Friday, April 15, 2011


Maria presented to Hospitalito Atitlan with a history of a previous cesarean section about 2 years ago.  She had received some prenatal care at the Central Salud (a government run clinic in town), but she knew that when she went into labor she should come to the hospital. 

When she presented to Hospitalito she was in early labor.  The fetal monitor showed that the baby's heart pattern was "not reassuring" and by Ultrasound the amniotic fluid was too low.  We did not have good dates regarding how many weeks pregnant she was but by a late US and unsure last menstrual period we felt she was somewhere between 36 - 38 weeks.  It was elected to proceed with a cesarean section.  The cesarean section was performed by 2 visiting Obstetricians from Hungary and anesthesia was provided by Brent. We also had a pediatric resident from the states, Kati, who was present to help with resuscitation of Mary's baby if needed.   

Mary's baby was born with an initial low apgar of 4 but the second apgar of 7 was more reassuring but over the next few hours the baby began to have more respiratory difficulty and the oxygen saturation was decreasing and the baby was becoming cyanotic (blue).  The team at Hospitalito worked together to place an endotracheal tube ( a tube in the child's lungs) so that we could breath for the child. The baby was then transferred to Guatemala City, to the government hospital Roosevelt.
Mary's baby spent the next 8 days on a respirator and 15 days total in the hospital, and returned to Santiago with mom.

Mary, baby and Kati, the pediatrician who helped with the resuscitation.