The Doctor Will See You Now [Non-Fiction]

Chapter 53: OBGYN

We admit Brianna, a 20-year-old woman who is pregnant with twins. Her membranes broke at 25 weeks' pregnancy. A full term is 37 weeks -- her twins are literally just over the threshold into the third trimester.

We watch her for several days. One more day in Mum's womb is one more day of maturation for these very premature babies and a slight decrease of their high risk of birth complications and death. She hasn't had contractions yet. Just the waters are broken. So we have time.

We keep a close eye on her. Broken waters for prolonged periods mean she's at risk of acute chorioamnionitis (infection of the lining of the womb and the waters), due to the bacteria that normally lives in the vaginal canal migrating up the opened cervix into the womb. Acute chorioamnionitis has a high mortality for babies, especially preterm ones. The plan was an emergency C-section the moment we get a whiff of this infection -- that would be the tipping point between keeping the babies in Mum for one more day and risking them getting an infection.

On the fourth day, Brianna spikes a fever and her contractions start. We examine her with a speculum, a metal device that allows us to see the inside of the vagina and the cervical opening. When the speculum opens, milky liquid pours out, not the clear waters we are hoping to see. Brianna got acute chorioamnionitis.

We whip her to the ultrasound room to scan the babies. They're still doing OK -- their heartbeats are strong and their placenta (they share the same placenta) still attached to the lining of the womb. We book an emergency C-section. Brianna asks if there is any chance she could deliver vaginally.

Unfortunately, both babies were breech -- bottoms first. Delivering breech is a difficult talk. Delivering breech twins is even more difficult because as one comes out, the other can turn in the mean time and end up lying transverse (horizontal) and that can never be delivered vaginally. She will only end up with a C-section. Plus, with the pus now invading her amniotic fluid bathing her babies, they needed coming out ASAP. We can't afford to wait for her to labour and push out the babies one at a time.

Brianna asks if she will be having a horizontal incision -- a lower segment C-section (LSCS), the most common type of C-section, which reduces future pregnancy complications and scarring compared to the traditional straight-down-the-middle incision. Unfortunately, no. The lower segment of the uterus only forms after about 28 weeks. Brianna doesn't even have a lower segment of the uterus for us to cut.

I don't attend the C-section. Three paediatricians attend at standby to resuscitate these fragile preemies. Three consultant obstetricians deliver the twins.

Twin 1 dies within minutes of birth. Twin 2 is immediately intubated and taken to NICU, where she'll probably stay a very, very long time.