Case of the Week

The patient in the picture is a gravida 9, para 8 (pregnant 9 times, has delivered 8 times) woman from a “far,far village” who came in complaining of a cough.  After talking with her a little, it seemed like she really came to our hospital because her last six babies have died during childbirth.  She says all but one of her stillborn children have delivered breech.  She knows they have been alive at the beginning of labor because she can feel the legs kicking.  Then the feet come out and she struggles for prolonged periods of time to deliver the rest of the body.  She stated that she could feel the feet stop kicking while she is “waiting long” for the head to deliver.  She has never delivered in a hospital before. 

The patient was asked to unwrap the layers of cloth she was wearing around her waist so that an ultrasound could be performed and an amazing site was seen!  She has a large abdominal hernia with a fascial defect probably 10-12cm wide.  The working theory is that her uterus tilts forward into her hernia sac, resulting in fetal malpresentation and possibly even fetal head entrapment in the hernia.  Now, she is only 24 weeks along by ultrasound.  A plan was made for her to return to her village for the next month.  Then she will come back to Nalerigu to deliver at our hospital.  We pray that all will go well.