Saturday with Padre

 I arrived back in Santa Clotilde from my part of the IMR trip on Friday evening July 27^th,  and Padre was “manning the fort” all alone. I took call Saturday when Toni and Julio were still on their journey back up river. Padre received a call from Angoteros  early Saturday morning that they had a woman who labored at home, but the baby would not come out due to an arm prolapse (arm comes first and then head and baby cannot be delivered) This happened at 5am in her house, she arrived to the health post in Angoteros at 630 am and started on the boat to CSSC at 7am. They arrived at 1pm with our team waiting. The baby’s arm was still hanging out and surprisingly not totally cyanotic.  (the story has already been elaborated to the baby actually waving at us from the vagina) After a few minutes of Doppler we did discover heart tones of the baby and rushed back to the OR. Padre and I scrubbed and did the c-section under local lidocaine, once the baby was out mom got Ketamine. However,baby was limp and non-responsive when we pulled her out, I scrubbed out of the surgery and Victor Hugo took my place as assistant. I had the help of one our nurses Dani and we rescessitated the baby. Thick meconium caused the issues (along with the 8 or so hours of arm prolapse), the baby’s heart rate was there but less than 100, cyanotic. I used a “trompa” to suction out the meconium. We do not have the fancy meconium aspirators we have back home and the trompa will not fit inside and ET tube, so I could not intubate to suction (Neonatal guidelines in US).  I took the trompa , which is a plastic cylinder that catches the meconium and is connected to 2 tubes, one to enter baby’s mouth and the other for the provider to suck on creating negative pressure. It was thick and I had to remove quite o bit of meconium, when I removed one large plug the baby improved immensely and started to cry. We provided some postive pressure ventilation (ambu bag) to help her breath along with supplemental oxygen. An IV was started and she got Gentamicin and Ampicillin (antibiotics) in the delivery room.  I do have to admit the trompa is set up so I cannot actually suck in the meconium all the way through the cylinder, however of course something went wrong and on my last suction I got a mouthful of meconium. What is meconium???? Well it is all the stool that was built up over the pregnancy that is expelled usually after birth, sometimes in the  amniotic fluid causing risk for aspiration in the baby. GROSS!!!!! However mom’s serologies were negative for any dangerous infections. I brushed my teeth and used Listerine afterwards and am still healthy. The mom is doing great, the baby is not out of the woods. She has and erb’s palsy of her arm from stretching and damaging the nerves to the neck and arms, but she is alive. Still tachypneic (fast breathing) and on oxygen, but truly a miracle to have made it this far! When Padre was finishing the operation and the baby was being put into our incubator, Toni and Julio arrived…..welcome back, you missed all the fun!

Brian