Somehow I don't cease to be surprised by new trends in obstetric practices of resident doctors. We had a patient who underwent a cesarean section. She had developed fetal distress and cesarean section was performed by residents of another unit. She developed hypotension and shock in the postoperative period. She was explored by our Associate Professor and resident doctors. She was found to have extraperitoneal hemorrhage staring from the rectus sheath and dissecting underneath the peritoneum. It was behind the posterior peritoneum too. On questioning it was found that the residents had stretched the edges of the abdominal incision. The method was to grab the side of the incision with both hands, one resident on either side of the incision. Then they would stretch the incision with their body weights by falling backwards with their upper limbs held extended.
"Do you not understand that this barbaric method is likely to tear the recti and even extend the incision irregularly? That may produce extensive damage, as in this case."
"...."
"Do you do this in our unit too?" I asked.
"Yes sir".
"Will you stop it with immediate effect?" I asked.
"Yes sir" they promised.
"Do our assistant professors who have come from three other institutes in this city do the same?" I asked.
"Yes sir" they said.
"Stop" I said.
"Yes sir" they said.
There was another case undergoing cesarean section in our OT today morning. Our junior resident doctors had changed three days ago. The operating surgeon was a local candidate, while the first assistant was from Down south somewhere. Before I realized what they were doing, they grabbed the sides of the incision on their respective sides and stretched the incision by leaning backwards.
"Stop stretching the incision" I said.
They looked at me uncomprehendingly.
"Do not stretch the incision by hanging onto its edges" I said. The stopped.
The senior resident who was the first assistant apologized later. I explained the reason for not indulging in that practice. Then I asked him where he had learned that technique.
"In our college during postgraduation" he said.
I was intrigued. How bad practices without scientific evidence of their usefulness spread all over the country was beyond me to understand. I wonder if they use 'Facebook' or 'Twitter' or any other social networking site for this purpose.
Thursday, November 4, 2010
Isometrics in Cesarean Section
Somehow I don't cease to be surprised by new trends in obstetric practices of resident doctors. We had a patient who underwent a cesarean section. She had developed fetal distress and cesarean section was performed by residents of another unit. She developed hypotension and shock in the postoperative period. She was explored by our Associate Professor and resident doctors. She was found to have extraperitoneal hemorrhage staring from the rectus sheath and dissecting underneath the peritoneum. It was behind the posterior peritoneum too. On questioning it was found that the residents had stretched the edges of the abdominal incision. The method was to grab the side of the incision with both hands, one resident on either side of the incision. Then they would stretch the incision with their body weights by falling backwards with their upper limbs held extended.
"Do you not understand that this barbaric method is likely to tear the recti and even extend the incision irregularly? That may produce extensive damage, as in this case."
"...."
"Do you do this in our unit too?" I asked.
"Yes sir".
"Will you stop it with immediate effect?" I asked.
"Yes sir" they promised.
"Do our assistant professors who have come from three other institutes in this city do the same?" I asked.
"Yes sir" they said.
"Stop" I said.
"Yes sir" they said.
There was another case undergoing cesarean section in our OT today morning. Our junior resident doctors had changed three days ago. The operating surgeon was a local candidate, while the first assistant was from Down south somewhere. Before I realized what they were doing, they grabbed the sides of the incision on their respective sides and stretched the incision by leaning backwards.
"Stop stretching the incision" I said.
They looked at me uncomprehendingly.
"Do not stretch the incision by hanging onto its edges" I said. The stopped.
The senior resident who was the first assistant apologized later. I explained the reason for not indulging in that practice. Then I asked him where he had learned that technique.
"In our college during postgraduation" he said.
I was intrigued. How bad practices without scientific evidence of their usefulness spread all over the country was beyond me to understand. I wonder if they use 'Facebook' or 'Twitter' or any other social networking site for this purpose.
