On deaths doors.

She came with abdominal pain and bleeding, drowsy but rousable and a pulse of 130 she wasn’t looking too good!   She was 37 weeks pregnant and all was going well till the day before when she started feeling dizzy then the pain and bleeding started- I kept asking her how she was feeling and all she could tell me over and over was – I am not fine, I am not fine!  She wasn’t bleeding too heavily anymore but unfortunately we couldn’t find the fetal heart beat and confirmed by uss that the baby had died.  When we did her blood test we found she had a Hb of 4! For the non-medics normal is above 10.  So it was obvious she had lost a lot of blood and was probably anaemic to begin with as most women are in Malawi.   Her abdomen felt hard and I thought she had an abruption- this is when the placenta starts separating and can lead to catastrophic life threatening bleeding.  Thankfully we know these women deliver quite quickly when labour is stimulated so we started resuscitating her with fluids and were lucky to get some blood which we stated giving her during the labour.  We were prepared for a Post partum haemorrhage, which is also common in these scenarios and managed it quickly and actively so as to limit the amount of blood loss, this could have all ended very differently had she delivered at home or not got to the hospital in time. 

This is why it’s so important to deliver in a health facility with doctors and midwives experienced in emergency obstetric care, without which this woman would have surely died.  I went to see her the next day and she told me with a smile- I am fine :)