My second maternity week continued today with more of the same but also some differences. An unfortunate theme of the day was birth asphyxia. Birth asphyxia is a common diagnosis here and one that I have witnessed first hand several times during my time here. This diagnosis is placed on babies that do not get oxygen quick enough at birth during a difficult delivery. This most commonly occurs during vaginal deliveries as c-sections involve directly going to get the baby from the uterus so it eliminates some of the variables related to birth asphyxia. The low oxygen can cause no effects on the baby or, depending on the length of time the baby is under stress, can result in poor oxygenation to the brain with resultant brain damage or even stillbirth. Today, there was a very difficult cesarean delivery of a baby whose mother had three prior c-sections (“scars” as they say here). These prior surgeries had caused extensive scarring of her abdominal muscles and uterus. When it was time to deliver the baby, the scarring was so constrictive that the baby’s head did not deliver quickly as it usually does. It took several minutes for the baby to be delivered and, subsequently, several minutes for the baby to breathe. The baby is in the NICU and doing well but I fear there may be some lasting damage. It is not uncommon here to meet women that have had 3, 4, or even 5 c-sections. More than 3 poses many risks to a pregnancy including risk of uterus rupture and the extensive scarring like was encountered in the scenario I am referencing. I am not sure of the exact statistics, but it does seem there is a high rate of c-sections here. In part this is because this hospital is known in the area for taking care of high risk patients but also there is no continuous fetal monitoring during labor. This means that if any abnormalities are detected during routine monitoring, the worst has to be assumed and patients are taken for c-sections. The midwives that attend to laboring patients are extremely skilled and knowledgeable within their scope of practice. If the technology was available for continuous monitoring, I am sure they would be able to learn how to use it and how to interpret the information. From what the staff tells me, this is not on the horizon any time soon but are dreams for the (hopefully not so distant) future in Uganda.
Lugandan word of the day: okusanyusa (please)
Medical learning point of the day: The current Ugandan guidelines for cervical cancer screening state it is to performed on all women from age 25-49 years old with either visual inspection (if premenopausal and has not had a child in the past 6 months) or by Pap smear cytology. This should be done every 3 years for HIV negative patients and annually for HIV positive patients. HPV testing is only available in a research setting.
