My Resident doctors presented a seminar on difficulties in cesarean section. They did a good job, listing all possible difficulties and then giving their solutions. At the end I felt compelled to narrate three unique case reports, (not my own, but which I knew of) because I thought they should not encounter them sometime without knowing about them.
Case 1: Where is the uterine incision
They performed a lower segment cesarean section and delivered the baby. Then they started defining the lower segment incision so that it could be sutured up. There was no incision. The uterovesical fold was intact and there was no question of an incision being present underneath. It seems they called the consultant down, who gave it considerable thought and finally found the uterine incision on the posterior wall of the lower segment. The explanation was that the uterus had dextrorotated through 180 degrees, and they had not corrected it prior to making the incision. I have heard of two such cases in 32 years. Both patients made uneventful recovery.
Case 2: Where is the uterus?
A lower segment cesarean section being performed in a case of previous cesarean section. The baby was delivered. One moment the uterus was there and the next moment it was not there.
"I just looked at the multipara monitor and in that time the uterus disappeared" the consultant assisting the operation said. "Where is the uterus?"
"It is in this only" the operating surgeon replied, pointing towards the placental mass and membranes in the field.
"What did you do when I was not watching you? the consultant asked.
"I made cord traction to deliver the placenta" the operating surgeon said.
Then the consultant discovered that it was a case of iatrogenic inversion of the uterus through the lower segment incision. The uterus was not seen because it was under the placental mass. He rapidly corrected the inversion. All this happened so rapidly that there was no hemodynamic change or shock. The patient made an uneventful recovery.
Case 3: Where is the baby?
The patient was taken to the oT for an emergency cesarean section for fetal distress in advanced labot. When the made the lower segment incision and put a hand inside the uterus to deliver the baby, they found there was no baby in there.
"Where is the baby?" shouted the operating surgeon.
There was a muffled cry in response, from under the surgical drapes over the patient's thighs. Someone lifted the drapes and found the baby there. It had delivered vaginally while they were approaching the lower segment surgically. The mother and baby made uneventful recovery.
"How did that happen?" someone asked me later.
"When the cesarean section is done in advanced labor for acute fetal distress, if the obstetrician is faster than the patient, the baby is delivered by a cesarean section. If the patient is faster than the obstetrician, she delivers the baby vaginally in the OT before a cesarean section can be performed. In this case both of them must have been equally fast, such that the woman delivered vaginally while the obstetrician reached the uterine cavity to take the baby out."
Case 1: Where is the uterine incision
They performed a lower segment cesarean section and delivered the baby. Then they started defining the lower segment incision so that it could be sutured up. There was no incision. The uterovesical fold was intact and there was no question of an incision being present underneath. It seems they called the consultant down, who gave it considerable thought and finally found the uterine incision on the posterior wall of the lower segment. The explanation was that the uterus had dextrorotated through 180 degrees, and they had not corrected it prior to making the incision. I have heard of two such cases in 32 years. Both patients made uneventful recovery.
Case 2: Where is the uterus?
A lower segment cesarean section being performed in a case of previous cesarean section. The baby was delivered. One moment the uterus was there and the next moment it was not there.
"I just looked at the multipara monitor and in that time the uterus disappeared" the consultant assisting the operation said. "Where is the uterus?"
"It is in this only" the operating surgeon replied, pointing towards the placental mass and membranes in the field.
"What did you do when I was not watching you? the consultant asked.
"I made cord traction to deliver the placenta" the operating surgeon said.
Then the consultant discovered that it was a case of iatrogenic inversion of the uterus through the lower segment incision. The uterus was not seen because it was under the placental mass. He rapidly corrected the inversion. All this happened so rapidly that there was no hemodynamic change or shock. The patient made an uneventful recovery.
Case 3: Where is the baby?
The patient was taken to the oT for an emergency cesarean section for fetal distress in advanced labot. When the made the lower segment incision and put a hand inside the uterus to deliver the baby, they found there was no baby in there.
"Where is the baby?" shouted the operating surgeon.
There was a muffled cry in response, from under the surgical drapes over the patient's thighs. Someone lifted the drapes and found the baby there. It had delivered vaginally while they were approaching the lower segment surgically. The mother and baby made uneventful recovery.
"How did that happen?" someone asked me later.
"When the cesarean section is done in advanced labor for acute fetal distress, if the obstetrician is faster than the patient, the baby is delivered by a cesarean section. If the patient is faster than the obstetrician, she delivers the baby vaginally in the OT before a cesarean section can be performed. In this case both of them must have been equally fast, such that the woman delivered vaginally while the obstetrician reached the uterine cavity to take the baby out."
