This time I was not in the NICU, but spent the day in the obstetrics department. After the handover and a short presentation on whether DHEA should be administered for a more successful IVF (no), as well as a cardiological consultation, it was off to the OR for 2 caesareans. Both babies were in fetal distress. The first baby had been noticed for severe decelerations in the CTG. As the spinal anaesthesia was not successful, the mother had to be put under general anaesthesia. This created additional time pressure because the foetus had to be protected from the effects of the narcotics. Although it needed 100% oxygen after birth, it recovered well over the morning and was soon returned to the mother. The second baby was less lucky. The mother had not felt any movements for a couple of days and arrived at the hospital just in time. The CTG showed only a flat curve without much activity. Like the first one, the baby had already discharged meconium into the amniotic fluid, but then also aspirated it. In addition, a kiwi bell, a hand-operated vacuum-generating bell, had to be used to get his head out of the womb. His APGAR score after the 1st minute of life was only 2 points and could not rise above 6 points despite ventilation and 100%oxygen. This little patient will probably have to stay in the NICU for a while. I will see how it looks next week.
The rest of the day I followed a midwife. Our pregnant woman had come to the hospital for monitoring because of contractions and a bit of vaginal blood loss. The blood can come from a ruptured vaginal vein, for example. In rare but serious cases, it can also be an indication of incipient placental insufficiency. The patient's contractions became stronger and more frequent and the bloody discharge increased, yet at the end of our shift her cervix was still as wide open as at the beginning and the active phase of labour had not yet been reached. As the fet showed 3 decelerations in the CTG, we changed the position of the pregnant woman. A very common reason is an unfavourable position, which can interrupt the blood supply of the fetus during contractions. This can usually be remedied by changing the position.
An operating theatre where caesarean sections take place.
On the obstetrics ward.
The monitoring of the CTGs, in the midwife's room.