“Sir, this patient is admitted for undergoing a cesarean
section” my Registrar told me on ward round. “She has central placenta previa.”
“What is the gestational age?” I asked.
“Thirty seven weeks” came the answer.
“It is unusual for a central placenta previa not to bleed by
this gestational age” I said. “Perhaps it is a placenta accreta, increta or
percreta. Ask the sonologists to see if she has such a condition.”
“But she has had two normal deliveries before. It is
unlikely she will have such a condition” piped my Assistant Professor.
“Why?” I asked.
“It is more common with a previous cesarean section” she
said.
“It is not impossible that she will have one, is it?” I
asked.
“Um… no” she said reluctantly.
“Is there any sensible reason not to perform an ultrasonic
scan?” I asked.
“Um… no” she said reluctantly.
“Then let us do it in her interest” I said. “Another reason
for doing it is that it may turn out to be a fundal placenta.”
“Fundal placenta?”
“Yes. When a novice sonographer hold the ultrasonic probe
directed 180 degrees wrong, top become bottom and right becomes left. A fundal
placenta becomes placenta previa and vertex becomes breech.”
There was no further argument, either because they were
convinced, or because they gave up on me.
“Sir, we got the ultrasonic scan report of that patient” my
Registrar told me in the afternoon. “It is fundal placenta” she smiled. She did
not know how I did it. I knew how I did it. It was sheer logic and my
experience with our sonographers.
“What shall we do now?” she asked.
“Send the patient home” I said. “She can deliver vaginally.
Tell our Assistant Professor about this report, so that she will refrain from
arguing with me in future.”
