Jan 12 2011
by Liz Lightner
Vanderbilt University, Department of Emergency Medicine
Santiago Atitlan, Guatemala
I received a 24 year old pregnant woman in the ED via ambulance. Her prenatal care consisted of one ultrasound at the city clinic months earlier. She was about 36 weeks pregnant by the date of her last period, and this was her first pregnancy. She had been pushing for 3 hours at home, and someone had administered an unknown IV medication to her at her home hours earlier. She was having contractions every 2-3 minutes, her cervix was fully dilated, and late decelerations were evident on the monitor. I called Dr. Laura, the on call OB physician on call, and asked her to come as soon as she could. On her arrival, she discovered that the baby was transverse and was unable to be rotated. Delivery by forceps and vacuum was not possible. The fetal heart rate by this time was dropping into the 60s with every contraction, thus we rushed to the OR for a C-section. There are no OR teams or standby OR's here, so Drs. Laura and Carrie set up for the surgery and I prepared for procedural sedation, this process seemed to take a very long time. Another on call physician arrived and set up to resuscitate the baby. Two other volunteers heard about the situation and arrived by the start of the procedure to assist in any way possible. Nobody on our team had much more experience than a training course on neonatal resuscitation, so we were very relieved when the baby started breathing and crying seconds after delivery. The mother tolerated the surgery well. I was amazed how well our team of volunteers with experience in various areas of medicine were able to come together to ensure a good outcome for these two patients, despite practicing outside our usual scopes of practice.