Dr. Jacob Meyer is a Bay Area family medicine doctor with a heart for international medicine, specifically in Peru. Last fall, he spent a month serving in an extremely impoverished area of Peru, and hopes to eventually practice there long term. The purpose for Dr. Meyer’s trip was to provide supplies for this impoverished area, to exchange knowledge with the local doctors and to get familiar with the Peruvian public healthcare system.
While in Peru, he worked at Health Center, which serves a province of about 15,000 people. During his stay, he assisted eight women in labor, but one of those women had an especially miraculous delivery. Here is an excerpt from Dr. Meyer’s Blog called “Yawar”, which means blood in the native language, Quecha:
Huancavelica had terrible maternal mortality numbers until the last few years because many women gave birth in bad conditions in their homes. This last Monday I was doing outpatient visits in the hospital, when a woman arrived in labor. Everything was going fine. She was 8 centimeters dilated with a bulging bag of water, so we moved her from the dilation room to the delivery room where she sat on the stool for a vertical delivery.
The women are not used to interventional obstetrics. We checked the heart tones a few times and everything was going well. A few minutes later, Sofia came running into my room a few minutes later saying, ¨Dr. Meyer, we need your help, she is bleeding¨!
Apparently the patient got inpatient and pushed towards the end of her delivery, the baby came out very fast, but she probably was not completely dilated. After the placenta came out, her bleeding did not stop. She had already received methergine and 10 units of IM pitocin, her uterus seemed firm but she was still bleeding. Upon examining her, we realized she had a large cervical laceration that extended very high. I quickly grabbed my ring forceps and suture.
I began repairing the cervix with very poor light, lots of blood obscuring my view and the only available pain meds being the equivalent of ibuprofen and diazepam. This was only her seventh baby, but only her first or second hospital delivery. The husband was wondering why we had to be doing any of this, he felt like the bleeding was normal. Upon obtaining some control of the bleeding, I stopped and spoke briefly with the husband to help him understand why we were doing what we were doing.
After about 15 minutes we had the large laceration sewn up but she kept bleeding. I examined the cervix again and realized she had a second tear on the posterior side, also extending very high. By the time I had the first laceration under control she had lost about a liter of blood. This second laceration was much more difficult to see but we quickly controlled the bleeding and finished the repair.
Upon finishing I took a deep breath and a sigh of relief. Honestly, I had never repaired anything like this before and I was glad it was over. We observed her overnight and then she was transferred to Ayacucho for an examination by a gynecologist.
The women are not used to interventional obstetrics. We checked the heart tones a few times and everything was going well. A few minutes later, Sofia came running into my room a few minutes later saying, ¨Dr. Meyer, we need your help, she is bleeding¨!
Apparently the patient got inpatient and pushed towards the end of her delivery, the baby came out very fast, but she probably was not completely dilated. After the placenta came out, her bleeding did not stop. She had already received methergine and 10 units of IM pitocin, her uterus seemed firm but she was still bleeding. Upon examining her, we realized she had a large cervical laceration that extended very high. I quickly grabbed my ring forceps and suture.
I began repairing the cervix with very poor light, lots of blood obscuring my view and the only available pain meds being the equivalent of ibuprofen and diazepam. This was only her seventh baby, but only her first or second hospital delivery. The husband was wondering why we had to be doing any of this, he felt like the bleeding was normal. Upon obtaining some control of the bleeding, I stopped and spoke briefly with the husband to help him understand why we were doing what we were doing.
After about 15 minutes we had the large laceration sewn up but she kept bleeding. I examined the cervix again and realized she had a second tear on the posterior side, also extending very high. By the time I had the first laceration under control she had lost about a liter of blood. This second laceration was much more difficult to see but we quickly controlled the bleeding and finished the repair.
Upon finishing I took a deep breath and a sigh of relief. Honestly, I had never repaired anything like this before and I was glad it was over. We observed her overnight and then she was transferred to Ayacucho for an examination by a gynecologist.
