Black Cloud

Warning to the growing number of pregnant readers: this blog, like nearly all of my entries, contains graphic material regarding pregnancy. If you need to skip it, you can stay tuned for top 10 Kenya baby names on 1/28/09!

This week the maternity week has had a black cloud over it. We haven’t had any maternal deaths all month, and yesterday there were 2. Both women suffered complications of pregnancy and both were transferred after being treated at the same outside hospital. Anne delivered twins about 2 weeks ago, but developed post partum hemorrhage due to retained placenta. Apparently she was taken to the theatre for surgery and lost 3L of blood. She then developed seizures. She was in a coma when she was transferred to Kijabe. She had been in the ICU for a week and a CT in Nairobi showed massive anoxic brain injury. Somehow she got transferred to the labor unit yesterday. Most of the women in that room are in labor, newly delivered, or being closely observed for some pregnancy complication, so I’m sure it was difficult for the other patients to see her suffering. The beds are separated by a thin curtain, if that. It was probably even harder for Anne’s family to be surrounded by happy post natal moms. We had a family meeting last night and told the family that comfort care was appropriate. She died last night at 7:20 pm. One of her twins also died, but the family was going to pick up the healthy twin from the nursery today. She had two other children at home as well.

Another lady was admitted last week with suspected pelvic abscess after a d & c for a miscarriage. In the theater, she was found to have a necrotic uterus and bowel and lost a lot of blood during the operation. She went to the ICU and developed pneumothoraces. One of the attendings thinks she might have had choriocarcinoma due to the appearance of her vocal cords (apparently it can metastasize there). She left the ICU in a beige cylinder. A

16 yr old pregnant Maasai woman came in to clinic yesterday with dehydration, fever, and “fainting.” Last night she had several eclamptic seizures and got a crash c-section this morning. I think her baby is 2.2kgs and doing well so far. I have enjoyed seeing so many Maasai people in the maternity ward.

Another woman, who had a radical hysterectomy yesterday for invasive cervical cancer, did not make any urine over night. Fluid boluses, lasix, and a catheter change did not help. My attending asked me to get her an IVP (intravenous pyelogram) to see if a ureter had been injured during the procedure. A physician has to go to I push the contrast, so I went. Mysteriously, none of her collecting system contained contrast after 20 minutes. We’re not exactly sure what happened to her kidneys, but she probably has intrinsic renal failure related to the surgery or anesthesia. She is now in the ICU and may need to go to Nairobi tomorrow for dialysis.

I hope the black cloud passes soon! We could use a silver lining on maternity.