30 Something Baby Doc

I was in the middle of a 24 hour call. The call started out on a sour note when as soon as I walked in the door my colleague left me with a cesarean section on twins to perform. I can't blame her for leaving it for me, she really got her ass kicked the night before (15 deliveries). She just wanted to get the hell out of there (I can relate). The cesarean section went fine followed by about 12 vaginal deliveries for the whole day. I came down for a vaginal delivery of a 24 year old patient. Her labor course went really well. She was completely dilated and started pushing. Suddenly the baby's heart rate began to increase to a rate of about 200 bpm (120-160 bpm is normal) Then the heart rate started to drop intermittently (decelerations) For individuals who aren't medically inclined, none of the latter is good. There was no clear explanation for the drastic changes in the baby's heart rate and my policy is " when in doubt get the baby out!" I told the resident to expedite delivery with a vaccum ( a suction device attached to the baby's head that assists in pulling the baby out). Just 2 pulls and the baby was out. The pediatricians were in the room to attend to the baby. The baby did very well after delivery but they still transfered it to the neonatal ICU for observation. I was sitting in the room writing a note in the chart while the resident was delivering the placenta. She delivered the placenta and started checking the patient for vaginal lacerations. She then had a very concerned tone in her voice and told me she thought something was wrong with the patient's womb and she was having alot of heavy vaginal bleeding. I looked at the patient and noticed she was very pale and her blood pressures were dropping. The resident said she thought the patient's uterus had inverted. This is a very nasty situation when the womb literally turns inside out (similar to turning a sock inside out). When this happen, the patient bleeds profusely then goes into shock. Unfortunately the patient was doing exactly that (to be continued).





Uterine Inversion