This is a state of sudden deterioration in the physical and clinical condition of a mother who just delivered a baby and it is known to occur due to a broad spectrum of causes. Many of these conditions are by nature rare, but the fact that they can cause such profound damage in the lives of a newly delivered mother makes them some of the most feared delivery room-related complications in any healthcare facility that renders maternity care. The events occur suddenly with rapid deterioration in every parameter used in monitoring a patient such as blood pressure, pulse rate, level of consciousness and body temperature. It is for these and so many other reasons that it is important for pregnant women to seek antenatal care for which they ought to register at an early stage of pregnancy. This early registration must happen without consideration for whether the patient in question is already an experienced mother or a greenhorn. However, in the most basic of all these situations, the affected woman is often well frequently with no issues at all in the course of the antenatal period. Usually, if any health challenge is documented, appropriate steps would be put in place to deal with all kinds of eventualities in the period before, during and after delivery, up to the first six weeks afterwards.
Now, a fit woman who has emerged from her routine antenatal period and is going into the labour room is expected to have a good outcome in the majority of cases. She is expected to have a normal supervised delivery. Occasionally, certain things go wrong either with the baby or its mother and a decision may be taken to terminate the process of a normal birth and offer the family an operative delivery known as a caesarian section. Sometimes, mistakes are made in either enforcing such decisions or in reaching them due to family resistance. Such resistance remains prevalent in our communities, big and small, and they are mostly predicated upon ignorance, stigmas and the terror of witchcraft. You will occasionally hear such statements as it has never happened before to anyone in my family. Or that they are rejecting such a label as being unable to deliver a baby naturally. In situations like these, several things can go wrong with the mother, especially but also with the unborn baby. When there is none of these kinds of events predating a sudden change in the mother’s physical and clinical condition, it is not due to juju; it is the recipe for a sudden maternal postpartum collapse. Common events which can lead to a situation like this are amniotic fluid embolism, anaphylactic reactions, pulmonary embolism or previously undiagnosed pulmonary hypertension and sudden, massive blood loss.
This sad event can be seen in a woman within 30 minutes of delivery and can also occur up to two days afterwards. The most commonly seen features associated with this disaster are low blood pressure, inability to get enough oxygen into the tissues, significant difficulty with breathing, loss of consciousness, seizures and cardiac arrest. Of these conditions, the most likely event to lead to low blood pressure, rapid heart rate, rapid loss of strength and cardiac arrest is massive bleeding soon after delivery, known as postpartum haemorrhage. Sometimes, such bleeding is concealed for a period before it becomes evident in a situation where there has been a rupture of the uterus, or some products of delivery have been retained. The blood loss is often torrential and truly scary and life can ebb away in a matter of minutes. Usually, these are not foreseen or expected events, and it often takes some extraordinary effort to save the affected woman.
Another catastrophe that can arise in this situation is due to amniotic fluid embolism, a situation in which the protein fluid surrounding a baby inside the womb somehow gets into the woman’s bloodstream and affects the respiratory system. Cells from the baby, hair and other cellular debris accompany the amniotic fluid and invade the pulmonary circulation, where they induce a reaction similar to anaphylaxis. This dangerous event often occurs during delivery or soon after childbirth. Other events like drug overdose, and biochemical changes like low blood sugar, can similarly cause disaster.
Anaphylactic reactions cause the body to release a rush of chemical substances into the circulation in such a tidal wave that the blood pressure drops precipitously, the airways become narrow and breathing becomes severely impaired or even blocked. At this point, the pulse becomes weak, barely evident and quite fast. A rash may develop in the skin and there will be a powerful urge to vomit. Often, vomiting eventually takes place. All these events work in tandem to cause the person to go into shock, a clinical state in which the circulation is no longer able to supply oxygen to the tissues such that they fail in conducting their biological functions. We examined the cascade of events that constitute shock on this page about a year ago.
These reactions are preceded by a feeling of giddiness, faintness and breaking out in a sweat. Breathing then becomes shallow, fast and associated with anxiety and the feeling of impending doom. It is often at this point that the nurses become aware that there is a problem and they act to rally the rest of the team. Once the team is in place, treatment will have to be really aggressive with the insertion of an intravenous line for rapid infusion of multiple drips. If the patient is found to be bleeding, then blood transfusion must be arranged quickly while the patient is quickly commenced on oxygen supplementation. This last aspect is useless if the patient is not able to breathe, she should then have a tube passed into the airway so that oxygen is delivered directly into the lungs.
At this point, the patient should be transferred into an intensive care unit with all the equipment needed to support her organ function. Many of our public hospitals, often having even more than 150 beds, lack an intensive care unit. At this point of care, the patient is very much on her own as no equipment exists beyond here to maintain life and sustain the tempo of resuscitation. However, in other jurisdictions, the mother will undergo rapid testing to determine what she has reacted adversely to. Blood tests for serum electrolytes and full blood count are rapidly performed and results made available within minutes. Also, a CT scan of the chest, abdomen and pulmonary angiography will also be done to determine the location of the problem. Emergency echocardiography and electrocardiogram are all thrown into the collection of tools to help determine what is wrong with the patient. These investigations could then also help determine if there has been a possible heart-related event that led to the cascade of problems or if there was a rupture of a major vessel. All of these events are quite possible but fortunately rare. It is clear from the above that these events are seldom predictable, but when they occur, the availability of the necessary personnel and the relevant equipment are absolutely vital to save the affected patient. In the absence of such supportive tools, not much can be achieved.
There is no doubt that registration for antenatal care starting at about 13 to 14 weeks of gestation plays a huge role in averting disasters around the delivery period and soon after. Expectant mothers must learn to register in properly designated hospitals and maternities in order to take advantage of this service. The antenatal clinic is where potential problems with any pregnancy are identified and planned for.
Questions and answers
Dear doctor, I have some little bumps on my penis which I have not been comfortable with. There is no pain but sometimes, when erect and I try to urinate, there will be a little pain. I have tried one doctor at a health centre but got no solution and that was three months ago. I later tried to see a doctor at a general hospital and the result was the same. I don’t know which cream or drugs I can get sir that will help me because I am getting frustrated. I will be glad to read back from you. I will send you some pictures of the things on my penis sir. 090624***
You have done very well by going to see a doctor and even seeking a second opinion. Perhaps, you should have shared with us how long ago you first observed these bumps. However, the pictures you shared indicate that these may be warts caused by a virus. In that case, the suggestion you will be getting here is to obtain an antiviral cream like Zovirax and apply it five times a day for up to three weeks. That should clear them. If that fails, then you should get any of the doctors you have seen before to give you a referral letter to see a dermatologist or an infectious diseases expert for a proper diagnosis and treatment.
Dear doctor, I am 20 years old and I have a yellowish vaginal discharge that comes with an awful smell which makes me very uncomfortable. I do have itching in my private parts which always leads to sores and swollen clitoris. This problem has been with me for over three months but I have not even used any medication. Please, sir, what can I do? 080682****
Well, you will first have to see a doctor who will perform a proper examination on you. As part of that effort, they will likely ask you to do a number of tests. The samples they obtain from you will be sent to a laboratory for analysis following which the organisms causing you this problem will be revealed. Within the same investigation, the effective drugs for the treatment will be known as well. After completing the treatment, it will be wise for you to return to your doctor for a follow-up check. If you have a boyfriend or are married, he also should be treated.
Dear doctor, I am a 28-year-old lady. I have been bedwetting since I was young. Please what can be the solution to this problem? I will be going for my National Youth Service Corps soon and I don’t want this to affect me. Sir, please help me. 08157****
Rest assured that this could be a difficult problem to treat at your age. Much of what you will have to do will depend on your attitude to it. To that end, it is possible to imbibe a few practical things on your own that should help you deal with a problem like this. First, you can stop the intake of every kind of liquid after 6pm. By fluids, I mean water, beverage, fruits, and so on. Secondly, you should have your urine tested for any sign of an infection and get whatever is found to be properly treated. However, this is not likely to be a contributing cause at your age. Lastly, you can find things to do to keep you awake late into the night such that you do not sleep before, say, 10pm. This is achievable if you find productive things like reading a novel until that time reaches.
Dear doctor, your medical advice to everybody in the Sunday PUNCH Newspaper is indeed fantastic. May Almighty Allah reward you abundantly; Amin. My health challenges in recent times are indeed a concern to me. I observe severe, deep pain down my waist and my two knees. It is hectic for me to rise up after sitting down and move freely as usual. I usually seem to be falling down. It seems to be betraying the application of various painkillers. I am 75 years old. I need your medical advice, please. 080284****
Thank you very much sir for your prayers and generosity with words of praise. At your age, these events can happen and they can usually be frustrating. However, the solution does not rest with the use of painkillers alone; it rests with a comprehensive appraisal of what the problem really is and whether that problem is related to advancing age or something treatable is responsible for it. To this end, it is important to have an orthopaedic surgeon give you a proper examination, which will include X-rays and specific scans. When a diagnosis has been made, because there is no diagnosis as of now, treatment can be offered. This treatment will include painkillers, physiotherapy, walking support of various types and even surgery. But the point at which what is wrong can be known is in the hands of a doctor. So, arrange a consultation with one and follow their advice.
Dear doctor, please what is the best antibiotic for typhoid fever and malaria? I am about two months pregnant and trying to be really careful and so, I went to a hospital to run a number of tests after which I was told that I have the above infections. I was given Augmentin to use 1 gm two times a day for one week and Artequick to use for two days. Then I was given paracetamol tablets. But after six days of usage, I am still having a headache, so I went to another hospital where more tests were conducted and the same diagnosis was made. But the doctor I met changed the antibiotic to Amoxicillin and placed me on daily injections for three days because I rejected her offer to admit me. I have no fever but I just feel tired. What should I do? 080344****
The treatment you will be offered for these illnesses is dependent on your condition. To start with, the fact of your pregnancy precludes certain medications from being given to you. However, it is puzzling that the latter doctor decided to substitute Amoxicillin for Augmentin. The only rationale for such a switch is cost. Health management organisations often do this kind of thing. Augmentin is a combination of Amoxicillin, which she has now chosen and Clavulanic acid, designed to make the Amoxicillin component more effective and more long-lasting in the body. The simple advice here is to stick with Augmentin, which you have already used for six days and just take it for another week. Perhaps, the injection that you are now taking is some artemether preparation but you have a right to ask your doctor what you are being injected with.
Dear doctor, my son is eight years plus and we woke up several days ago to find that he had a fever, catarrh and stomach pain. He is not eating much which is a big surprise because he is always ready to eat. We went to a hospital where we did some blood tests for him and he was given Armatem and Paracetamol. He was also given Loratadine and we were advised to use steam inhalation to help clear his nose. But my question is that he was not given any antibiotics and we are worried about that especially because of the stomach pain. Please what is your advice, sir? 08139****
Thank you very much for your question. The good thing is that you took him to a hospital where appropriate tests were conducted. If despite the abdominal pain no evidence of an infection was found, there would be no need to prescribe an antibiotic. Importantly also, you must know that certain species of the plasmodium parasite, the organism that causes malaria, can cause such abdominal disturbances that it will be tempting to assume that there is some other problem. Therefore, abdominal pain is not a reason for your son to be given an antibiotic. If abdominal pain continues to be a problem, do not hesitate to take him back to that hospital for a reassessment. Finally, for a regular eater who is not able to eat, as he is accustomed to during this period, there could be some unpleasant reactions within the stomach.
Dear doctor, I follow your column religiously. Please I want to seek your professional insight; I am thinking of freezing my sperm and storing it for some time till when I am ready. Can you advise me how to go about it? 080995****
Thank you very much for keeping a date with us every Sunday. We appreciate you. The question you asked is very profound and the advice you can obtain here is to visit any of the fertility centres around the country, which are mostly in Lagos, Ibadan, Port-Harcourt and Abuja and inquire. They will be able to advise you about the steps you must take, what it will cost you financially to undergo this process and what guarantees you can go away with. This procedure has been available elsewhere in the world for nearly eight decades. There will be legal documents to sign. You will have to make a down payment for the service and an annual fee as well, so the total sum will be dependent on how many years the sperm is frozen. Lastly, it is necessary for you to understand that obtaining the sperm is a straightforward process but not all the sperm will survive the freezing and subsequent thawing.