‘Thanks. We’ll go and see her,’ Lucy said. She knocked on the door, walked in and introduced herself and Nic to Mrs Andrews. ‘Yvonne tells me you’re in pain and you’re losing blood. Would you mind if we examined you?’
‘Please. Anything. Just don’t let me lose my baby,’ Liza Andrews whispered brokenly. ‘I’m forty-three. It’s my first baby. We waited so long, and if I lose him…’ She choked. ‘I might not be able to have another.’
‘We’ll do our best,’ Lucy reassured her. ‘There are lots of reasons for bleeding in pregnancy so don’t assume it’s the worst.’ Lucy glanced at the observation chart. ‘Your baby’s heartbeat is still pretty regular, though your blood pressure’s a bit low so we’ll get some blood into you to help. Yvonne, can you cross-match and get me four units of O-neg?’ she asked as the nurse came back in.
‘We’re waiting for the portable scanner to arrive,’ she told Liza, ‘then we’ll be able to check what’s going on a bit better. It might be just that your placenta’s low-lying, what we call placenta praevia, so I’m not going to give you a vaginal examination.’ If it was placenta praevia rather than an abruption, a vaginal exam could cause a catastrophic bleed. ‘But I will give you some oxygen to help you breathe more easily.’ She unhooked the mask from the wall. ‘Just breathe in through this and try to relax.’ She set the output at fifteen litres a minute. ‘OK?’
Liza nodded.
Lucy gently examined the woman’s abdomen.
‘That hurts,’ Liza said, taking the mask off her face.
‘I’m sorry,’ Lucy said. ‘The good news is that your baby’s lying normally.’ She mouthed to Nic, ‘I’m almost certain it’s an abruption.’
Nic nodded and took Liza’s hand. ‘It says here you’re thirty-six weeks.’
Liza’s face screwed up in anguish. ‘And it’s too early for the baby to come!’
‘It’s quite normal for babies to arrive at thirty-seven weeks—so a few days earlier really isn’t as bad as it sounds,’ Nic reassured her, smiling. ‘You’re in the right place.’
‘So my baby’s going to be all right?’
‘We’ll do our best,’ Lucy said, gently settling the oxygen mask back in place. She listened to the baby’s heartbeat and didn’t like what she heard. Nic was watching her face and she gave him a very brief shake of her head to let him know.
Yvonne arrived with the scanner in tow and the units of blood. Lucy quickly set up an intravenous infusion while Nic put the scanner in place.
‘Lucy,’ he said quietly.
She took one look at the screen and her heart sank. The placenta wasn’t low-lying. And as Liza Andrews hadn’t been visibly losing that much blood, the chances were that most of the blood from the abruption was trapped, known as a ‘concealed abruption’.
‘Mrs Andrews, you have what we call placental abruption,’ Lucy said. ‘It means that your placenta’s started to come away from the wall of your womb.’
Liza blenched. ‘Am I going to lose the baby?’
‘Not if we can help it. But it’s too big for me to let you go home again,’ Lucy said. ‘And I don’t want to take any risks with the baby.’
‘I’d like to deliver the baby by Caesarean section,’ Nic said.
‘Now?’ Liza asked, horrified.
‘Now,’ Nic said. They could have given Liza tocolytic drugs to stop the contractions, then medication to help mature the baby’s lungs, but from Liza’s symptoms they knew the abruption was big. The baby needed at least half the placenta to be attached and functioning, so they couldn’t take the risk of leaving it.
‘But—why me? Why now?’
‘We don’t know the causes,’ said Lucy, ‘but it’s more common if you’ve had high blood pressure, you’re an older mum or you have twins or triplets, you’re a smoker or you take cocaine.’
Liza smiled weakly. ‘I’ve never smoked or done drugs. I haven’t even have a glass of wine since I found out I was pregnant, let alone anything else!’
‘That’s good,’ Lucy said, squeezing her hand.
‘Have you been in a car accident or had a fall, or banged your stomach in any way?’ Nic asked.
Liza shook her head. ‘Not that I can remember.’
‘We’ll take some blood for tests to see why it’s happened,’ Lucy said, ‘and to check that your blood’s clotting properly.’ If Liza Andrews had lost a lot of blood, she might have clotting problems after the birth, known as DIC or disseminated intravascular coagulation—around a third of cases did. And she had a much higher risk of a large bleed after delivery, so she might need a transfusion. ‘We might need to give you some drugs to help your uterus contract after the birth.’
Liza nodded.
‘And because your baby’s early, we’ll need to take him—or her—to the special care unit for a little while, to help him with his breathing and feeding. But you’ll be able to see the baby any time you like,’ Nic said.
‘Is there anyone you’d like us to call?’ Lucy asked.
‘My husband’s already on his way in. And my mum.’ Liza’s eyes filled with tears. ‘He wanted to cut the cord.’
‘I’m sorry,’ Nic said. ‘I’ll need to give you a general anaesthetic, so he won’t be allowed in for the delivery. But as soon as the baby arrives, he’ll be able to have a cuddle.’
A tear slid down to pool on the mask. ‘It was all supposed to be so different.’
‘I know,’ Lucy soothed. ‘Though you’re not alone. This happens in around one in fifty pregnancies.’ Not all abruptions were as severe as this one—if the baby wasn’t in distress and the bleed was minor, the mum could often go home if she chose. ‘But you’ll have your baby very soon.’ She just hoped the abruption wasn’t so severe that the baby wasn’t getting enough oxygen—it could suffer brain death or even die.
‘I’d like you to sign a consent form, please,’ Nic said.
‘I’ll call the anaesthetist and get Theatre to prep,’ Lucy said.
On their way up to Theatre, Nic said, ‘You handled that well. It’s a rough situation.’
‘Let’s just hope she doesn’t get renal failure or a bad PPH,’ Lucy said, referring to postpartum haemorrhage, a major bleed after delivery. She couldn’t bring herself to talk about the risks to the baby.
Before she knew it, they were in Theatre and Nic was making the first incision. Lucy couldn’t believe how fast he worked, but she was relieved when she was finally able to lift the baby out. ‘It’s a girl,’ she said.
‘Welcome, bellissima,’ Nic said softly. His eyes crinkled at the corners,
