O Negative

 She was referred from the health center with profuse vaginal bleeding. On our ultrasound she was found to have a term pregnancy with placenta previa (thé placenta is over the cervix so it bleeds when the nurse performs an exam). 

The lab slip for her blood type had O- written on it. Our hearts sink when a patient has O negative blood. If the patient needs a blood transfusion to save her life we may not have enough of that precious limited resource. We performed a cesarean. When the baby came out we noticed the uterus had torn far laterally and posteriorly  into the blood vessels. The blood poured out within seconds.

The baby was alive and crying for which we were grateful. We were able to stop the bleeding with sutures, but she had already bled a lot at the health centers. She was pale and had low blood pressure. She was oozing from every surface. We gave her our last bag of O- blood. She wanted a tubal ligation which we performed. 

I scrubbed out to write the operative note. Stopping by the baby boy, he looked gray. I patted the baby. No cry like before. Only an agonal breath. Then no breathing. This mother had delivered 12 children. As is typical in Tchad however, many of them died before the age of 5. Children are critical here as they are one’s social security in old age. She has only one living child. This baby she hoped would be her second and her tubes were tied. 

We quickly started breathing for the baby. He was cold and gray. We placed her on our only rapidly available incubator, the mother’s chest under the drape while Staci was suturing the incision closed. With breathing and warmth the baby turned pink. Then he started breathing on his own and the mom is alive! 

The baby didn’t live a long time. One of our goals is to develop a NICU here to save more babies like these. Our current reality is that we struggle to have enough staff to save people like the mother. She did live for which we are very grateful.