Woman with complications travels 122km to Pune for cure

PUNE: Lack of proper health infrastructure and skilled doctors at civic as well as state-run hospitals in Ahmednagar forced a 20-year-old woman to cover a distance of 122km and come to Pune for seeking urgent medical intervention for her inside-out uterus, which kept protruding through the vagina for seven days after her normal delivery.
The woman had delivered the baby at Ahmednagar civic-run Deshpande hospital at 1am on July 17. She had unusually rapid (precipitate) labour that led to spontaneous expulsion of the infant vaginally.

“The possibility of attachment of the placenta towards the woman’s spine and short cord might have led to uterine inversion, a potentially life-threatening complication of childbirth,” said Sassoon hospital’s gynaecologist, Shilpa Naik.
Normally, the placenta detaches from the uterus and exits the vagina around half an hour after the baby is delivered. Uterine inversion means the placenta remains attached, and its exit pulls the uterus inside-out.
Since the doctors at Deshpande hospital couldn’t handle the complication, they referred the woman to bigger hospitals in Ahmednagar city, including a medical college hospital. According to the woman’s mother, the medical college hospital refused to admit and treat her.
The woman was finally admitted to the state-run Civil hospital around 8am on July 18. “Doctors at Civil hospital admitted her, but could not fix the problem for seven days for want of equipment and skilled doctors,” said the woman’s mother.
Later, the doctors gave her resuscitative management at the hospital’s intensive care unit (ICU) and put her on higher antibiotics to avoid complications arising out of hospital infection.
When contacted, Satish Rajurkar, chief of the Ahmednagar Municipal Corporation’s health department, said, “We do not have ICU back-up. Hence, we refer such complicated cases needing tertiary care to Civil hospital.”
Civil surgeon Sunil Pokharna, head of the Civil hospital in Ahmednagar, said, “We have gynaecologists but the post of the physician is yet to be filled. The opinion of a physician matters in certain cases where other medical conditions are involved, in addition to uterine inversion.”
The woman was kept in the Civil hospital’s ICU for seven days and later referred to the Sassoon hospital in Pune on July 24. “By the time, she was moved to the Sassoon hospital, she had already developed sepsis, a potentially life-threatening condition that occurs when the body’s response to an infection damages its own tissues,” said Sassoon hospital’s senior gynaecologist Ramesh Bhosale.
Doctors then carried out laparotomy, a surgery to open up her abdomen, and reposited the uterus and saved the woman’s life.
“We managed to conserve her uterus despite all the problems,” Bhosale said.
“Obstetric emergencies need timely, skilful and expert management to decrease mortality and morbidity. Timely referrals are key to the outcome of such cases. Private-public partnerships, the help of obstetrician in practice could have helped this mother,” said Sassoon hospital’s dean Muralidhar Tambe.