Document 6429107

THE OBSTETRIC EMERGENCIES WHICH
I NEVER FORGET
KfuKyu Win
The town was very beautiful with
surrounding mountains and forest.
There were many green paddy
fslds between the mountains and
town. The forest was always green
because in rainy season, there were
200 inches of rainfall I was posted
as a trained nurse after 1 finished
the 3 year - Nursing Diploma
course. In the year 1968, the
diploma 3 year - course was pure
nursing on medical, surgical for
women, men and children. We had
no experience of mtdwifery
education. The hospital was 16
bedded, with one Township
Medical Officer (TMO), one staff
nurse and one trained nurse. The
doctor I met !tt that time was Dr. I .
Guha, who served as a TMO from
lndia by contract system. He
performed emergency operation on
Lower Segment Caesarean Section
(LSCS) and a staff nurse worked as
the assistant. The compounder and I
had to give the anaesthesia by the
order of TMO. We used chloroform
at that time When that doctor
returned to India, another doctor
Lccturer/Head,
DcpC of Maternal and Cbild Health Nursing
University oCNuming,Yangon
Dip. G.N, Cert. Mid.,
Dip. Gen. Nsg. Tutor,
B.A (Q), RL, B.N.Sc,
M.N.Sc (ACI, AdefaYde)
came as a TMO. There was a day
that I %odd never forget for the
rest of my life. The night of that
day was very dark with only the
light of shining stars. At that time,
the security worker called me to the
hosp~tal because there were
emergency patients.
There were only two nurses in our
hospital at that time and the duty of
each nurse was 24 hours alternately.
One day whlle I was on duty, the
patient Ma Saw Nwe, my
neighbour and classmate at middle
school was admitted to the hospital.
She was suffering fiom labour pain,
and was groaning due to that pain.
Her blood pressure, pulse, and
respiration was normal. She was
gravida 1, Para 0, with transverse
lie. Because the contraction was
very severe, she was given injection
Pitocin before she came to the
hospital. The infant's hand was
prolapsed outside the vagina. So we
arranged to m s f e r the patient to
Dawei District Hospital because the
newfy posted doctor did not dare to
operate her.
In 1968, the outside of the town
was insurgent area There were
troops of communist rebels taking
power at the villages. We were
afraid of going to district, but
luckily we got a car and the patient,
her family and I went to the District
Hospital. It was one hour drive.
After we arrived at the hospital, the
patient suffered more severe pain
with prolapsed hand and no foetal
heart sound (FHS). Bandl's ring
was seen in her abdomen. The
doctor performed an emergency
operation. The patient was saved,
but the infant was dead. This was
the first case of my experience
when the patient had ruptured
uterus due to unjudicious use of
Oxytocin.
Ruptured of the uterus is one of the
most serious accidents that can
occur in obstetrics. In the above
situation, the client was having
signs of impending rupture,
appearance of Bandl's ring and
signs of obstructed labour
becoming pronounced because of
injudicious use of Oxytocic drugs.
I had served 3 years in my home
town as a trained nurse. ARer I had
passed matriculation class, I was
transferred to Yangon Central
Women Hospital. There I got
married and hired an apartment at
Pazundaung Quarter. The owner
was 40 years OM woman with 9
children. The family aarned their
living by selling meat. The house
was two storey building with 4
apartments.
Each
apartment
included 1 guest room, 1 bed room
and a kitchen. The apartment was
.
big and wide enough for the two of
us, husband and wife. It was in
1972 that tht hospital services were
free of charges, free medication and
free meals were provided.
My duty was at the B Block,
emergency theatre. The house
owner Daw Khin Aye was pregnant
again. She was G10, Para 9. She
told me that she had no fear for
pregnancy and it was very simple
for her to deliver a baby. She said
that all the previous deliveries had
no difficulty, with only a few pain,
she delivered easily. I told her that
the tenth pregnancy was very
dangerous. That was Grande
Multipara and there could be so
many complications. She said that
she had no worry. The night 1 was
on duty at the operation theatre, my
husband came and Daw Khin Aye
was admitted to the hospital with
Hypotonic Uterine Contraction.
The doctor preferred emergency
LSCS operation. After delivery the
placenta, the bleeding did not stop.
Her blood pressure was falling
down. I assisted the Anaesthetist
Dr.U Tin Hlaing, and we tried very
hard to control and stop the
bleeding. The blood transfusion
was given one bottle after another
very rapidly. So the Obstetric and
Gynaamlogist (0.G) decided to
remove the uterus. Nearly 15
bottles of blood were given and we
saved the lives of both mother and
child. Daw Khin Aye's family was
so grateful to us becaw they never
considered the complications of
Grand multipara.
In this second case, Daw Khin Aye
was over confident of her
pregnancy although she was grand
multipara. She did not know its
dangers and complications. She had
never used contraceptives because
of personal choice or lack of
knowledge concerning pregnancy
and had never attended antenatal
care clinic.
The third time, I found a case of
ruptured uterus which was criminal
abortion. The patient was a young
woman about 20 years of age, with
good looking face, fair skin and
long black haw. One day, my
younger sister came to me cryrng
because her neighbour, the above
young woman was admitted to the
West Yangon General Hospital.
The pregnancy of this woman was
criminally aborted. She suffered
pain in abdomen with cold and
clammy skin. When 1 arrived at the
hospital, the patient was suffering
from shock with BP zero and
thready pulse. She was nearly
dying. My you,iger sister told me
that this young woman and her
mother came from Thongkwa
Township. The young woman was
pregnant with no husband. They
decided to abort the fetus and they
stayed at my sister's house as
guests They went to the house
where criminal abortion was done
and they had to give some money.
After the fetus was aborted, the
woman was suffering severe
abdom~nai pain. The ~nternal
bleeding could not be controlled
and the patient was taken to the
hospital. The hospital staff, doctors
and nurses were very angry with the
mother and they scolded her. But
they could not save the life of this
young woman. I was very sad,
because the woman was very young
and pretty. I wanted to know "Why
did she do ~t?"The answer of the
postmortem was ruptured uterus.
In this third case, the abortion was
performed without any medical or
obstetrical permissron. It was a
criminal abortion and the woman
died of perforation of uterus. The
mother and the young woman were
lack of health education. They only
know to abort unwanted pregnancy.
According to the above three cases,
I always teach my students about
ruptured uterus and complications
of Grande Multi-parity with three
examples. So we nurses have the
duty to educate the community, to
promote an environment free of
hazards for the life of individual,
family and community.