Have you ever heard placental implantation on scalp of Foetus?
No...then Read this.
We have seen it.
Saturday, April 17, 2010
Case History –
1.28 years female patient came with complaining of pain in abdomen
2. Third gravida, unregistered. Patient.
3.Only with card of primary heath center.
4. Full Term.
On Examination
General & Systemic examination was in normal limits…
Pulse – 88 /min. Blood Pressure – 118 / 78 mm hg
No pallor No pedal edema….No ecterus.
CVS & RS – normal…nothing significant
Per abdominal Examination –
Full Term, Head just slightly oblique but fixed
FHR – 140 / minutes.
Per Vaginal Examination –
Show was present, Cervix – 2 cm loose , vertex was high.
Investigations done:
As was mentioned in card of primary health center.
HB – 10 gm%. Blood Group – ‘A’ positive. HIV = negative
HB – 10 gm%. Blood Group – ‘A’ positive. HIV = negative
Action Plan:
Decision of emergency cesarean was taken
Accordingly preparation was done…like consent and related.
Problem
Problem during LSCS
After spinal anesthesia by anesthetist cesarean was started.
Abdomen was opened and bladder was pushed down
Uterus opened on lower uterine segment.
After insertion of right hand the feeling to palm was different.
Hand was not able to go behind the head so as deliver it.
Then it was withdrawn and put to palpate anterior side of fetal head.
But on that side also there was no free space between head and uterine cavity.
Now hand was inserted third time posterior to head…
Not able to deliver head of fetus…
Aim was to deliver fetus
Aim was to deliver fetus in any condition
There no choice and no option as head and fetus and placenta has to be removed…in short time…
Hand was inserted fourth time with strong intention of removing fetus in this attempt only.
As this was last chance to remove baby by hook or crook…
Now palpation was little bit more careful.
Then it was the impression as if some soft part…rather placenta was sticking to fetal head.
And that’s why it was difficult to deliver fetal head.
And God gave me the thought …why not to deliver placenta first?...
Placenta was delivered before Fetus…
Placenta was delivered before Fetus…
And the hand inserted was smoothly worked to find the space between placenta and uterus…as we do in case on manual removal of placenta…
And placenta was separated and removed.
Along with placenta…fetal head followed…
delivered in Toto
Placenta and Fetal head was delivered at a time…in Toto…
Means both Fetal head and placenta came out through the lower segment incision at a time…
Placenta accompanied fetal head…
And the whole fetus was removed with ease.
Baby started crying immediately.
Cord was cut…and….
While preparing to suture first layer of uterine incision …baby was observed.
Not a normal baby
It was not a normal baby and it was not a normal placental insertion.
Surprising three fact were noted:
1.It was congenital anomaly…cleft palate.
2.There was also a encephalocoel…( meningomyelocoel…)
3.And placental membranes were inserted on scalp of fetus…and adherent to meningomyelocoel…
Surprising three fact were noted:
1.It was congenital anomaly…cleft palate.
2.There was also a encephalocoel…( meningomyelocoel…)
3.And placental membranes were inserted on scalp of fetus…and adherent to meningomyelocoel…
Cesarean was completed.
Cesarean was completed.
It was later on uneventful…no bleeding…uterus was well contracted…
Abdomen was closed as usual…
What about Newborn?...
What about Newborn?...
1.It was shown to father…
2.Advised to take the newborn to Institutional hospital for further treatment..
3.But father refused…as knowing the chance of mortality.
4.Newborn was of weight -3 kg…
5.Was alive for 36 hours…
6 After the neonatal death…dead body…was handed over to father.
7.The mother was discharged after 9 days of stay in hospital
1.It was shown to father…
2.Advised to take the newborn to Institutional hospital for further treatment..
3.But father refused…as knowing the chance of mortality.
4.Newborn was of weight -3 kg…
5.Was alive for 36 hours…
6 After the neonatal death…dead body…was handed over to father.
7.The mother was discharged after 9 days of stay in hospital
chapter was closed.
And the chapter was closed.
After discharge patient came for follow up for two ..three time…
After that the couple shifted somewhere else and chapter was closed.
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