full moon behind cloud

In labour ward for a delivery at ten thirty p.m. when a GP asked me to see his patient who had bled two litres after delivery. She had been given oxytocin, ergometrine and rectal misoprostol. An oxytocin infusion was running, blood was on its way, the uterus was contracted and the bleeding had settled.

She had stitches but I still checked the vagina for lacerations. I couldn't detect any abnormality, but said to notify me if the bleeding recommenced. There was no one in labour but I couldn't sleep.

The phone rang at one forty five a.m.. She had lost another 800ml. I organized the operating theatre and went back in.

To my surprise I found a large spontaneous laceration of the cervix extending well into the lower uterine segment which I was able to blindly oversew with great difficulty using a large curved needle. As soon as the apex was secured the bleeding stopped, but she had now lost at least four litres. She was given more blood and fresh frozen plasma, the bladder was endoscoped, showing two functional ureters, and the rectum was also undamaged. She was transferred to intensive care overnight and I drove home.As I arrived home the temperature had dropped  to freezing and a full moon lurked beneath the thin cloud. I would soon be warm in bed.

 The adrenaline has gradually worn off and now I am looking forward to the delicious sleep of the reprieved, the exhausted survivor.

 Let tomorrow do its worst.