Nightmares in Obstetrics & Gynecology: 4

There was a time when a midline vertical incision was made in the upper segment of the uterus for performing a cesarean section. But that time is long gone, many years before I began my residency. In modern times, everyone makes a transverse incision in the lower segment of the uterus, because the upper segment incisions are associated with a high incidence of complications like severe hemorrhage, postoperative infection spreading to the peritoneal cavity, adhesions between the scar and bowel, rupture of the scar in a future pregnancy. I recall a time when I was doing my house post in obstetrics and happened to be in the OT when my room partner’s unit was performing a cesarean section. Their lecturer was among many things greedy and would try and operate herself when someone else was supposed to operate. The operation was about to begin when she suddenly decided to join the operating team. They knew she would take over if she joined. So the residents rushed through the steps while she went to wash up. The Houseman made a bold midline incision in the abdominal wall as instructed by the Registrar. The incision happened to be so bold that it went right through the abdominal wall and cut the outer part of the upper segment of the uterus. The Registrar hid the uterine cut with a mop and they proceeded with the lower segment operation. The lecturer arrived, saw what was happening, ordered the Registrar to remove the mop to show what was underneath, and realized what had happened. “You guys did this so that you would deliver the baby before I joined you” she said with disgust and walked away. Ten years later history repeated. It was my operation day, and there was an emergency cesarean section of another unit. Their Registrar decided to perform a fast operation and made a bold midline vertical abdominal incision. It happened to be bolder that my roommate’s of 10 years ago. It went through the abdominal wall and the front of the upper segment of the uterus in a single stroke. The uterine opening was 2-3 cm long and part of the baby was seen through it. The tragedy of the patient was that the Registrar extended the incision upwards and downwards to make it an entirely upper segment operation, instead of performing a lower segment operation and then suturing the upper segment incision. She did this before we could stop her. Whether she did this because she was too dumb or because she always wanted to do one remains unknown to date. She is an associate professor of Obstetrics and Gynecology in a teaching institute today. I just hope she has improved in the meantime.