Every healthy baby delivered and every heathy patient is a success to me. But when certain cases that could have a very bad outcome end up going well, I'm super excited! 🎉 And relieved 😪
- •STAT C-Section: skin incision to baby in less than 1 minuteWhen the baby's heart rate has been down for several minutes, every second counts. Luckily, I've only had to do this a few times. My classmate had to do a perimortem C-section in the ER on a patient who was coded. She saved the baby, but the mom died. 😣
- •Shoulder dystocia at delivery: no neonate nerve injuryShoulder dystocia is when the baby's shoulder gets stuck behind the mom's pubic bone after the head is already out. This is an OB emergency! It sometimes happens when the baby is too big for mom's pelvis, but may be unpredictable. The force against the shoulder stretches the brachial nerves in the baby and can lead to nerve injury in that arm (often temporary). I can use multiple maneuvers to get the baby out and am always relieved when I see both arms moving equally.
- •Infertility: patient pregnant after first roundYay! Even better when I get to deliver the baby ☺️
- •External Cephalic VersionTurning the baby from breech (bottom down) to vertex (head down) so the patient can have a vaginal delivery instead of a C-Section. Most OBs have about a 50% success rate because it's not easy.
- •Vaginal delivery, 1st baby: No lacerations!It's a source of pride for an OB to deliver a baby without any perineal tears. Especially for first time moms who have never stretched out that area before.
- •Postpartum hemorrhage: saving the uterusBleeding after delivery should slow down as the uterus contracts. In some cases, the uterus is tired from a long induction or infection. If we can't stop the hemorrhage, a hysterectomy has to be done to save the woman's life. But no more uterus = no more babies. In a recent C-section, my patient lost 2.5L of blood. I gave her meds to contract her uterus, then placed compression sutures (B-Lynch) to squeeze her uterus, then tied off an artery to the uterus (O'Leary) and we saved her uterus!
- •Ovarian torsion: saved the ovaryThe ovary is suspended near the uterus by a ligament with blood vessels. A big cyst or tumor on the ovary can cause it to twist around the ligament, cutting off blood supply to itself, and putting it at risk for dying. Patients usually come in with severe pelvic pain and sometimes nausea or fever. Emergent laparoscopic surgery to untwist the ovary and take out the cyst or tumor can save the ovary for future fertility. I've seen some cases where the ovary twisted around 3 times!
- •Vaginal breech deliveryWe don't usually do vaginal breech deliveries because the baby's head can get stuck (head entrapment). However, I can deliver a breech second twin if the baby is smaller than the first twin! Once in residency, I delivered a singleton breech baby vaginally because the patient came in with the baby's legs already out.