Alternative title for this post: Reasons I’ve said “oh sh*t” in my head during obs and gynae rotation
I previously made a Part 1 for my time in Surgery so I guess that means there has to be a Part 2. I’ve also written about my first 2 weeks of internship if you’re curious. Obstetrics is the speciality of medicine that deals with pregnancy, and birth (and yes, it definitely needs its own speciality apart from gynaecology).
If you’ve met me, then you likely know that I’m not one who swears much. I think swearing should be used when the situation calls for it. Unfortunately, that means that the field of work I’ve gone into has many such situtations. I still don’t normally swear out loud (because let’s be honest here, no one wants to hear their doctor swear after being told about their case or after examining them) but I have found myself thinking “oh shi*t” at least four or five times every day. There is a range of scenarios that can lead to this particular phrase springing to mind from “oh sh*t, I forgot to check that blood result” to “oh sh*t, this lady might die”. Anyway, here’s a list of situations where it has sprung to mind.
In the ward:
(these are either situations I’ve been personally involved in or issues raised on the doctors’ ward rounds)
- working out gestation for a pt realising she’s only 24 weeks and experiencing labour pains, knowing that the neonatal unit’s limit on viability is 27 weeks
- bilirubin levels above exchange transfusion level in a newborn
- baby’s blood glucose level of less than one
- “please can you take out my implant” said by a woman who has just given birth after an implant failure
- so many babies born to mother’s who were not on contraception and didn’t want kids
- “did you want to be pregnant?” “no”
- first time seeing a foetus in a bucket after termination of pregnancy (and many times thereafter)
- any time I heard IUFD (intra uterine foetal demise) (especially knowing the woman will still need to go through labour to deliver the foetus)
- scanning a woman with a positive pregnancy test, finding an empty uterus (extra-uterine pregnancies/ ectopic pregnancies are incredibly dangerous and so need to be ended)
- 2 ruptured ectopics expected to arrive from outlying hospitals at the same time
- 2 ruptured ectopics (thankfully stable) sitting in clinic until beds could be found for them in the wards
- women who desperately wanted to be pregnant being told that they’ve had a miscarriage/there’s no heartbeat/it’s an ectopic pregnancy
- doing an ward Hb and getting a result of 4 (normal for women is >11)
- platelets of 12, ‘surely that’s wrong, repeat them’, platelets of 9
- activating the massive blood transfusion protocol, it taking forever for the blood, platelets and freeze dried plasma to arrive
- a patient receiving 8 units of blood through her hospital stay (seriously, please donate blood. It is life saving stuff)
- lab results showing HELLP syndrome
- putting on a ctg, immediately getting a deep deceleration with poor recovery and poor variability (doing a tracing of the baby’s heart rate and it showing the baby is distressed)
- multiple women with foetal distress needing caesars at the same time
- patient needing a caesar, no theatres available
- anytime anyone spiked a temperature (so many causes that need to be looked for from covid, to wound infections, to blood clots, to simple dehydration)
- checking labtrack results: covid positive (ok, this became less and less of an oh sh*t moment; and more of an ‘ugh, that complicates things’ moment)
- rupturing membranes and thick meconium liqor spilling out
- reviewing a pt in labour and they haven’t progressed at all
- a woman known to have placenta praevia starting to bleed
- hearing the word ‘abruptio’
- new mother being diagnosed with cancer that was found incidentally during her caesar
- raised blood pressure with protein in the urine (intensity of situation exponentially increases if she has signs of imminent eclampsia)
- a woman on anticoagulants with imminent eclampsia needing a c-section
- baby needing work up for a congenital anomaly
- baby needing cooling
- shoulder dystocia (baby’s head come out but the shoulders are stuck, meaning blood supply through the cord is likely compressed and no longer delivering oxygen)
- shoulder dystocia and starting to consider salvage manoevres
- unbooked patient in labour. Surprise it’s twins, and the leading twin is breach, and both babies heart rates are dropping
- women younger than me asking to have their tubes tied because they have finished having children
- uterine rupture resulting in a hysterectomy
- severe eclampsia in women with babies who are pre-viable having to undergo medical terminations of the pregnancy to keep themselves alive
- a woman needing a blood transfusion having an adverse reaction to the blood
- a CT showing the one ureter has been ligated during surgery
- wound sepsis (so. much. wound. sepsis.)
- bowel injury leading to a stoma
- “there’s no beds available”
In theatre:
(I was personally involved in all of these)
- opening the abdomen, seeing the cord just past the sheath. Diagnosis: uterine rupture
- adhesions everywhere, bladder stuck to uterus, uterus stuck to muscles
- baby coming out flat
- tears in the uterine corners
- uterine arteries spurting blood everywhere
- any difficulties getting baby out the uterus
- the delay between the body coming out of the uterus and the head with breech babies
- seeing thick meconium stained liqor
- worries about bladder injuries
- eyes shutting while struggling to stay awake assisting a caesar on hour 20/26
- any bmi over 40 needing a caesar
- seeing the amount of blood in the abdomen after a ruptured ectopic
- a woman complaining that she’s feeling pain (thankfully the spinal hadn’t failed and it was only pressure that she was feeling)
- the IUCD that was just placed coming out when expelling blood clots
Submissions from others
(fellow interns, you’re welcome to send me your stories)
- clerking a patient for admission due to malposition (no other issues) and a blue arm appears below, no theatres available
- termination of pregnancy pt flushed the foetus down the toilet
- the entire block
- where do you want me to start?
- cord prolapse
- hysterotomy leading to a hysterectomy
- so much syphilis present. One notably marked as negative on her booking bloods when the results showed positive – meaning she hadn’t been treated and so baby had congenital syphilis
And lastly,
here’s a few that immediately bring the phrase to mind but can also be something like “you forgot to write a sick letter for the patient”
- Any call from the ward
- Any call from the mo on call
- A call from a consultant
- 10+ unread messages on the O&G whatsapp group
So there we go, a brief summary of 3 months in obstetrics
Feel free to ask me questions on instagram or elsewhere.
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