Case Study by Dr. Meena: A Young Mother in Need of Emergency Care

Thank you to Dr. Meena (pictured here with fellow DFN doctor, Nahakul) for sending us this case study from her time working in Mugu. This case illustrates how Meena and her colleagues’ quick actions and decisions led to a positive outcome for a young mother and her baby, despite working in a setting with limited resources.  It is just one of the many, many cases that shows the vital importance of quality maternity care being in reach of patients to decrease the levels of maternal and infant mortality in the region.

‘A 19-year-old female from Mugu was brought to our emergency (department) with a complaint of per vaginal bleeding for one hour at eight months pregnant. The vaginal bleeding was painless, with abrupt onset, and blood was fresh red colour, not mixed with clots, and bleeding was continuous.

I got call from emergency duty at 6pm. After 15 minutes walking I reached the hospital. Then I examined her. While examining the patient she was pale, her pulse was feeble and blood pressure was 80/60 mm of hg and there was continuous per vaginal bleeding. I called for help, for a sister and another medical officer. IV line was opened on both hand with a wide bore cannula and at the same time, blood sample was collected for Hb , platelet, blood grouping and cross match. Intravenous fluid was infusing four pints fast and then the patient was catheterized.

 After five minutes of resuscitation her per vaginal bleeding stopped. She was continuously monitored and in total five pints of normal saline was given and there was only 10ml of urine in the urobag. Foetal heart sound was 152 beat per minutes regular and there was low lying placenta on ultrasonographic examination and no other significant finding. Lab report was Hb 8, blood groups B Positive. We asked for cross match and planned for blood transfusion. After an hour of resuscitation there was a blood pressure of 100/60mmof hg and the patient felt better but there was only 20ml of urine in urobag. Again there was per vaginal bleeding at approximately 500ml.

I was so scared and call to a Doctor At Karnali Academy of Health Sciences. He suggested that I do an emergency LSCS (caesarean section). I was worried that intraoperative bleeding would occur and also about low urine output, but the KAHS Doctor suggest that I go ahead with the LSCS which is the definitive treatment of choice. We planned for emergency LSCS at 10:30 pm and at least three pints of blood were arranged. The emergency LSCS was done and both mother and baby were good. There was an intraoperative blood transfusion at two pints. There was no intraoperative complication.

A single live female was born with a birth weight of 3400gm and APGAR 7/10, 9/10 . There was blood pressure at 110/80mm, hg pulse 120bpm, respiratory rate 16, and her urine output was 100ml only after seven pints of NS (normal saline) and two pints of fresh whole blood infusion. We then gave an injection of Furosemide 10mg and the patient was shifted to the postoperative room. Her vitals were maintained, and urine output gradually increased.

On the first day after the LSCS, her urea and creatinine tests was repeated, which was normal, and her Hb was 8.5 so we planned to start tab. iron per oral twice a day. On the same day she developed features of fluid retention then we decreased intravenous fluid and encourage her to perform oral feeding and ambulation.

Both mother and baby were discharged on day seven.’