Fetal demise, PIH C-section, late decels all in one night.

Last night was all kind of things mixed into one. I mean, damn, was it a full moon or something?!

Before I ramble on, you might wanna stop reading if you're squeamish.

So, it started off slow, my patient was 5 cm when I came in and stable. After a few hours with her, I ventured around the corner to where my two group mates were, and that's when I saw something odd in the basinet next to the baby warmer across from us. It was a bunched bloody blanket and I saw a surface of red flesh and I thought it as a placenta and wondering why would they wrapped a placenta and put it in the basinet?

My friends spotted the same thing and all three of us went to take a closer look, and that was when the nurses told us that earlier that evening a 24 weeks mom had come in saying she hasn't felt the baby moved in a week. Sure enough, it was a fetal demise, and she was induced to give birth to a stillborn baby.

I will never forget what I saw last night, I don't think I will ever that image of the nurse unwrapping the blanket to reveal the red glob of fetus beneath it out of my mind. Judging by the appearance of the fetus: red, floppy with no apparent bone structure (it looked like a red blob of Jell-o or a red water balloon), underdeveloped features, and peeling of the skin, they were thinking it died due to chromosomal abnormalities and that it had died a week or more before the mom came in last night. As I went back to my patient's room, I caught a glimpse to the stillborn's mother's room, where silent grief enveloped the family that had gathered there. I said a prayer for them.

My patient, in the meanwhile, was progressing slowly, only going from 5 cm to 6 cm, so the doctor order the Pitocin to speed it up. Sure enough, minutes later late decels started showing up on the monitor and it was a "Holy crap! Is that what they meant when they talked about that in class?!!" moment for me. We turned the mom to the sides, put her on O2, and turned the pit off.

It's funny because in class, my instructor taught us a song to help us remember what to do when decels happen, and that exactly what was done last night. I'm still getting used to the feeling when things I've studied in the textbook happen in front of my eyes, it's like "HEEEEYYY!!!", the dots connected, light bulb goes on, whatever.

Mother and baby were okay after that, and nearing the end of my shift, my instructor came around telling us that she was going to sneak us into a C-section in a few minutes after they got the mother settled down and ready to go. The mom was 32 weeks along with PIH and overweight, which is not a good combination for the surgeons and the anesthesiologists.

They started and not long after that the patient started moaning and you can see everyone was alarmed, but the anesthesia team reassured that she was just feeling uncomfortable from the tugging and retracting they surgeons were doing to try to locate the uterus. As they cut through more layers of fat, the patient started groaning and it got louder and louder.

My friends and I looked at each other wide eyed, thinking "What in the world?!!", then we saw the surgical tech and my instructors rolling their eyes and giving each other "What the hell are they doing?!!!" It was bizarre to see someone with their abdomen open and blood flowing out and hearing them making noises that indicate that she is obviously in PAIN!

All this time, the surgeons continued to try to get to the baby as fast as they could, and the anesthesia team announced to the room whatever everything they cannot do because she was so large and hypertensive with low platelets therefore the pending complications, and I was just screaming in my head "DO SOMETHING, SHE IS IN PAIN!!!!"

They finally got the baby out after a series of groaning from the mom, who was still groaning as they sew the uterus. The baby needed intubation and some helped to breath, but the NICU team finally go the baby to cry, so that was good. We left right after that and didn't see the rest of that procedure.

I had no idea why the anesthesia didn't seem to work completely and why the team couldn't get it right. I knew the mother posts a series of complications but it doesn't mean you would just let her feel the pain of her surgery. Uncomfortable? Okay. Pressure? Okay. Pain? Oh hell no! That's not right, but unfortunately, it happens.

So that was my night on the OB floor yesterday. It was a night to remember for sure.