It's been a full week at LAMB - I'm staying busy either doing ultrasounds, rounding on antepartum and postpartum patients, and working on the labor & delivery unit! I had two 24 hr call shifts this week with lots of interesting patients.
I've also been introduced to the difficult concept that female infants are considered a liability. A few families have been disappointed this week because they delivered females, and one family refused a C-section for a very distressed infant because they knew it was going to be a girl from an ultrasound they obtained elsewhere. Here, we don't tell anyone gender on ultrasound because of this phenomenon.
It's also interesting to be the second or third hospital that people come to for care. Last week I admitted a term severe preeclamptic (BP 190/110 with headache and significant edema) who had been treated at a clinic for high blood pressure...3 days before. The clinic had actually given her a shot of magnesium and sent her home. Incredibly, the baby was still OK.
On my most recent call night, a woman came in with severe abdominal pain and a very small amount of vaginal bleeding after 2 months of amenorrhea. She gave the odd history that she had 2 prior D&Cs, both done in outside clinics. She was awake for the first D&C and no product came out - the doctor simply told her that the baby must have already passed despite having no bleeding. After 2 more weeks of pain, she had a second D&C at the same clinic. And now she came to us with exquisite abdominal tenderness. I was surprised by the ultrasound to see products of conception and a fetus (without heartbeat), but also saw fluid and irregular masses everywhere. I called Dr. B who agreed this was a very strange ultrasound. We discussed the possibility of uterine perforation vs ectopic. After overnight antibiotics, we took her to surgery yesterday and found an abdomen full of blood clots, swollen adnexa & tubes, and a huge ectopic pregnancy in her right ovary - it was actually difficult to find the tiny uterus in the midst of the mess in her pelvis. Learning point...if you can't get the products out on D&C, the fetus is probably somewhere else!
I have been so impressed with the quality of medicine that is done here at LAMB with relatively few resources. The guidelines that the hospital follows and teaches the residents are evidence-based and up to date, the facilities are very clean, and everyone is constantly looking for ways to learn and improve. It's definitely a model of missions hospital that others could learn a lot from. I've felt so welcomed and have been working with the best people - both the Bangladeshi staff and missionaries.
Feel free to email if anyone has questions :-) I'm looking forward to sharing more when I get back!
I've also been introduced to the difficult concept that female infants are considered a liability. A few families have been disappointed this week because they delivered females, and one family refused a C-section for a very distressed infant because they knew it was going to be a girl from an ultrasound they obtained elsewhere. Here, we don't tell anyone gender on ultrasound because of this phenomenon.
It's also interesting to be the second or third hospital that people come to for care. Last week I admitted a term severe preeclamptic (BP 190/110 with headache and significant edema) who had been treated at a clinic for high blood pressure...3 days before. The clinic had actually given her a shot of magnesium and sent her home. Incredibly, the baby was still OK.
On my most recent call night, a woman came in with severe abdominal pain and a very small amount of vaginal bleeding after 2 months of amenorrhea. She gave the odd history that she had 2 prior D&Cs, both done in outside clinics. She was awake for the first D&C and no product came out - the doctor simply told her that the baby must have already passed despite having no bleeding. After 2 more weeks of pain, she had a second D&C at the same clinic. And now she came to us with exquisite abdominal tenderness. I was surprised by the ultrasound to see products of conception and a fetus (without heartbeat), but also saw fluid and irregular masses everywhere. I called Dr. B who agreed this was a very strange ultrasound. We discussed the possibility of uterine perforation vs ectopic. After overnight antibiotics, we took her to surgery yesterday and found an abdomen full of blood clots, swollen adnexa & tubes, and a huge ectopic pregnancy in her right ovary - it was actually difficult to find the tiny uterus in the midst of the mess in her pelvis. Learning point...if you can't get the products out on D&C, the fetus is probably somewhere else!
I have been so impressed with the quality of medicine that is done here at LAMB with relatively few resources. The guidelines that the hospital follows and teaches the residents are evidence-based and up to date, the facilities are very clean, and everyone is constantly looking for ways to learn and improve. It's definitely a model of missions hospital that others could learn a lot from. I've felt so welcomed and have been working with the best people - both the Bangladeshi staff and missionaries.
Feel free to email if anyone has questions :-) I'm looking forward to sharing more when I get back!
Sounds like a great experience! Looking forward to this Friday's post.
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