COTW: Postpartum Hemorrhage

The call started off badly, if by badly I mean busy. I was called by my intern at 4:30pm to see two patients in the delivery area, both of whom were bleeding. One was a woman at term, six centimeters dilated in labor, probably having a placental abruption (placenta tears away from the uterine wall before the baby is born). The second was a woman who had delivered two weeks earlier and had stayed in the hospital because her baby was in the nursery for extra care. Both has been discharged earlier, but she hadn't yet gone home.

Both of these patients could have been considered an obstetrical emergency in the US. But the postpartum mom, RC, was lying in a huge puddle of blood and blood clots. My intern informed me that her hemoglobin at discharge had only been 5.0 (normal is 12-16). I knew by this point she had already lost several units of blood, and was in danger of dying if she bled much more, so rushed her to the OR (or theatre, as it's called here) for a D&C to clean out her uterus, suspecting that perhaps there were bits of placenta left inside the uterus that was causing her to bleed. (On a side note, another OB was around and delivered the other woman bleeding, who ended up with a normal, healthy baby.)

After the D&C, a blood transfusion, and several different medications to keep her from bleeding, I took RC to the ICU for the night. Her bleeding was minimal at this time, and I left instructions for her to get 2 more units of blood. I got called back to the hospital at 5:30am to evaluate yet another bleeding pregnant patient. While I was there, the ICU called--RC had started bleeding again. Again, I found her in a giant puddle of blood and clots as she was lying in bed, nursing her baby. This time, the only option left was to do an emergency hysterectomy and remove her uterus. While the ICU staff got her ready for theatre, I carried her little baby back to the nursery. Please, God, don't let this be the last time they see each other...was all I could think.

Another OB graciously came in to assist me as we opened up her abdomen to remove her uterus. A fourth unit of blood arrived and began emptying into her veins, as we tried to minimize the loss of blood into her abdomen from our hysterectomy. Someone drew her blood to check the hemoglobin again...this time 3.4. There was no more blood of her type in the hospital. I prayed harder. We finished the surgery and waited for her to wake up from anesthesia. And waited. It took almost 30 minutes for her to open her eyes and breathe regularly on her own. The whole time I could only think of her baby, and four other children, knowing we had done as much as we could do, trusting the rest to God.

RC went home on Monday, four days after her hysterectomy. It was a remarkable recovery (in fact, she went home so quickly that I didn't get a chance to take a picture with her, since I don't work until Tuesdays). My resources and abilities were not enough to save her--she should not have survived. But again, it brings to mind Tenwek's motto: We Treat, Jesus Heals.