Nadia's Delivery - by Dr. Merryman

Dr. Duroseau and I initially met Nadia on our first mission trip to Haiti last October. We worked together in the mountains of Noyeau with Friends of Haiti; seeing 2000 patients in 5 days. Nadia was an interpreter and pregnant. Carol Ritter had known her from previous trips and began planning to have her deliver in the US. She asked if we would do the delivery and provide her care. Thus began the journey. Upon arriving home, we all wrote letters in support of her VISA to no avail.

Then the horrific tragedy occurred. The Ritters left for the DR to work on the border. Dr. Duroseau followed. They got Nadia to the border. Only after this tragedy and the extraordinary efforts of the Ritters did the VISA come through. She returned to the US with them. I was reunited with Nadia last Thursday when Dr. Natalie Blagowidow performed her sonogram. I knew the basics of her history; 36-37 weeks, previous C-section and fibroid tumors. Nothing could have prepared me for the picture on the sonogram. Dr.'s Duroseau, Ritter, and I were shocked to see an 18 cm fibroid tumor enveloping the front wall and left side of the uterus. The remainder of the front wall of the uterus was covered on the inside by placenta. The bladder was skewed to the right and the head was wedged behind the fibroid.

On Monday Nadia had an amniocentesis for lung maturity. Later that evening we got the news that the lungs were O.K. and we were on for Tuesday. Over the previous days I had given extensive thought to the surgical approach; strongly considering the need for Cesarean hysterectomy. We prepared Nadia that she may well lose her uterus. Until I made the incision, I was not at all certain how we would get the baby out of this grossly distorted uterus.
I had to make a large vertical skin incision. After getting into the abdomen all we could see was fibroid. I had to extend the incision so that I could palpate the uterus. I started to manipulate the fibroid and it began to peel off the uterus. We keep dissecting until we were uncomfortable about its attachments to underlying blood vessels. With Dr. Duroseau pulling up the uterus, and Dr. Ritter deflecting the fibroid far to the left, I found a spot on the uterus to make my incision. I delivered the head with difficulty but it ran directly into the fibroid making the delivery of the shoulders our biggest challenge. We delivered a healthy baby boy. We then delivered the placenta and closed the uterus. The fibroid was a large parasitic mass on the anterior abdominal wall. After much dissection it came free. The uterus looked relatively normal and the blood loss was as expected. We finished the case without any problems.

With the current state of medical care in Haiti, I am convinced that Nadia and/or the baby could have been lost if she delivered there. To all those who made it possible I salute you. Everyone rose to the occasion in support of our goal to provide Nadia the safest delivery; from the nursing staff, to the anesthesiologist Dr. Tom Pesar, to Dr. Blagowidow and her staff, to our department chairman Dr. Khouzami, and finally to the hospital administration. Dr. Ritter, Dr. Duroseau, and I all trained at GBMC and did our residency under Dr. Khouzami. I have spent my entire twenty year career at this hospital and I consider it my second home and the staff, my family.