A third gravida second para presented to our emergency room with 32 weeks of pregnancy and congestive heart failure due to a tight mitral stenosis. Her respiratory rate was 50 per minute and heart rate 140 per minute. She was urgently rushed to cardiology department, where they started treatment for her cardiac condition. They attempted a balloon mitral valvatomy, on an emergency basis. Unfortunately it failed. So they scheduled her to undergo an open mitral valvotomy the next morning. When I reached the hospital in the morning, my Assistant Professor came to meet me.
“Sir, the cardiac surgeon wants us to perform a cesarean section on her at the time of the open heart surgery” he said.
“But she does not need it” I said. “She will surely die if we do that.”
“I explained that to him, but he refuses to listen” he said.
Just then the said cardiac surgeon called.
“The woman should be delivered by a cesarean section at the same time as the cardiac surgery” he said. “Or the fetus has a 99% chance of dying.”
“But the baby is preterm” I said.
“These days they have excellent neonatal care” he said. “Surely the baby will survive.”
“Not unless we mature the baby’s lungs with betamethasone. We have not done that.”
“Uh!” he said. That was new to him, I thought. “But she is already anesthetized. It is so easy to perform a cesarean section.”
“If she is already anesthetized, by the time we send someone over and arrange for a cesarean section, the fetus will be so depressed due to general anesthesia, it will be birth asphyxiated and may die or be extremely moribund” I said.
“Hmm…” he said.
“Besides, open heart surgeries are done during pregnancy world over, in selected cases, without the fetuses dying” I said.
“Hmm..” he said. He must have been surprised I knew about it.
“You will heparinize her during your surgery, I suppose” I said. “Then she will keep bleeding from the placental bed and the uterine and abdominal suture line until you reverse the action of heparin with protamine sulfate. That will surely kill her.”
“…” he seemed to have nothing to beat this logic. “But send a faculty to be a standby during our operation” he said.
There was nothing to be done obstetrically, and keeping a staff member sitting in their OT was meaningless. But it would keep his mind at peace and he would operate better. So I consented. “OK” I said. “Our Assistant Professor will reach your OT in ten minutes.”
They made our Assistant Professor stay in their OT for more than four hours. They even asked for a baby tray to keep the baby if the woman delivered during the cardiac operation. He was quite amused by whatever happened. He narrated the whole thing after coming back with a grin on his face.
“Sir, the baby was dead in utero. It must have died sometime during the night due to maternal cardiac failure causing hypoxia.”
“So they wanted us to do a cesarean section to save a dead baby from dying again?”
“They did not know it then. But even after I told them about it, they kept asking me if it was safe to give aminophylline and adrenaline, in view of the fetus still being in utero” he said.
I was speechless for a few moments.
“But he has M.B.B.S. degree. Does he not know that a woman does not pop out a baby just like that? She has to go in labor and remain in labor for many hours” I said.
“I don’t know. He was quite ‘hyper’ about it” he said.
He must indeed have been hyper. He called us the next day moring, asking us to extract the fetus so that they could extubate the patient.
Perhaps we shoud invite him for a continuing medical education program, perhaps better termed as a refreshing medical education program.
"Where did he get this idea of performing a cesarean section and an open heart surgery at the same time?" my Assistant Professor asked me.
"We had a Professor in our department who was very friendly with the cardiac surgeons. She would go to their OT and perform a cesarean section at term if they were performing a cardiac surgery for any reason. It would save another anesthesia, should the woman require a cesarean section later - the cardiac-obstetric team apparently believed. That team has left this institute. But this fellow might have been a junior resident doctor at that time. He might have recalled those wonderful days" I said.
