Common sense could have saved the day--and a life
“Jericho,” CBS, March 28, 8 p.m.
The premise: Dr. April Green, who is 16 weeks pregnant, passes out while treating refugees in the post-apocalyptic world of Jericho, Kan. Upon awakening, she begins to experience uterine contractions. The staff lacks both a diagnostic ultrasound machine and the drug ritodrine, which could stop the contractions.
They consider administering an intravenous drip of 10% ethyl alcohol as an alternative method of slowing the contractions, but April begins to bleed profusely and so is taken to the operating room. The surgeon, Dr. Kenchy Duwhalia, soon concludes that the fetus cannot be saved (one of the nurses hears the fetal heart rate at five beats per minute), but he continues operating for several hours in an attempt to stop the bleeding and stabilize the patient. The last power generator goes off in the middle of the operation, and as Kenchy continues to operate by candle and battery light, April’s blood pressure drops to 66/30 and she dies.
The medical questions: Could ritodrine or intravenous alcohol have helped stabilize this patient? Was the surgeon right to operate on the uterus via an abdominal approach and not abort the dead fetus? Was this the best way to attempt to control the bleeding and stabilize the patient? Would a hysterectomy have been an option? Would such an operation have gone on for several hours?
The reality: Ritodrine (which stops the uterus from contracting) or even alcohol might have slowed this patient’s contractions.
But the unchecked uterine bleeding -- likely from a damaged placenta -- and precipitous drop in blood pressure are sure signs (even without a confirmatory ultrasound) that the early-stage fetus was doomed.
Dr. Ilana D. Lustig, clinical associate professor of obstetrics at New York University Medical Center, says that, in such situations, a surgeon should immediately remove the fetus and the placenta vaginally to control the bleeding and save the mother. This should cause the uterus to automatically contract, clamping down on the damaged blood vessels and stopping the bleeding. This is why Kenchy’s approach, operating through the abdomen and leaving the fetus in the uterus, makes no sense.
“When the emptied uterus contracts, the bleeding will generally stop,” Lustig said. “In rare cases, you might need to embolize the large vessels or even proceed to a hysterectomy, but this would all be via a vaginal approach, and would occur in under two hours even when the power goes off in the middle.”
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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He is also the author of “False Alarm: The Truth About the Epidemic of Fear.” He can be reached at marc@doctorsiegel.com.
