Bismillah..
Ever since I started my oncall shift, my night never been peacefully. Except last night when I managed to sleep from 9.00pm-4.45am.
At 5.00am i received a call from my colleague in Obgyn, she want to post one case for MRP (Manual Removal of Placenta) for retained placenta. The condition when the placenta has not been delivered after 30minutes of labour after baby delivered.
My patient she is 33 years old, Para 4, with underlying controlled bronchial asthma. Has been post labour for 30 minutes with estimated blood loss is 250cc, and initial Hb was 12. She's comfortable and vital sign remained stable. Only the heart rate is 92 beats per minutes.
So I proceed the case under regional anesthesia. Alhamdulillah successfully give 1 shot spinal dose for her. Intraoperatively she remain stable but the placenta still not coming out. Then I noted her pulse was tachycardia but the MAP remain >65.
I asked my staff nurse to call in my senior colleague to help me in theatre because i think patient need a blood tranfusion but im not very sure. So she asked me to run pint of colloid first and keep the blood warm.
I did.
Till the Obgyn specialist come and managed to removed the placenta but bloods still oozing out. They proceed with hysterectomy.
This case really give me a lot of points to ponder.
Initially i tought it will be an easy case. I already write down my discharge plan in the beginning of the case.
Seriously, we wont ever know whats is going to be happened for every patient intraoperatively.
I hope my colleague manage to extubate her today.
Ever since I started my oncall shift, my night never been peacefully. Except last night when I managed to sleep from 9.00pm-4.45am.
At 5.00am i received a call from my colleague in Obgyn, she want to post one case for MRP (Manual Removal of Placenta) for retained placenta. The condition when the placenta has not been delivered after 30minutes of labour after baby delivered.
My patient she is 33 years old, Para 4, with underlying controlled bronchial asthma. Has been post labour for 30 minutes with estimated blood loss is 250cc, and initial Hb was 12. She's comfortable and vital sign remained stable. Only the heart rate is 92 beats per minutes.
So I proceed the case under regional anesthesia. Alhamdulillah successfully give 1 shot spinal dose for her. Intraoperatively she remain stable but the placenta still not coming out. Then I noted her pulse was tachycardia but the MAP remain >65.
I asked my staff nurse to call in my senior colleague to help me in theatre because i think patient need a blood tranfusion but im not very sure. So she asked me to run pint of colloid first and keep the blood warm.
I did.
Till the Obgyn specialist come and managed to removed the placenta but bloods still oozing out. They proceed with hysterectomy.
This case really give me a lot of points to ponder.
Initially i tought it will be an easy case. I already write down my discharge plan in the beginning of the case.
Seriously, we wont ever know whats is going to be happened for every patient intraoperatively.
I hope my colleague manage to extubate her today.
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