COTW: Cord Prolapse

Doctors go into OB-GYN for a variety of reasons. Usually people cite things like an interest in womens' health, variety of care/procedures, surgery (without being a general surgeon), and overall happy outcomes. And sometimes the adrenaline rush that comes from critical situations. :) But here, one of the Kenyan medical officers rotating on our service said candidly, "I don't like OB. It's such a sad service." I had never heard that said about OB before, but she's right. When things go well, it's the happiest service in the hospital. When things go wrong, it's devastating--losing small babies and young mothers is one of the hardest things to deal with in medicine. So I wanted to share one of our victories with you, that should have been a terrible outcome, but was nothing less than a miracle.

Last week I was on call, performing a C-section with one of my interns in the early evening. The mom was pregnant with twins (kids #8 and 9), both in the breech position. Other than some increased bleeding from the uterine incision that we were trying to control, things were going fine. And then a nurse walked into the OR and called to the team, "C-section for cord prolapse coming down the hallway!" For those of you who have never heard the term, let me explain. An unborn baby's total oxygen supply comes from the umbilical cord, attached to the mom through the placenta. Usually when a woman's water breaks, the baby's head is pushing against the open cervix, acting as a cork or barrier so that the umbilical cord stays inside the uterus. Very rarely, however, a loop of cord will slide past the baby's head, through the cervix. It is a critical situation because the baby's head will then compress the cord against the cervix or vaginal wall, cutting off blood flow and oxygen to the baby. When this happens in the hospital, it is an emergency and the baby needs to be delivered via C-section immediately to protect against severe brain damage or death due to lack of oxygen...immediately meaning within 5-10 minutes.

So, without other options, I left my brand-new intern to finish up the first C-section (we were almost done by this point) and ran to the other room. The only history I had on this patient was that she had just arrived at the hospital with the cord already hanging out, and was close to her due date. I did a quick exam to feel the cord and it was still pulsating with the baby's heartbeat, a good sign, although it was on the slow side. We put the mother to sleep and I started the C-section. When I opened the uterus, I found that instead of being head down or breech, the baby was lying sideways in the uterus. It was difficult to maneuver the baby out of the uterus, but as soon as it (he!) was delivered, he started crying. Praise God!

After finishing the surgery, I was looking through some paperwork that had come with the mom and found a note from a referring clinic. She had come in to the clinic at 3pm and had been diagnosed with a cord prolapse at that time. I started her surgery at 8pm, FIVE HOURS LATER. Reflecting on why this baby hadn't died, as it very probably should have, I think his "malpresentation" was what saved him. Because he was lying sideways, neither his head, feet, or butt were compressing the cord. Well, let me change that statement. I think a miracle saved this little boy, with all odds stacked against him.

I wish I had a picture of this little kiddo to show. After many calls with babies and moms dying, it was so refreshing and uplifting to have delivered three beautiful, alive baby boys in the span of an hour. Things like this are why I went into OB.