Inez arrived at 9pm with labor pains. She had no prenatal care and didn't know how far along her pregnancy was. By ultrasound, she measured 30 weeks which is one and half months PREMATURE. Her cervix was not opening, but we gave her some IV fluids and steroids to mature the baby's lungs. We don't have surfactant here (helps premie babies breath) and we wanted to give the baby as much time as possible inside mom. The next morning, she started having strong labor pains. Within 30 minutes she was fully dilated, which isn't surprising being that this was her 8th pregnancy. Dr. Juan did an exam to check for dilation and realized that she had a CORD PROLAPSE... the cord came out and the baby's head was compressing it against the pubic bone. "There is a pulse" he said. Seconds later as we prepped the OR, "there is no pulse." We delivered a live baby under LOCAL ANESTHESIA, but the baby was very preterm. I put lidocaine in the skin, and when there was a delay in obtaining more lidocaine, I just made two cuts and pulled the baby out. Mom was given Ketamine immediately and thankfully doesn't remember being opened without much anesthesia. Dr. Juan was scrubbed with me and multiple times he reminded me to breath. Brian and Jason Howell worked on the baby. She was having trouble breathing so Brian intubated him. Lili the nurse started a peripheral IV and the baby got a bolus and then dextrose and antibiotics. For two hours we helped the baby breath with an ambu and a little bit of oxygen. Meanwhile, we were trying to coordinate getting him to Iquitos where they have surfactant and a ventilator. The 5 hour boat ride + 10 min mototaxi + 1 hour boat ride + 15 minute mototaxi (normal mode of transportation) was out of the question, so we called the military to ask them to transport the baby by helicopter, which would take only 2.5 hours. After over two hours, the baby decompensated, the heart rate and oxygen level dropped, and the decision was made to remove the tube and bring her to mom. We don't know why...maybe pneumothorax? It was a sad day. Mom is doing well. She went home today (across the river) and will be back in a few days to remove her staples. Pray for Inez and her family and baby Julia.
27 March 2012