My large patient eventually had prostaglandin gel last night for induction of labour then intravenous oxytocin this morning. She started to bleed after three hours, and not yet in established labour. After seven hundred ml a Caesarian Section was arranged. Due to her size(BMI>55) there were delays but eventually the baby was delivered in good condition. The placenta was marginally low with bleeding from beneath its lower edge. When it was removed there was heavy bleeding from the lower uterine wall. I have seen this before and tried to oversew the bleeding area without success , eventually removing the uterus entirely, but this time it seemed to work. Measured blood loss was two and a half litres so blood transfusion was begun. She was given multiple treatments to contract the uterus as it was repaired.Soon after , both mother and daughter were fine but for a moment I had been about to perform a hysterectomy. Now she will be able to have more children if she wishes. None of her problems were due to her weight but it would be nice if she was a little smaller next time.
Back to clinic, two hours behind.
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