Most patients would sue doctors for leaving cotton or gauze in their abdomen, but for 26-year-old Rajeshree (name changed), this proved to be a life-saving move. Doctors inserted a 1.6-metre-long surgeon’s gown into Rajeshree’s abdomen and left it there for two days to stop bleeding,which could have killed her.
What led to the unusual last-ditch attempt to save Rajeshree was that she had an ectopic pregnancy, a rare condition where the egg is implanted outside the uterus. Rajeshree’s case was even more complicated because her foetus was implanted in the abdomen.
Rajeshree, who had carried her pregnancy to term, was brought to the civic-run Sion hospital from a private hospital in Ulhasnagar at midnight two weeks ago.
“She had lost the foetus and her uterus had ruptured; she was in a very critical state,” said Dr Ganesh Shinde, professor and unit chief, obstetrics and gynaecology department, Sion hospital.
Rajeshree is from a lower middle-class family and this was her sixth pregnancy. She has had one abortion and four normal deliveries at home. Only two children survived.
“An ultrasound revealed that the foetus was in the abdominal cavity — just 1% of all ectopic pregnancies are abdominal. And advanced abdominal pregnancy (near term) like Rajeshree’s is the rarest of all,” said Shinde.
According to Dr CP Purandare, president, Federation of Obstetricians and Gynaecologists Society of India, “Abdominal pregnancies are rare, though they have been known to occur.”
Greater awareness has resulted in such pregnancies being dealt with by doctors before they are brought to term, he said. The trickiest part of tackling such cases is severing the placenta, which could result in excessive bleeding, Shinde said.
Doctors said the mortality rate of the foetus in an abdominal pregnancy is eight times higher than tubal ectopic pregnancy (egg implanted in a fallopian tube) and 90 times greater than intrauterine pregnancy (egg implanted in the uterus).
Shinde said as Rajeshree’s foetus had died, they had to make an incision and remove the baby.
“Since the 2.6-kg foetus was in the abdominal cavity, Rajeshree’s intestines, stomach and other organs were all in one mass. Once we removed the foetus and separated the placenta, there was torrential bleeding,” said Shinde, adding that they thought “she would die on the operating table”.
When normal methods to stop the bleeding failed and with time running out, Shinde did something he had never thought of doing in a 22-year-long career. “I took a surgeon’s gown, rolled it and started inserting it into Rajeshree’s abdominal cavity, packing it tightly. I then sutured the opening back,” he said.
As the best way to stop bleeding is to apply pressure, Shinde said they also tied five saline bottles together with a string and pressed them on Rajeshree’s abdomen. “It was a do-or-die situation. All of us prayed that this unusual method works. Surprisingly, it did,” he said.
Rajeshree was put on a ventilator and shifted to intensive care where she was kept under observation for 48 hours. “After that we operated on her again and removed the surgeon’s gown,” Shinde said.
Rajeshree, who was discharged a couple of days later, is unaware of how doctors managed to save her. Her family was, however, kept in the loop.
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