Hey everyone!
Week 2 at Loma de Luz has wrapped up. This past week we had an OB/GYN from Colorado Springs join the team, so we had a lot of GYN action. I think I fitted more women with pessaries this last week than I had my entire life. I worked closely with Dr. Lockey and she taught me really good exam tricks. Unfortunately, cervical cancer ,although preventable, is a major cause of mortality here. Some women don't have access to health care and find out too late. There is also the case of not having reliable test results, here at Loma De Luz all the cytology samples get sent to the US. So, needless to say we saw a lot of really sad cases involving cervical cancer this week.
This upcoming week there will be a team of ENT residents joining. Im looking forward to working with them.
And to end this week of OB/GYN with a Bang! Mrs Rosalia (not her real name) is a 39yo G13P9 who presented to the hospital after 2days of laboring at home. She walked [in labor] 3hrs to get to the hospital. She was 6cm dilated on arrival. We AROM'ed her and prepared to have a quick delivery. PPH kit was in the room. Baby looked great on the monitor, but after 1hr went by and she was unchanged and then 2hrs went by we knew something was wrong. She had 1 prenatal visit and nothing more, she had all of her babies at home previously- 2 breech deliveries that ended as fetal demise. Bedside US showed an EFW 4800g, no wonder baby never came out. We decided to go to c-section. After delivery of the placenta uterus was still pretty boggy and there was brisk bleeding. As we started closing the hysterotomy we noticed what appeared to be an inferior extension of the hysterotomy into the cervix. We continued to close quickly and steadily. BP was 74/36, but the anesthesiologist believed it to be related to the spinal anesthesia. By the time the uterus was closed the bleeding seemed well controlled. Tone had improved after a pit bolus and methergine. We did a BTL and put the uterus back in the abdominal cavity. BP remained low. There was more than normal amount of bleeding but at this point it didnt seem overly concerning. As we finished closing and we started to clean up we started noticing the towels around the surgical field were soaked in blood, so was underneath the surgical drape (we dont have fancy drapes that catch the blood..). Then I noticed there was a huge puddle on the floor and more blood kept falling from the bed. Initially we thought it was just from moving the towels, but vaginal exam revealed brisk bleeding. We gave cytotec. We tried a bakri balloon. We gave 3L of NS and 1 UPRBC. We were unable to bring the blood pressure back up and by this point patient was tachycardic. There is no blood bank in the middle of Honduras, we were going to need more blood. We put out an emergency alert to have everyone who was O+ run to the hospital to donate blood, 8 of us donated. In the middle of all of this the general surgeon arrived and she was taken for a hysterectomy. And 9 units of blood later, she is currently stable. Baby likely has some meconium aspiration and is requiring a bit of oxygen, but is also stable. Today was stressful to say the least. However, I am humbled by the response of the staff at the hospital. I am not at all surprised to have nurses and doctors donate blood for a patient, but electricians and kitchen staff also stepped in and that is incredible.
And so one more day goes by at Loma de Luz.
Until next time.
-g
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