Well, Dr Clack is back and very welcome. After a smooth flight and a good night’s sleep, we arrived on the labour ward the following morning and were back down to earth with a bang.
Preeclampsia is a common illness in pregnancy which affects most body systems often starts with high blood pressure and protein in the urine. It then gradually gets worse until the baby is born and the placenta delivered. One of the major problems in The Gambia is that complications of pregnancy are not recognised or treated early. This means it is common for patients to develop preeclampsia which is so severe that the placenta has separated from the womb before the baby is born. The mother has life threatening complications of massive bleeding with severe blood clotting problems as well as convulsions and kidney failure. Sadly, the baby has often died before the mother arrives at the hospital.
This was the situation last Tuesday morning, when the 21 year old lady had given birth to her baby and then was bleeding heavily. Dr Clack led the mammoth team effort to stop the bleeding. We had to make sure repair the injury she had during delivery, give her all the right medication and eventually, when that didn’t work insert a device inside her uterus to apply pressure to bleeding vessels. Meanwhile, she needed lots of blood to be transfused. Midwives ran to the lab to get any blood of the right type which was available. We asked the patients relatives to donate fresh blood for her as this is the only treatment we have for blood clotting problems. They were really slow, but our lab worked quickly to release five units of blood which saved her life.
By 11am, the drama was over and we were left with a very sick woman who wasn’t bleeding but was developing other complications as her kidneys were not working well. Back in the UK, this sort of problem would be managed in an intensive care unit by consultant anaesthetists and senior nurses. Here we had to do the best we could, relying on first principles, careful management and hope for the best. I’m really pleased to say things improved gradually and she is now much better.
We were really proud of the way the team worked together in an emergency situation and made use of the systems MCAI have put in place to make sure the medication is available and equipment is sterile and ready to use. It’s an ongoing struggle to ensure these things are in place every day though it’s clearly pays off when major problems arise.
It is possible to avoid most of the complications of preeclampsia by inducing labour when it is in the early stages and women are still well. As a team we are encouraging women to attend antenatal clinic regularly and clinic staff to send patients to us when they are worried problems are developing. Brikama is one of only a few units in the country to have this proactive policy and it is an integral part of our training programme.
Pictured below is Fatou with her sister and the Brikama team.