Monday, December 12, 2011

Deep impacted foetal head.......Thank god we have Pathwardhan method

Today was a Sunday I was awaiting since the whole week.It was busy throughout the week.And today I had all the intentions of catching up with any of the shows of 'Dirty Picture' at DT Mega Mall.Think will have to wait for one more week.
One of my patient went in labour today morning.A lady whom I had seen only in the evening an on examining her after probably many months I thought.......Oh there seems some problem.The outlet looks contracted(The outer most bony part of  the pelvic bone which the baby must cross to deliver vaginally).Gave her a hint to the same.She became little nervous and few drops of tears rolled down.I thought not to talk about it further till she is actually in labour and as luck would have been ,I got a call around 4 am from Dr Asimita,a smart registrar,that the Lady was in with ruptured bag of membranes and contracting too.Things went fine and she progressed well till 7 cms and then I put her on syntocinon drip at least 10 hours of her admission.I thought,never mind can still watch Vidya Balan in one of the late evening shows.Ok ,she did progress and as anticipated was fully dilated as well and I kept on waiting and waiting and ultimately after an hour of wait decided to take her to OT for a trial of ventouse application.I would say it was a half hearted attempt from my side as deep within I felt that she won't deliver vaginally but baby's head which was already quite low(just at the outlet)will get stuck making a caesarean delivery also challenging.I am quite Ok with  second stage caesareans but this one I felt was going to test my Obstetrics skills to the max.And so it happened.
Abdomen opened in layers,uterus cut open and baby's shoulders were all what I could see,The head was deeeeeeeeeeeeeeep down in the pelvis.I asked the nurse whom I had requested to be ready for such an eventuality to push the  baby's head up,She had never done it before and thus was very scared(Told me later that in private set ups as such caesareans aren't so common she has not done it before).Anyways even if she wasn't scared still that would not have made any difference.The head was not buzzing up.My assistant Dr Dipti a fresh Postgraduate mumbled nervously....Patwardhan method mam.....I said yes of course.You just can't do anything else in such a situation.
So what is done is that both the hands of the baby are delivered out of the uterus first and then comes out the bum followed by body and lastly when there is enough space last comes the head.This might be 15th or 16th time that i have delivered baby by this method and it was one of the difficult ones cause my assistants lost the tract  somewhere.They had never seen it before and it horrified them.Our efficient OT technician sanjay came to the rescue who gave a good fundal push to deliver the bum as I pulled the body out gentlyy.It ended well.I realised i had a few drops of sweat on my forehead.Mirena one of my favourite nurse said.....mam haven't seen you nervous ever before in last 4 years.But that is Obstetrics.The baby is fine.Mother is fine too.Thanks to Dr Pathwardhan.But I missed silk Smitha Once again.better luck next Sunday :)))))) While I was managing my patient my poor husband waited very patiently for almost 2 hours in the car.So much for his Sunday!!

In today's case the head had come upto +3 and got stuck there!!!!!

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