Tuesday, June 23, 2009

McGuyver Deliveries.


Anonymous said...

Hi Dr S. What are the consequences of ignoring the Department of Health directive not to resuscitate?

Roxy said...

Oh em gee!! That's craaazy!

Dr S. said...

Anonymous: There are no real consequences - If I felt that the baby had a real chance of survival I could have made a decision, despite the guidelines, and given the child maximal rsuscitation including intubation and ventilation. However, the problem comes in when I have to refer the baby to a specialist neonatal care unit with paediatricians and neonatal specialists. I could not keep the child at the primary health care centre as we do not have a ventilator or the facilities for overnight stay. There are no wards at the day hospital and no staff for constant monitoring. Thus, I would have to have sent the child to a tertiary health care centre, and none of them would have accepted the child based on it's gestational age and weight ( which was about 750g).

Roxy: It's so crazy - these obstetrics emergencies follow me around. That wasn't the first time it happened to me. But I'll tell you about that some other time...

Ketan said...

Hi Dr. S!

That was bad! Is there particular reason, why so many of your experiences involve patients ignorant/in denial of their pregnancy? Because, that's one problem I've hardly seen in India. Here, even in the villages, pregnancies are taken seriously, at least acknowledged, because of overseeing by the mothers in law--people in villages tend to stay in joint families (parents with their married children and grand children). The average literacy rate among women in rural areas here must be 40%. How does it compare with your area?

And preterm breech--well that's really bad! If the baby would've been 7 months (which to me appears to be an overestimate on part of the mother), then the baby at 750 g was too small for age, right?

In India, the cutoff for not resuscitating is 23 weeks, I'm not sure of the weight--but could be 1000 g.


Lauren said...

Dude. Strike updates, seriously. I'm looking for the inside scoop here. Give up on the MJ shrine.

Dr S. said...

Ketan: Our societies, even in the poorer communities have lost all sense of community spirit, and family. Most of the patients who fall pregnant are unmarried, ashamed, poverty stricken. They are left alone bytheir partners to raise the child by themselves.

Often they are in such denial that they believe the child will just "go away" by themselves.

They are ashamed and thus do not go to the clinics to book. So when they go into preterm labour that is the first time that they will be examined by a professional!

Lauren: I've got my MJ closure.

Next post is about the strike.

Ketan said...

Dr. S,

Okay, now I understand. Thanks for explaining. What I was referring to to be the case in rural India isn't exactly community spirit. Mothers in law (just like the rest of the family) would have a very strong desire to have a male grandchild, and that's why they'd be most anxious to see pregnancy through. Though, considering your description, situation in India seems to be one of far greater solidarity. In India, the female to male ratio is 928:1000. It's as low as 750 in some districts. This is largely owing to indiscriminate prenatal sex determination and female feticide and in olden days female infanticide. There stringent punishments for parents as well as medical professionals involved in this, and though the incidence of such crimes is on wane, they've not been totally curbed.

What's 'McGuyver', BTW?

I checked, the lower cutoff in India to not resuscitate is 400g, which I'll clarify has nothing to do with status of neonatal care in India.



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