SHE IS ALIVE!!

SHE IS ALIVE!!

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Mrs X at 31 yrs,was happily pregnant with her second child.The first scan at 6weeks’ pregnancy time showed no evidence of a pregnancy inside the uterus.I always nurture in my mind a caution in such cases.it can be an ectopic pregnancy,ie,a pregnancy in a location other than inside the uterus,for example a tubal pregnancy.Pregnancy of Unknown Location (PUL) is always a matter of concern as it cannot grow beyond a particular stage and will terminate in a life-threatening way.

Mrs X was advised in the right way and she turned up for a second scan 2 weeks later.Both of us were happy and relieved to find a live pregnancy inside her uterus itself.She was very obese and had a lot of hormonal problems naturally.

Exactly one month later,one day nearing her check up date,she landed in our Emergency Care Unit at 10 pm with a sort of lower abdomen discomfort and nausea.She always had gastric upsets before also.A pregnancy scan was done to see a healthy baby inside,though I felt it was implanted more on the right corner of the upper part of the uterus where the Fallopian tube opened.

At midnight she developed a sudden severe pain,vomited and became semiconscious.Her pulse and respiration were too rapid,her blood pressure too low,her body cold and sweating and the tummy got distended more and more.She was in ’shock’ due to internal bleeding.The pregnancy location near the right corner struck my mind.A part might have been implanted in the narrowest part of the right Fallopian tube which opens into the uterus and this part might have ruptured causing very profuse bleeding from the side of the uterus.

SHE WAS DYING WITH INTERNAL BLEEDING.All her vital organs were failing due to lack of blood circulation.All her blood was pouring fast into her abdominal cavity .Her Haemoglobin was just 4 grams/dl.This was 12 grams/dl at 10PM..so grave was the situation.

Absolutely no moment to lose,emergency arrangements for blood and medicines were done.Other specialists and staff were summoned to the theatre.Bystanders were informed briefly and consent was got for any lifesaving procedure.My Rev.Sisters started their prayers in the chapel.

Our Anaesthesiologist was struggling to keep Mrs X alive with intubation and oxygen,intravenous fluids,medicines like adrenaline,dopamine etc,blood (7 units were already available) and blood substitutes.He was watching the monitor in dismay and and asking me silently to proceed very fast.

Yes,I could reach the abdominal cavity within minutes,rapidly suck out the litres of blood inside,reach the right upper part of the uterus from the pool of blood without seeing it and pull it up to see a big rupture there with very profusely bleeding blood vessels.The pregnancy with the 3 months grown baby had slipped into the abdominal cavity.The Fallopian tube had been detached and hanging free pouring blood.

There was no meaning in retaining such a damaged uterus and it was removed fast.Fortunately she had a son delivered by me 10 years back.The husband in the Middle East was not willing for the uterus removal but could convince him over phone which was glued to my ear by a nurse.

The bleeding stopped,the lost blood replaced and the hurting organ removed,resulting in regaining a precious life.The kidneys ,heart,lungs and other organs restarted their functions happily.

Reason for such a calamity,very rare indeed, may be asked.A block in the Fallopian tube very close to the uterus might have happened,preventing the embryo formed in the tube from moving in and getting implanted well inside the uterus.It might have got stuck by a small part in the tube and the major part inside the uterus.So growth upto 3 months was possible.This cannot be easily detected by a Sonologist(one who does the scan).Mrs X had mentioned about a lot of infertility tests she had undergone while in the Middle East,like tube testings,D&Cs,Laparoscopy etc.Not that such tests are bad,but slightest infections inherent in such procedures even can cause scarring and tubal blocks.

Last night I was called just to support as an onlooker for a similar case,which prompted me to write this article.The patient was saved too from the gravest calamity by our rapid and expert action.