EMERGENCY!

It was a busy day in the labor room.
All 8 suites were full.
There are 4 beds in the ABC - we even had to put patients in active labor there.

One MO was in the OT.
Another one was running around in the labor room.

Then, suite 7 had prolonged 2nd stage (basically, the baby was not coming out as fast as it was supposed to).

MO consulted specialist, decided for vacuum.
While the vacuum was being done for suite 7, one patient in ABC had fetal bradycardia.
MO was busy, told one of us to call the specialist.

Called specialist, specialist came over.
Suite 7 delivered by then.
Specialist decided that the patient in ABC should go for vacuum.
She started to prepare for vacuum, but we couldn't really get a CTG reading for the baby.

The ultrasound machine was pushed in.
The fetal heart rate was really slow.
Specialist decided then and there - LSCS NOW!

Preparations were made for LCSC (thank God the other LSCS in the OT was over).
Patient was pushed in as fast as possible.
Paeds team told to standby.
Baby was out in less than 5-10minutes I think.
Baby born crying.
Hurray!!

Came out to labor suite - suite 1 also had prolonged 2nd stage - another vacuum delivery.

That day, we had SO many deliveries that there were about 12 babies in the baby room at one time (usually we have about 4).
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It was 4am. I was oncall.

The CTG for patient in suite 7 showed some fetal deceleration (I think it was Type II).
My friend did everything that was necessary, but nothing worked.
And patient had some bleeding.

My MO was in the VE room.
I decided that we shouldn't wait for him to come in.
I tore off the CTG and went straight to him.

MO wasn't very worried, but he attended to patient.
Hmm..why was patient bleeding, he wondered out loud.

He did a VE.
His face changed.
2 words - cord prolapse (basically the umbilical cord has fallen out).
Everyone rushed to do whatever necessary - inflate bladder, raise buttock, prepare for LSCS.
I ran and called the other MO who was oncall.
Ran into OT.
Baby delivered within 5 minutes - not crying at first, but was eventually OK.

The Labor Room

O&G was not like the other postings.
There were more emergencies. More excitement.

It's because in the other 2 postings that I went through, Paeds and Ortho, all cases are screened in the A&E before they come to the ward. If the patient is unstable, they are stabilized before being sent to the ward.

In O&G, the labor room is our A&E. All pregnant ladies are sent there (very few are sent to the A&E). So, you see and play a part in managing emergencies in the labor room.

It's not to say that you see an emergency very often, but you see it enough.

There are some stories that I would like to share..these are the things I saw, my experiences. They are better stories, but then I wasn't part of it, so can't really tell those stories properly, so most probably won't be telling them.
(I will try my best to tell it as simple as possible, but am not going to explain everything (cos then it would take very long), so if you are curious enough, please google for it)
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My MO was doing a Caesarean Section (LSCS) in the OT. Our specialist(S) was doing rounds in the labor room. S received a call and was on the phone, so I decided to go to the VE room (where we clerk patients before deciding whether to admit them to the labor room or to the ward or to discharge them) to see if there were any patients to clerk.

One lady was there, doing CTG (cardiotocography - to see the fetal heart activity). It was her 5th pregnancy, and she had already delivered 4 children via SVD (vaginal delivery). She came due to contraction pain.

I asked her all the questions I needed to ask, and then left her to finish the CTG (which takes about 20 minutes) and started writing down the clerking. She came after completing her CTG and looked quite uncomfortable, so I decided to do a VE first before proceeding with the clerking.

I did all the necessary examination and then did the VE (vaginal examination). I was shocked!! I felt a feet, and I could feel the whole feet. I panicked, and told my friend to call the MO.

I waited for my friend for what I felt like eternity. Then, I decided that I can't wait any longer. I told the lady to just lie down and not push and ran into the labor suite myself. Then I was told that there were no MOs around, only the S.

I went straight to the S, and told, Dr. L, there is a patient in the VE room, feet presentation. The S immediately came with me and attended to the patient. Confirming the presentation, she said prepare for LSCS (which mean you have to take her blood, set line, get the op consent and blood consent and send the booking slip).

But we only have one MOT. Dr. L decided that she would go into the OT to finish up the op that was going on so that this lady can be pushed in faster, before this baby decides to come out. At the same time, there was another emergency inside the labor room, a fetal distress. That makes it 2 LSCS waiting with one OT occupied.

The solution - fetal distress was sent to GOT (an ambulance will bring the patient to the main building for that) and feet presentation will go in after either of the LSCS (whether in MOT or GOT) is done.
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I didn't expect 1 story to be that long!
Although now, I feel it's not as exciting as when it was happening.
Will try a different story tomorrow.
Hopefully that will sound better once written down.
Good night!

Shut Out From The World

Finally.
After almost 2 months, now I am at the O&G headquaters - the labor room.

But life in the labor room is isolated.
You are practically there the whole day long.
You don't go out for lunch.
You don't go out to get a drink.
You just sit/walk in there as the day passes by.

It is quite a happening place.
You never know when an emergency will surface.
Sometimes, when you have to be fast, you have to be fast.
Patients get pushed in for caesarean in 5 minutes.
By then, you have to prepare everything - consent, booking slip, make sure bloods taken, make sure blood is available at the blood bank, set line, inform anaest, inform paeds.
You just have to, somehow.

Since life is just labor room and nothing else, I can't think of anything to say.

But I've been getting some rather interesting e mails recently, 2 of which I would like to share..

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The Bathtub Test

During a visit to the mental hospital, I asked the Director 'How do you determine whether or not a patient should be admitted to the hospital.'

'Well,' said the Director, 'We fill up a bathtub, and then we give a teaspoon, a teacup and a bucket to the patient and ask him to empty the bathtub.'

'Oh, I understand,' I said. 'A normal person would use the bucket because it's bigger than the spoon or the teacup.'
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'No.' Said the Director, 'A normal person would pull the drain plug.

Well... Would you prefer a bed near the window?'

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Dan was a single guy living at home with his father and working in the family business.
When he found out he was going to inherit a fortune when his sickly father died, he decided he needed a wife with whom to share his fortune.

One evening at an investment meeting he spotted the most beautiful woman he had ever seen.

Her natural beauty took his breath away. "I may look like just an ordinary man," he said to her, but in just a few years, my father will die, and I'll inherit $200 million."

Impressed, the woman obtained his business card and three days later, she became his stepmother.

Women are so much better at financial planning than men!