Last Couple Days in OB/GYN

Our time in the obstetrics and gynecology department will end Friday (June 8th). Next we will move onto pediatrics. The posting as a whole has been very interesting, with the last couple days being the best so far. I am still not sure if this is the specialty for me- but I can say I have enjoyed my time with the department. The physicians, staff, and other students have been extremely helpful and Eva and I are very appreciative. As in the States, OB/GYN is female dominated specialty. We have only encountered one male physician in the department.

On Tuesday, Eva and I reported to the OR (operating room) at 8:30 to observe a laparoscopy assisted vaginal hysterectomy. I wasn’t sure what to expect… but can say now that it was definitely one of the coolest things I have seen. The patient was a post menopausal woman who presented with intermittent vaginal bleeding. After examination and biopsy it was determined that she had a large uterine fibroid and potentially uterine cancer. The treatment selected for this patient was total hysterectomy (uterus, fallopian tubes, and ovaries- are all removed). The decision was made to do a laparoscopy assisted vaginal hysterectomy (the uterus is removed through the vagina after its internal attachments are cut) rather than an abdominal hysterectomy (the uterus is removed through an incision in the abdomen) because it is a less invasive procedure. Here is the play by play… (or at least what I understood)

• the patient was first put under general anesthesia
• 4 small incisions were made on the abdomen (a camera with light was inserted in the incision near the umbilicus and various instruments were inserted in the others- two lateral and one midline but inferior to the umbilicus)
• carbon dioxide was pumped into the abdomen to slightly inflate the abdomen (this gives more room to work and a better view)
• then with the use of a cauterizing tool and scissors (which were inserted into the two lateral incisions) the superior attachments of the uterus were severed
• a instrument which looks like a wand with a small corkscrew at the end (which was inserted into the inferior midline incision and screwed into the fundus of the uterus) was used to move the uterus from side to side stretching the attachments- this made it possibly to identify, cauterize, and cut them
• in a similar fashion both of the ovaries/ fallopian tubes were unattached from the inside (they remained held in clamps which were inserted in the lateral abdominal incisions until they could be removed through the vagina)
• the carbon dioxide was then let out of the abdomen and the physician proceeded to perform the vaginal hysterectomy- first the uterus was removed then the ovaries/ fallopian tubes
• after suturing was complete near the vagina the abdomen was inflated one more time
  the physician used the camera with light to visualize the inside- check for bleeding and suction out remaining blood/clots
• the instruments were removed from the abdomen and the 4 small incisions were sutured

The surgery took around 3 hours and was pretty amazing.

Today, June 7th, was an equally amazing day. We reported to our posting at 10 AM and it didn’t appear that the students we had been accompanying knew where we were supposed to be. Eva and I decided to check the labor ward as we still had not seen a vaginal delivery here (we saw a c-section last Saturday). The labor ward is two rooms, one for women in the latent phase of labor and one for women in the active phase of labor (again no private rooms- just large rooms with multiple beds). As soon as we walked in we heard some moaning/yelling from the active phase of labor room. Eva turned to me and said, “that sounds promising.” We have been trying to see a delivery all week long and have had no luck. Between 70-90 babies are delivered per month here and we just happen to miss all of them.

One of the physicians we have followed on a few occasions told us that one woman was in active labor (7 cm dilation) with her first child and would likely deliver shortly. Another woman was at 3 cm dilation but was failing to progress much. Child birth in India is very different than child birth in the US-

• epidurals are not used (in part because of a shortage of anesthesiologist and partly because children are considered a gift worth experiencing pain for)
• no family members/friends are allowed in the delivery room (it is just the patients and staff)
• normal delivery at a private hospital costs around 2000-3000 Rupees (40 Rupees= $1)
• c-section at a private hospital costs around 5000 Rupees

The woman delivered a healthy baby girl (with a bit of a cone head) after a lot of hard work, vacuum assistance, and an episiotomy. A pediatrician was present upon delivery to examine the infant. The delivery went well and the physicians did a wonderful job caring for the mother and fetus… but I still can’t help but think I hope I deliver my children in the US w/family in the room and maybe an epidural. :)

The physicians decided to take the other woman, who was failing to progress, to the OR for a c-section. They told us to go have lunch and meet in the OR in half an hour. Eva and I saw our second c-section… this one a little faster than the first as the baby was showing signs of distress. The woman had a healthy baby boy. Turned out to be a very exciting day!

This weekend we are headed to Badami and Bijapur, two cities close by, with Eva’s Uncle and Aunt. Both places are supposed to have some pretty amazing architecture- temples and mosques. (hopefully I can get some pictures and fingers crossed... we will get broadband internet at some point so I can post them) On Monday we will report to our pediatrics posting.