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‘OK. Tell the crew not to do a vaginal exam until we’ve had a chance to do an ultrasound and we’re sure that it’s not placenta praevia. Are there any obvious signs of blood?’
‘Hold on, I’ll get patched through.’ There was a pause. ‘No.’
Which meant it could be a ‘hidden’ abruption, with a huge blood clot behind the placenta. The most complicated sort—and the one with one of the highest risks. ‘OK. I’m on my way down. We need a scanner, and I’ll get Iris to sort out Theatre just in case. Ask the crew to secure IV access and if she’s going into shock get her on oxygen. As soon as she comes in, I want six units of blood cross-matched.’
‘Will do. Thanks, Theo.’
Theo hung up and left his office. To his relief, Iris was at the reception desk with Madison. ‘Iris, I’m on my way down to the emergency department. I might need to do an emergency section, so can you get me a theatre and anaesthetist on standby?’
‘I’m on it,’ Iris said, picking up the phone.
‘Do you want me with you?’ Madison asked. ‘If you’re doing an emergency section, you’ll need someone to assist.’
He grimaced. ‘Maddie, I’m not sure this is a case for you.’
‘It’s my job,’ she reminded him. ‘And I’m pregnant, not incompetent. I can put my feelings aside for work. If anything, I might be able to help more because my bump might help reassure the mum that I know exactly how she feels.’
And it would also mean she was kept too busy to think about the test results: exactly the same technique he was using. ‘OK. But I reserve the right to ask someone to take over from you if I think it’s going to upset you too much.’
‘All right. So what’s happened?’ she asked as they made their way down to the emergency department.
‘Mum-to-be was a passenger and their car was involved in a crash. No sign of a bleed, but she’s got cramps, tachycardia and pallor.’
‘You’re thinking an abruption?’
‘Could be.’ Theo sighed. ‘If it’s concealed or severe, we could be looking at DIC—in which case there’s no time to give steroids to help mature the baby’s lungs.’
The expression on his face meant that Madison made a final connection. This must have been what had happened to Theo’s mum after the embolism. She would have gone into DIC—disseminated intravascular coagulation, meaning that the clotting factors in the blood were activated throughout the body instead of being localised to the site of the injury. So small blood clots developed throughout the body, using up the blood’s clotting factors so it couldn’t clot where it was really needed.
Every time he had to deal with a case like this, it must rip his heart to pieces. Doubly so, now that he was a dad-to-be.
‘It’s going to be all right,’ she said softly, taking his hand briefly and squeezing it.
‘I’m going to try my damnedest to make sure it does.’
There was the tiniest, tiniest crack in his voice. Nobody else would have noticed it, she was sure. But she had.
But by the time they’d reached the emergency department there was no fear or emotion in his face. Theo was cool and calm and so very reassuring when he introduced them both to the patient.
‘Mrs Staveley, I’m Theo Petrakis, the senior consultant obstetrician, and this is my colleague, Maddie Gregory.’
Mrs Staveley pulled the oxygen mask from her face. ‘My baby. Please tell me my baby’s going to be all right,’ she begged, her face absolutely white.
‘I know you’re worried,’ Theo said gently, ‘and that’s why we’re here. If you don’t mind, I’d like to examine you while Maddie does a few checks on you, and I’d also like to give you an ultrasound so we can see exactly what’s going on. And keep that mask on for me, because it’s going to help you breathe and make you feel a lot better.’
Madison took Mrs Staveley’s blood pressure and checked her heart rate while Theo examined her abdomen. Although his expression didn’t change, she caught the concern in his eyes, and she guessed that Mrs Staveley’s abdomen was tense and ‘woody’ to the touch. Given that her blood pressure was low and she was still tachycardic, this was looking more and more like a case of abruption.
Quietly, she gave Theo the figures. He nodded, but kept the concern out of his face. ‘Thanks, Maddie. Mrs Staveley, I’m going to rub a little bit of gel on your tummy now—it’ll feel a little bit cold. And then we’ll take a look at the baby. Can you still feel the baby moving?’
