Today we were grateful for a slow start and a very clean and organized delivery room. With the extra time Cathy taught us how to do pelvimitry. Pelvimitry is measuring the pelvis. It is a lost art in Canada because it is rather unnecessary and somewhat inaccurate- most Canadian woman have an adequate pelvis and a trial of labour is the best test of a pelvis. However, here in Uganda women can have small or mishapen pelvis' due to malnutrition and childhood diseases. The first woman Cathy and Carolyn examined had such a pelvis and was waiting for a cesearean.
Carolyn caught a baby born to a woman suffering from acute malaria- she was thin and feverish. She had had a retaind placenta with her first birth so we had an IV set up and a bag of oxytocin waiting- good thing because she had a hemorrhage which Carolyn managed with a calmly and efficiently.We were worried about her baby but it was well- still, we sent it to the nursery for observation.
The second birth was a teen woman, first pregnancy with symptoms of an STI and a boderline pelvis who had been stuck at 5cm for 36 hours. The doctor broke her waters and suggested a little oxytocin. Two hours later she was fully dialated. She had a nice slow crown then a massive postpartum hemorrhage (1.6L). Alix quickly checked for tears (none), removed clots, Carolyn examined the placenta (it was all there) and then Cathy put up an IV with oxytocin. Next Carolyn gave an injection of ergometrine, Prossy gave misoprostol sublingually, Prossy set up a 2nd IV and drew blood to determine blood type. All the while Alix compressed the uterus with one hand in and one hand out. She still bled. Finally Cathy remove some clots from inside the uterus and the bleeding stopped. We ran through every postpartum hemorrhage management step.
Two more deliveries- both rather straight forward and we were done!
We have learned that whatever we study or review the night or morning before happens on the next shift. This morning Alix mentioned that she had gotten the postpartum hemorrhage meds wrong on the exam and Cathy warned- "now we will have a PPH" and we did. The same thing happened with breech and resuscitation! Tonight I think we should review normal birth but Cathy just mentioned abruption...
We are planning a half day tomorrow and then we want to go check out the weekly market- hopefully it will happen beause tomorrow is martyrs' day- a national Christian holiday. Last week when we were at the Equator we saw people walking on a pilgrimage to Kampala for martyr's day. It's a long walk, and it's especially long without proper shoes and baskets on your head.
Posted by Carolyn and Alix
No comments:
Post a Comment