Sunday, March 13, 2011

Russsssssh for caesarean .........Baby has passed stool!!

In current day Indian Obstetric practice,there are couple of situations (out of many) which lead to an immediate Cesarean section. Both of them are controversial indications.

A Pregnant lady goes for a routine ultrasound scan.Ultrasonologists after looking at the doppler declare there are two loops of cord around the baby's neck!!!''Aaap ka baccha neta hai,mala pahen kar hi paeda ho raha hai.So it calls for a Cesarean section.Baby's cord will get strangulated and there is a high risk that baby will get choked.'' So speaks the Ultrasonologist and then a concerned gynaecologist.They sincerely believe that,CS is the only safe way out.But is really so??Evidences are to the contrary.In my practice I do find it a challenge these days to motivate would be parents for trial of labour if a loop of cord is reported,as nearly every one tells a story of how their friend had a c-section for the same indication.Most of the times they do get convinced,after a lot of counselling and perhaps seeing a non buzzing attitude on my face and achieve vaginal deliveries as well and that too without any problem.And what for are the modern day Foetal heart rate monitoring machines?If it shows a foetal compromise a crash Cesarean section can be done immediately .

Now comes other one.Baby passing stool inside the womb.This stool is called meconium.Now this thin meconium again isn't an indication for Cesarean section but here comes a big handicap if one doesn't have acess to Foetal blood sampling (like I don't have and neither I know of any other Indian hospital which has)facility.One can try to be little brave as a doctor to try for a vaginal delivery if baby has passed stool but can't keep on waiting for n number of hours without knowing if baby is alright or getting acedotic.So,no wonder passage of stool inside the womb leads to a much higher number of cesareans in India than required. Few days back did one such cesarean where I did wait for 6 hours post detection of meconium but then got scared to try further,because if things went well.....No big deal,that's my job.But if baby aspirates meconium and has a meconium aspiration syndrome,onus would be totally mine.Baby was fine at delivery .May be if I had a FBS facility,may be could have given a different outcome!!Just Wondering!!


Rural Physician said...

Very true for Indian set-up.
Got to know about your blog today!
Well written and interesting!

Dr Kaushiki Dwivedee said...

Thanks Doc!!

Meghala Devi said...

Very true in India..i had such experience... :(