Wednesday, October 13, 2010

European congress of gynaecological endoscopist,Barcelona

Recently I had a short trip to Barcelona for a paper presentation on laparoscopy.My paper was selected for Oral presentation at the 19th ESGE conference and it was amonst the top ten papers.Only one from Indian subcontinent.There were 2 more Asian presentations,one from China and the second one from Japan.It was a great learning experience.

Is the effort worth it?

It was a very busy September for me.Lots of deliveries.I try to manage my labour patients  in a logical manner.To try for a vaginal delivery unless there is an Obstetric indication for a Cesarean or unless the mother demands a Cesarean section.
As per my training in UK ,a trial of instrumental delivery is an accepted method where you know that there is a chance of faliure of instumental delivery but still it is worth trying.One succeeds mostly but some time it might fail and the patient ends with a Cesarean section.Its a pity that in India even doctors are unaware of correct protocols and would like to go for a C/S as a part of defensive practice.
Recently I was appalled to hear from a doctor colleagues that I should leave my' passion' for vaginal delivery  .I am not passionate about a vaginal delivery,but just wish to treat my patient the way I would like myself to be treated.It might mean little inconvenience to me or to my colleagues as Vaginal delivery NEEDS PATIENCE.It needs one to attend patient at anti social hours( any time of day or night).But can that be a reason for CS.Just thinking????Am I actually doing something wrong by trying to give fair and safe trial of labour to patients who actually want a vaginal delivery if possible. Any answers??????????

Intrauterine Death of one twin

Am handling one such case these days.The couple and her family came to me with lots of hope.It isn't an easy situation to handle.The trauma of loosing a twin is a great shock to parents.And then the risk to surviving twin and mother is no less.Thankfully it is a diamniotic diachorionic twin where the prognosis is slightly better.
With Monochorionic twin the prognosis is quite bad with risk of brain damage to surviving baby.
Am intending to take her Pregnancy up to 34 weeks which is almost 11 weeks away.
Just hoping the best for mom and her baby who have come all the way from Gujarat with lots of faith!!

Post Partum haemorrhage:Obstetricians worst nightmare

I am back to my blog after many days.lots to share.On 21st sept had one of the worst professional nightmare,which almost every busy Obstetrician must have encountered sometime in their life.
A patient of mine who had a previous LSCS had a very smooth vaginal delivery under my care.I was happy after a VBAC.her family was rejoicing after a smooth labour and delivery .In dead of night 2 hours after her delivery I got a call from worried Registrar'Madame ,She is in pool of blood  I rushed realizing Post partum hemorrhage is the commonest cause of maternal death in our country.
After that started the nightmare.There was too much to handle.Take quick actions,break the news to a rejoicing family that all wasn't well any longer,arrange for blood.nothing seemed to be working.Performed an Internal iliac artery ligation which was partially effective,Ended with a relaparotomy and removal of uterus to save her life.It was a difficult time.Its not at all easy to take quick clinical decisions,keep the Families faith intact in you,keeping them informed of each and every step,procedure,progress.Console them .
Today I saw  her in my OPD.She coped well with the whole situation.Her family after an initial dilemma trusted me enough not to transfer her to any'bigger' centre.
I am thankful to all my team mates including my assistants,anaesthetist colleagues,Nurses,ICU staff because of whom she is alive today.