These
stories are from1960 when the maternal mortality rate in
India
was very high. Almost, 600 women died out of 100 000, live births. With the
introduction of modern health, it has come down, one almost never sees what I
am going to describe. These procedures were historically first done in the18th
or 19th century.
(Warning)These
stories are not to be read by the faint of heart. This day in the monsoon season
was the hardest day of my 55 years of working life. The rain was nonstop, the roads?
If we can call them that were flooded, Ram Devi came to our hospital in a
bullock cart after being in labour for 2 days in this rain. She was 32 years of
age had had 5 babies at home without any problems. When she arrived her baby was lying across
her stomach, the head was on the right side of her belly and a hand was
prolapsing from the vagina. Above all this baby was dead and the mother was dying
as well. She was septic, had a very high temperature and her haemoglobin was
only 6. Our assessment was that her uterus was probably intact but very thin. We
could not have done a Cesarean for a dead baby lying across the belly instead of lengthwise.
She
was very weak; we had no trained anesthetist I was still very junior, I called my chief resident she decided to do what we called embryotomy. This means the
dismembering of a dead fetus to remove it when normal birth and even Cesarean section is not safe. After this destructive procedure the woman can have a
normal birth next time. My chief resident had witnessed an embryotomy but never
done one herself. It required a lot of skill. Any way one of the residents went
to pathology which was about half a kilometer from the hospital to cross match blood for her. I decided to help the patient to sleep after putting the woman
in a comfortable operative position we started the antibiotic, gave her
pethidine and Valium cleaned all the operative field put a catheter in her bladder,
unfortunately the urine was blood stained. We were not sure if the uterus may have
ruptured. The cervix was fully dilated, anyhow we proceeded with dismembering
the baby. First the head, then the body; trying to protect the vagina all the
time. At completion the uterus felt intact, we gave her the 2 units of blood. We
all were happy as if we had saved the mother. We wrapped the baby parts and disposed
of them. Since then I have never seen a case where this procedure has been required.
I have seen a live baby with hand prolapsed on two occasions, and saved the
baby and the mother both by Cesarean section.
On
this occasion our mother died three hours later probably due to septicemia.
While
we were still overcoming this disaster, Sitara a nineteen year primigravida
came in with obstructed labour with a dead fetus. Her pelvis was very small and
she had been in labour for many days. She was also septicemic and very ill. We
had to do
a
destructive operation for her called Craniotomy in which we crush the head, compress it and remove it. We gave
her some blood and antibiotics but could not save her.
Within
2 hours after this second maternal death, Bimla Devi aged 22 having had her
second baby came in with a retained placenta. She had delivered about ten hours
prior had been bleeding, but the placenta did not deliver naturally.
Unfortunately
She
was dead on arrival.
I
was totally broken, three maternal deaths in one night.
The
World Health Organisation has introduced a program called The Millennium Development
Goals trying to improve maternal health and mortality rates around the world.
This
includes nutrition, infectious diseases and they hope that things will improve
by 2030. The most affected countries which need help are, India, Pakistan,
Papua New Guinea and some African countries.
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