Quite a weekend…. I’d arrived late Wednesday night, spent the day Thursday organizing and distributing the meds and supplies I’d brought with me. Friday I met with the medical staff and with our SIM Liberia Director. Saturday morning I took over as the on-call physician at ELWA Hospital, covering our 50 bed facility for the weekend. One of my local colleagues helped me with rounds on Saturday. And then, about 11:30 AM, it all started….
Amelia (not her real name) is a 32 year old mother of 3 who had not been to ELWA before. She came from 25 minutes down the road—the rural area between Monrovia and the airport. She told us she’d never had a day of formal education. She was 9 months pregnant, and had severe abdominal pain starting around 10:00 in the morning. There were no fetal heart tones, and she had significant vaginal bleeding. The abdomen was so tender that it was difficult to really get a good exam. I talked with Amelia, her sister, and an Aunt who had helped get her to the hospital. I told them she’d need an urgent operation, as it looked like the placenta had separated from the uterus and we needed to get the baby out and get the bleeding controlled, though it looked like the baby had already died in her abdomen.
After the surgical team made their preparations, I scrubbed in and got ready to start the case. I’d been hoping for an easy first weekend—maybe a c-section or two, but let them be healthy ones with good babies. Not this time. As we entered the abdomen, we encountered copious clots and blood—I reached my hand in through the incision and explored, and realized this was not an abruption, but a uterine rupture—the baby had been expelled through a tear in the lower uterine segment, along with the placenta. We extracted the stillborn baby and the placenta and brought the uterus into view—there was a stellate rupture extending in 3 different directions. With some skillful help from Gideon, the assistant, we pieced the uterus back together and repaired it in 2 layers. After a transfusion, Amelia’s BP stabilized and she was able to go on the postpartum ward.
Sunday morning I was awakened at 5:30 by a call from the ER—a pregnant woman had come in, short of breath, with O2 saturation of 57%. When I arrived, she looked like she might give up the ghost at any moment. Her heart was massively enlarged, she was in pulmonary edema, and she was full term. I silently prayed for her as we gave her oxygen, lasix, hydralazine, and IV digoxin. Miraculously, she gradually stabilized, and later in the day delivered a full term baby girl who unfortunately appeared to have brain damage from her prolonged hypoxia.
Add to that a couple other challenges—a vacuum extraction on a woman whose baby had apgars of 5, 5, and 7; and a c-section on a patient attempting a trial of labor after prior cesarean.
All these women survived, and two of the four had good neonatal outcomes. If these women had been pregnant just 18 to 22 months ago, during the worst Ebola epidemic the world has ever seen, it’s quite likely that all 4 of them would have died or had even more complicated deliveries, due to the closure of most health facilities here. Timely, skilled maternity care is a lifeline in a place like Liberia—a very fragile lifeline. One of our priorities is to extend that lifeline to as many women as possible, as well as training local midwives and physicians in quality emergency obstetric care. I’m so grateful to practice as part of teams, both here in Liberia and in Worcester, that make women’s health and maternity care such a priority!