THE OBSTETRIC EMERGENCIES WHICH I NEVER FORGET KfuKyu Win The town was very beautiful with surrounding mountains and forest. There were many green paddy fslds between the mountains and town. The forest was always green because in rainy season, there were 200 inches of rainfall I was posted as a trained nurse after 1 finished the 3 year - Nursing Diploma course. In the year 1968, the diploma 3 year - course was pure nursing on medical, surgical for women, men and children. We had no experience of mtdwifery education. The hospital was 16 bedded, with one Township Medical Officer (TMO), one staff nurse and one trained nurse. The doctor I met !tt that time was Dr. I . Guha, who served as a TMO from lndia by contract system. He performed emergency operation on Lower Segment Caesarean Section (LSCS) and a staff nurse worked as the assistant. The compounder and I had to give the anaesthesia by the order of TMO. We used chloroform at that time When that doctor returned to India, another doctor Lccturer/Head, DcpC of Maternal and Cbild Health Nursing University oCNuming,Yangon Dip. G.N, Cert. Mid., Dip. Gen. Nsg. Tutor, B.A (Q), RL, B.N.Sc, M.N.Sc (ACI, AdefaYde) came as a TMO. There was a day that I %odd never forget for the rest of my life. The night of that day was very dark with only the light of shining stars. At that time, the security worker called me to the hosp~tal because there were emergency patients. There were only two nurses in our hospital at that time and the duty of each nurse was 24 hours alternately. One day whlle I was on duty, the patient Ma Saw Nwe, my neighbour and classmate at middle school was admitted to the hospital. She was suffering fiom labour pain, and was groaning due to that pain. Her blood pressure, pulse, and respiration was normal. She was gravida 1, Para 0, with transverse lie. Because the contraction was very severe, she was given injection Pitocin before she came to the hospital. The infant's hand was prolapsed outside the vagina. So we arranged to m s f e r the patient to Dawei District Hospital because the newfy posted doctor did not dare to operate her. In 1968, the outside of the town was insurgent area There were troops of communist rebels taking power at the villages. We were afraid of going to district, but luckily we got a car and the patient, her family and I went to the District Hospital. It was one hour drive. After we arrived at the hospital, the patient suffered more severe pain with prolapsed hand and no foetal heart sound (FHS). Bandl's ring was seen in her abdomen. The doctor performed an emergency operation. The patient was saved, but the infant was dead. This was the first case of my experience when the patient had ruptured uterus due to unjudicious use of Oxytocin. Ruptured of the uterus is one of the most serious accidents that can occur in obstetrics. In the above situation, the client was having signs of impending rupture, appearance of Bandl's ring and signs of obstructed labour becoming pronounced because of injudicious use of Oxytocic drugs. I had served 3 years in my home town as a trained nurse. ARer I had passed matriculation class, I was transferred to Yangon Central Women Hospital. There I got married and hired an apartment at Pazundaung Quarter. The owner was 40 years OM woman with 9 children. The family aarned their living by selling meat. The house was two storey building with 4 apartments. Each apartment included 1 guest room, 1 bed room and a kitchen. The apartment was . big and wide enough for the two of us, husband and wife. It was in 1972 that tht hospital services were free of charges, free medication and free meals were provided. My duty was at the B Block, emergency theatre. The house owner Daw Khin Aye was pregnant again. She was G10, Para 9. She told me that she had no fear for pregnancy and it was very simple for her to deliver a baby. She said that all the previous deliveries had no difficulty, with only a few pain, she delivered easily. I told her that the tenth pregnancy was very dangerous. That was Grande Multipara and there could be so many complications. She said that she had no worry. The night 1 was on duty at the operation theatre, my husband came and Daw Khin Aye was admitted to the hospital with Hypotonic Uterine Contraction. The doctor preferred emergency LSCS operation. After delivery the placenta, the bleeding did not stop. Her blood pressure was falling down. I assisted the Anaesthetist Dr.U Tin Hlaing, and we tried very hard to control and stop the bleeding. The blood transfusion was given one bottle after another very rapidly. So the Obstetric and Gynaamlogist (0.G) decided to remove the uterus. Nearly 15 bottles of blood were given and we saved the lives of both mother and child. Daw Khin Aye's family was so grateful to us becaw they never considered the complications of Grand multipara. In this second case, Daw Khin Aye was over confident of her pregnancy although she was grand multipara. She did not know its dangers and complications. She had never used contraceptives because of personal choice or lack of knowledge concerning pregnancy and had never attended antenatal care clinic. The third time, I found a case of ruptured uterus which was criminal abortion. The patient was a young woman about 20 years of age, with good looking face, fair skin and long black haw. One day, my younger sister came to me cryrng because her neighbour, the above young woman was admitted to the West Yangon General Hospital. The pregnancy of this woman was criminally aborted. She suffered pain in abdomen with cold and clammy skin. When 1 arrived at the hospital, the patient was suffering from shock with BP zero and thready pulse. She was nearly dying. My you,iger sister told me that this young woman and her mother came from Thongkwa Township. The young woman was pregnant with no husband. They decided to abort the fetus and they stayed at my sister's house as guests They went to the house where criminal abortion was done and they had to give some money. After the fetus was aborted, the woman was suffering severe abdom~nai pain. The ~nternal bleeding could not be controlled and the patient was taken to the hospital. The hospital staff, doctors and nurses were very angry with the mother and they scolded her. But they could not save the life of this young woman. I was very sad, because the woman was very young and pretty. I wanted to know "Why did she do ~t?"The answer of the postmortem was ruptured uterus. In this third case, the abortion was performed without any medical or obstetrical permissron. It was a criminal abortion and the woman died of perforation of uterus. The mother and the young woman were lack of health education. They only know to abort unwanted pregnancy. According to the above three cases, I always teach my students about ruptured uterus and complications of Grande Multi-parity with three examples. So we nurses have the duty to educate the community, to promote an environment free of hazards for the life of individual, family and community.