Recently, a woman was delivered of quintuplets in the University ofCalabar Teaching Hospital (UCTH), Calabar. OLANREWAJU AROTIMI had a session with the physician behind the successful caesarean Section. He is Prof Asuquo Davis Ekanem, the chief consultant Obstetrics and Gynecologist, UCTH. He reveals what it took him and what it takes to perform such a feat.
How were you managing the woman pregnant with quintuplets before the day of delivery?
The lady became pregnant and came to see me and I first noticed that the womb was bigger than the two months she claimed the pregnancy was. It looked like a four month pregnancy, and so, I asked her to go for an ultrasound scan to be sure and the scan told us that there were five babies in her womb. From that moment, I realized that she needed full antenatal care and a close watch, a close management; if she was to have those babies alive because such pregnancies are usually complicated by hypertension. First, we had to monitor her blood pressure because such pregnancies are also complicated by anaemia- shortage of blood- because all those babies would be competing for food from their mother. So, we advised her on the type of diet she had to eat. We had to give her blood tonic, in addition to supplements. We also had to protect her against malaria; especially in this our environment where malaria is very endemic.
When she was about 10 weeks pregnant, I knew that the neck of the worm may not be strong enough to support the pregnancy to a level that she would deliver those babies safely. So, we were seeing her every two weeks to ensure that the babies were doing well. After every six weeks, we had to scan her again to be sure the babies were alive because in the competition for food in the mother, one of them may not do well and may die inside the mother’s worm. Luckily for her, she had a normal blood level. She and all the babies survived.
In such pregnancies, the mothers go into labour around between 28 to 29 weeks when the babies are very small and they may not be able to survive. So, we had to give her some drugs to relax the womb so that the womb doesn’t contrast at all times. And when she went into labour, we felt that the best way to deliver the babies was by caesarean Session. We had to break the sack one after another and we brought out the babies.
Due to its complexity, what procedure did you apply to ensure a successful outcome?
Because the womb had been extended, she tended to bleed during the operation, but then we were able to use the World Health Organisation’s (WHO) standard that says; in such a situation you use 40 international units of oxytin applied into a litre and keep running it between 45 to 60 drops per minute. That, of course, kept the womb firmly contrasted and it helped to checkmate any complication while the operation lasted. As we removed the babies, the womb kept on contrasting, but we were able to remove all and the placenta and then handed over the babies to the paediatricians.
Before we started the surgery, we had to call in the paediatricians. They had to arrange incubators where those babies were kept. Everything was nice. Luckily, before then, we had enough incubators. We have excellent paediatricians and nurses who were able to take care of those babies. Such babies are always able to survive if they don’t have infections, if they are not jaundiced; if they can have good temperature control. And the rest is feeding. The incubators provided the ambient temperature for them to stay comfortably. They did not have any infection because everything we used for the operation in the theatre was sterile, and luckily, they were not jaundiced.
After delivery, how healthy were the babies?
They were hale and hearty. Each of them gained weight up to two kilograms. They weighed a minimum of 2 kilograms, each of them, before they were discharged. For them to survive, we had to ensure that the mother was counselled on how to feed each of them properly. Remember, she had three boys and two girls. There should be no differential treatment; all of them must be well cared for and she did that. We also advised the mother on how to rest so that she doesn’t have high blood pressure after delivery because of stress. She recruited able hands to support her in the babies’ upkeep, and up to date, those babies are alive and strong. In six weeks’time when we shall review them, I am sure we are going to see big! big! babies.
The bottom line is; if you have good care by a medical doctor right from the time of conception, you should be able to achieve good result. It was a unique pregnancy and not the kind of pregnancy you just handle anyhow you like.
What gave you the confidence that the exercise would be successful?
God intervenes in good cases. We prayed that God shall help her carry the babies to a reasonable stage, but we also used our medical knowledge to support her. I told you how we were able to give her anti-malaria drugs, ensure she avoided infection, blood tonic to build her system so that the babies would be kept well. I told you how we gave her some drugs to relax the womb so that the babies could stay comfortably. On the day of delivery, I made sure blood was available, and I ensured that there were good anaesthetics. I made sure that the surgery was done properly in order to save her live and that of the babies.
You have put in almost 40 years into practice, kindly let us into your experiences?
As an obstetrician, I did residency for five years and I have been in practice since 1978. And since then, I had delivered women of twins and triplets in the past, this particular one didn’t frighten me. I had to do it the way I used to do it.
How do you relax amidst your tight schedules?
Two ways: I spend my time reading. When I really want to relax, I read my Bible; to know what God wants me to do. It takes my mind off medical practice for a while. Number two: I don’t miss watching international football matches. I also spend my time singing. When I am in the mode, I spend my time singing lots of choruses with my wife and I relax that way. That way, you do away with stress; you a have less worry on worldly things.