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Logo of bmjThis ArticleThe BMJ
 
BMJ. 2007 April 21; 334(7598): 850.
PMCID: PMC1853231

Don't give up

Sally Edmonds, obstetrician and Bashiri Mmbare, anaesthetist

She was brought in one night from a distant health centre from our rural Tanzanian hospital. No fetal heart beat could be found, so the on-call doctor decided to allow nature to take its course. In the morning when I reviewed her I thought I heard a weak and rapid fetal heart beat. The mother was pale and sick, and we started to resuscitate her. She had no contractions and was only 5 cm dilated, so we agreed to take her to theatre to save the mother and possibly the baby.

Arriving in theatre, the anaesthetist looked at her and said he didn't think we should operate—he didn't relish a death on the table. She had indeed reached the gasping stage, seemed to gasp for the last time, and looked beyond our help. Believing that the baby might still be alive, I threw on some gloves and grabbed a knife. The patient had the typical peri-mortem look as I cut, there was no bleeding, and her flesh had the grey-white look of death. I removed two macerated babies followed by numerous clots, confirming a concealed abruption. With a deflated uterus giving her diaphragm space, the patient then gasped deeply, and the anaesthetist, his interest renewed, started vigorous resuscitation. I completed her hysterectomy as her uterus was beyond saving, and we poured blood into her.

Five days later she went home cheerful and pink. Resuscitation with a full uterus is supposed to be difficult, but even when it seems too late, keeping going can produce miraculous results. Don't give up.


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