Woman with huge bleed at 38-weeks pregnant

Recently, we received a call from Wataluma Mission Hospital about a 38-week pregnant woman who was having a huge vaginal bleed in the middle of the night. Thankfully, she was carried to the hospital but by the time we heard about it, she was still bleeding.

The nurses couldn’t hear the baby’s heart beat and there was no foetal movement. Our immediate thought was either placenta previa or abruption and because she had lost so much blood, her vital signs were indicating that she had gone into hypovolemic shock. There was no time to get blood from the hospital, as the delay would have killed her. We needed to get to her as soon as physically possible.

Sometimes we fly to the Vivigani airstrip on Goodenough Island which is 10km west of Wataluma. Because it is a water landing, we carry anchors and fenders in case the tide is low and we can’t get close to the beach. If the seas are rough, then the patient is transported to Vivigani but it is more than a one-hour drive. The best option in this case was to load her into the ambulance and drive 3km to the beach. We made a quick call to flight planning and we were on our way.

When the Beaver is in standby mode, it takes 15-minutes to wheels up. We had to fly to 4500 feet to clear the clouds covering the Owen Stanley’s but once we did, we could see Goodenough’s highest peak poking through the distant clouds nearly straight away.

The trip took us 44 minutes altogether until we could see the ambulance waiting for us on the beach. Luckily for all, the landing conditions seem to be okay – a slight onshore breeze and calm seas. Wataluma can be a tricky landing as there are only two approaches suitable for landing the Beaver. The ‘water runways’ are 40 metres wide and 600 metres long and are fringed by reef on two sides at the end. The other end is a sandy beach lined with coconut trees which have to be cleared before touching down. Usually, I line up the landing alley at 300 feet when the reefs to port and starboard are still visible as they become invisible once on the water.

However, when landing this time, my greatest fear about landing the Beaver in and around the reef was realised. We landed into a slight breeze but drifted to port. By the time the Beaver pulled up, I could see reef to my left. A hard-right rudder wasn’t enough to avoid a slight bump under the portside float. We had hit the reef for the first time. Now it was a matter of powering up and taxiing quickly back to the beach to assess the damage, get our patient on board and get going again.

Kila jumped out to prepare the mother and fit the compression garment while I inspected the float for damage. I couldn’t see any visible marks and pumping the floats didn’t indicate we were taking on water.

When it was all done, I grabbed the mother’s cargo – the 25kg bag of yams would have to stay! It would have been too heavy for the water take-off and possible hole in the float! With the guardian strapped into the co-pilot seat and the mother in the cabin, the Beaver came to life and off we set.

Kila put the mother on oxygen and gave her IV fluid and kept checking her blood pressure, pulse and oxygen saturation. The mother was pale but the compression garment did a wonderful job of looking after her vital organs while low in haemoglobin. She needed blood urgently. Picking up tail wind, we flew back to Gurney at 115 knots.

Upon landing, the hospital ambulance was waiting for us so after a quick transfer, the mother was in the labour room. An ultrasound confirmed what we had first thought – placenta major previa. The mother underwent an emergency C-section but sadly, her baby died as a result of the massive bleed she suffered.

We usually pick up placenta previa by doing an ultrasound at ANC and after 33 weeks when the uterus is expanding in the lower segment. A placenta previa major may not give us an early warning sign as it is located directly over the OS. Babies with a low-lying placenta are delivered by C-section.

Thankfully, the mother made a good recovery.

Thanks so much to the THOR team and the obstetric team at Alotau Hospital.