there." (Of course, this is the summarized version)

"OK" (Not a summarized reply)

I was heading towards the Operating Room and my phone went blasting again.

"Now, already 8cm, Paeds agreed to be done in Maternity Hospital."

After a few unintentional driving drifts (I made up this part), I was there in the Maternity OR.

The cool anaest MO, JY was there smiling, probably a bit pissed not being able to chill in the middle of the night. Just probably.

2 warmers were on standby with nurses busy preparing.

Paeds team stepped in subsequently in large numbers - which is a wise thing to do.

As JY was pushing in the magic potion to wipe out the contraction pain and numb out the lower part of the body.

My mind was racing through what would be different in this C-Section.

First, delivery of the babies must be pre-planned based on their positions. I reconfirmed. It was cephalic, breech and breech. Mainly the most important thing is to keep the sufficient pool of liquor, go in, manouvre and grab them out. The only way I can screw up is to have an impacted triplet in tranverse lie - which is minutely possible.

Second, anticipatory bleeding from uterine atony secondary to the accomodation distension for the triplets.


At that time, my game plan was set.

I went in vigilantly, managed to entered the uterine cavity with the amniotic membrane intact. My hands felt the buttock of the 2nd triplet at the opening and slid down further to scoop up the deeply engaged head of the 1st triplet with slight difficulty.

A cartoon thought flashed through my mind. The 2nd and 3rd triplets were trying very hard to kick the 1st triplet out.

Once the 1st exited, subsequent deliveries of the 2nd and 3rd weren't shrouded with much difficulties as I was able to hold on their respective ankles before rupturing their respective amnion membrane.

The uterine muscle clamped down well with the continuous infusion of the love potion.
No crimson tide for tonight, thank God.
(credit: carrie)

My first triplets delivery. Ecstatic. For the right reason.


1 comment:

Haris Abdul Rahman said...

That was a full week if you ask me. And a fruitful one as well! You deserve a well-earned weekend!