CRASH!

OMG! I‘ve officially done my first Crash section! Wow. Wow. Wow. Talk about an adrenaline rush.

It all started with a 30-something year old woman who was 37 weeks into her pregnancy. She walked into Triage with a blood pressure of 200/120 (normal blood pressure is 120/80). The first thought on everyone’s mind was Severe Preeclampsia. Preeclampsia is no joke. It is a hypertensive disease of pregnancy that can have serious consequences for both mom (seizures, liver failure, renal failure, pulmonary edema) and baby (fetal demise, intrauterine growth restriction, placental dysfunction). Given that the “badness” of this disease often happens suddenly, we take it very seriously. We rushed our patient into a room, started an IV, drew her blood for labs, and started blood pressure and anti-seizure medication.

Her physical exam was just as scary as her blood pressure. While she denied any symptoms, her reflexes were abnormally brisk and she had marked clonus (meaning after I flexed her foot, it continued to involuntarily tap) – both signs that the Preeclampsia was affecting her nervous system. The only cure for this disease is delivery. We knew that this woman needed to have her baby ASAP. Orders for induction of labor were written.

While all this was taking place, her baby started to tank on the fetal heart monitor. It began to show prolonged episodes of dropping its heart rate. The variability, or ability of the baby to respond to its environment by increasing and decreasing its heart rate on a beat to beat basis, was minimal. These were all signs that the baby was not getting enough oxygen. We repositioned mom on her side. We put her on an oxygen mask. We increased her IV fluids. The tracing just got worse. At this point, the decision was made: We were not going to have time to induce this woman. We needed to get this baby out NOW.

In less than 3 minutes, the patient is in the operating room. The OR staff worked like a well-oiled machine to get the patient ready for surgery. In the next 3 minutes, my attending and I were gowned and gloved and ready to start. The goal on everyone’s mind, including my own, was to GET THIS BABY OUT. My usual OR anxiety was gone, and I was focused solely on our mission. I made the first incision. In two swipes of my scalpel, we were through the skin and onto the fascia (the last layer of the abdominal wall). A couple of cuts with our scissors and we were on the uterus. I made the uterine incision. The baby’s head was easily delivery, followed by her shoulders and body. She was floppy, did not instantaneously cry, and was not at all the vigorous infant we like to deliver. Once she was out, we clamped and cut her umbilical cord and handed her to the NICU team waiting beside us.

Next we delivered her placenta. A large hand-sized clot came out behind it. Our patient had had a placental abruption. (Her blood pressure had gotten so high that the placenta had started to tear away from the uterine wall, compromising the amount of oxygenated blood that went to the fetus.) We had found our reason for the baby’s poor tracing.

The room breathed a sigh of relief. The baby was out. The rest of the case was like your average c-section. The tension and anticipation in the room dissipated, the anesthesiologist put on his music. We sutured mom back together. And with a little TLC, mom and baby did remarkably well.

By the end of the case, I was on Cloud Nine. I was riding high with the feeling that for the first time, I had just helped to save someone’s life. The rush was indescribable.