Day two of maternity week started out as all days do with prayers, the doctors meeting, and then rounds. This morning, rounds were interrupted by a string of mothers needing C-sections. The first was a first time mom with twins. It was my first time assisting for a twin delivery and it went very smoothly. It was really neat delivering two placentas. Both babies were almost full term and were healthy. According to the obstetrician, twins are very common in Uganda, and I have actually observed this in the community. Next there was a mother with elevated blood pressures not responding to medication. While she was being brought to the operating room and prepped, I assisted the surgeon during the repair of a cystocele (prolapsed bladder out of the vagina) via vaginal access. Again, this was something I had not seen before. The next C-section went smoothly and as the surgeon was finishing, we got word there were two more mothers with obstructed labor that needed C-sections. It was a busy day to say the least. I apologize for the shorter posts this week, but I feel like maternity will take a lot of my energy and focus, which of course I’m happy to give to my favorite part of medicine!
Lugandan word of the day: nnaalongo (“nah-loan-go”, noun, mother of twins)
Medical learning point of the day: A clinical sign of obstructed labor (failure to progress in either cervical dilation or descent of the baby’s head into the birth canal in a timely manner) is Bandl’s ring. This is an indent in the mother’s abdomen, like a valley around her middle between two bulges on top and below it. This occurs because the uterus has had stress on it for too long and the upper uterus is in a state of constant tension while the lower uterus has been stretched out during labor. The demarcation forms this visible sign. This is helpful when assessing a patient who has been brought in from an outside facility or from an attempted homebirth. It gives you a clue as to how long the patient has been laboring and how concerned you should be for complications of prolonged obstruction.
