Jahan, Nusrat

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Journal of Asian Midwives (JAM) Volume 11 Issue 1 Article 11 7-2024 Complicated home delivery: A real story Nusrat Jahan Aga Khan Health Services Pakistan Follow this and additional works at: https://ecommons.aku.edu/jam  Part of the Nursing Midwifery Commons Recommended Citation Jahan, N. Complicated home delivery: A real story. Journal of Asian Midwives. 2024;11(1):141–142. Complicated Home Delivery: A Real Story Nusrat Jahan 1  Shuist BHC Staff “Nafas Bibi” At 1 o'clock in the night on March 15, Nafas Bibi the Lady Health Visitor (LHV) at Agha Khan Health Center, Shuist, received a call for home delivery from a village Inchipun close to the Boroghol. The village where the baby was to be delivered was located at least 10 hours away by foot from the center. However, due to heavy snowfall over the past two days, the roads were in poor condition. The staff gathered their belongings and set off on foot, but unfortunately, after one hour drive to the village, their vehicle became stuck in the snow. Determined to reach the patient, the AKHS, P staff began clearing the snow. Meanwhile, Nafas Bibi LHV Shuist BHC set off on foot, braving the bitter cold, and leaving the stranded vehicle behind. After making a path for the vehicle, the rest of the team caught up with her, and they managed to reach the patient after five grueling hours. Upon arrival, a Patient named Salima Bibi W/O Abdu Rehman Khan, 40 years old, G4, P4, discovered that the baby had been born, but the placenta had not been expelled. The staff maintained the IV line and started the Oxytocin drip. Despite their best efforts, the staff was unable to remove the placenta. The patient's bleeding worsened, and it became necessary to refer her to the secondary Health Care facility. However, due to the heavy snow, the roads were impassable.  The community members brought the FOCUS stretcher, which was kept in the same village's Jamat Kana. Patients are carried to CHC on stretchers. They safely arrived at the car after a few-hour walk and proceeded to the Booni Medical Center. Meanwhile, staff Nafas contacted the Field Office for help, and office staff approached the Council for volunteer help. After the road was cleaned by volunteers, the patient arrived at Booni Medical Centre at 4:00 PM. Case study:  A patient named Salima Bibi W/O Abdu Rehman Khan, 40 years old, G4, P4, hailing from Broghil, the remotest area of Upper Chitral, was referred from BHC Shuist and came to BMC on March 1, 2024, at 18:50 hours with complaint of retained placenta.  Initial assessment with ultrasound was done by Dr Alina Shahid (gynecologist), basic lab investigations were done and the patient was in BMC for manual removal of placenta after 48 hours of delivery at home but that failed as the placenta was adherent in the walls of the uterus. Started IV fluids with Injection oxytocin, catheterization was done, antibiotics started observed for next 6 hours. After 6 hours of the treatment, again attempted for manual removal of the placenta  1 Manager Community Health Service Midwives, MPH Aga Khan Health Services Pakistan 141Journal of Asian Midwives (JAM), Vol. 11, Iss. 1 [2024]Published by eCommons@AKU, 2024under general anesthesia was done but failed because of incorporated/embedded into the myometrium keeping in view the risk of perforation & inversion. Planned for Laparotomy/ Hysterotomy & shifted the patient to OR after arranging the blood. Hysterotomy done, T-shaped incision given, a full placenta, totally adherent in the left cornu of the uterus, removed with gentle traction. Specimen sent for sampling. Uterus preserved; 3 pints of whole blood transfused with other treatment. The patient was stable completely at the time of discharge (5/3/2024).  Patient statement: She has taken three antenatal visits (1 in BMC in the first trimester, 2 visits in BHC Shuist). During delivery there was heavy snow and the BHC was away 5 hours of walking distance. After delivery when the placenta did not deliver the family went to BHC to call staff. She reached home early in the morning, was examined, and started IV line with Synto. After half an hour when the trial failed, she referred the patient to BMC. It took 5 hours to reach to vehicle and took a whole day (6-7 hours) to reach BMC, here she was well-managed, revived, and discharged today.         142Journal of Asian Midwives (JAM), Vol. 11, Iss. 1 [2024]https://ecommons.aku.edu/jam/vol11/iss1/11

Complicated home delivery: A real story

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1134&context=jam

Complicated home delivery: A real story

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