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Another missing twin caused panic at operation, as the first twin was delivered, the second could not be found. The surgeon and his assistant shifted their gaze from the site of operation in a callisthenic manner and focused on each other in a kind of stare that asked the question; what have we got ourselves into? There  was panic and commotion in the operating room as each group of health workers in the theatre moved even closer to see for themselves a miracle they will never wish to be associated with. This was happening at a time when a similar incident involving one of the tertiary health centres in the country was still making the  air waves that, the health workers allegedly connived  to steal one  of their patient’s twin baby after a cesarean section delivery. Stay with me as I take you through the  journey of how we got here.

WHEN THE MYSTERY STARTED

My team was on call duty the day the patient came to us with a 5 months old  pregnancy and a referral letter for our expert care on account of anemia in a woman pregnant with twins. We investigated her and found that she had malaria,  urinary tract infection and her blood volume was severely low. She was treated for both malaria, urinary tract infection and she also had 3 pints of blood transfused over a 3 day period. A repeat test done after the treatment showed she was free from the malaria infestation and urinary tract infection that were the supposed causes of her low blood volume which was still low though, not as bad as the one she came with. There was a 3% increase in her blood volume from what she came with which was far below expectation. With this new challenge my team called in the experts in blood medicine; the hematologist. They ran a barrage of tests for her and could not find the cause of the low blood volume. They however order another round of blood transfusion, this time she got 2 more pints and a repeat blood volume check was same as the value we got after she received the 1st 3 pints of blood. Both my team and the hematologist were perplexed by this and sadly, we did not know what is causing this blood shortage. She also had several scans done which only showed she was carrying twins and nothing else. A meeting of both the hematologist and the obstetrician was called to brainstorm on her case for a possible cause because one can only fight an enemy he knows. At the end of this meeting there was no answer but more unanswered questions. Later she developed pregnancy induced hypertension for which she was managed with medication. By the 7th month plus, she starting passing protein in her urine with the hypertension uncontrolled despite being on medication. The decision was made to have a Cesarean section done the next day which happened to be my team’s operation day. She was counselled and consent for surgery taken, materials needed were made available for  the surgery.

MYSTERY CONTINUED

Well the day never signaled that it would be a dramatic one but, one can never tell how each day will be until it ends. In my usual way I first get to the room where patients for surgery stay before I changed into my theatre outfit. The patient was already there and was happy to see me because she could not wait to see her babies. As the theatre nurses were setting up the operation table and instrument tray, the anaesthetists were at their corner preparing their medication to ensure the patient will not feel any pain during the operation. The team Involved in the surgery which comprised of the obstetricians, anaesthetists, neonatologist and scrub nurses introduced themselves to the patient. The operation check list was read and the patient was taken into the theatre to the operation table. The anaesthetists did what they know how to do then, here comes the unsuspecting surgeons to begin the  surgery. The operation began and after 5 minutes, the palatable cry of the first twin elated the staff in the operation room. The baby was handed over to the neonatologist who was patiently waiting to receive the baby. The surgeon went back to deliver the second twin both there was no second twin in the womb.

THE MOMENT OF PANIC

The surgeon and his assistant looked at each other and announced that there is no second baby since they could not  see any other one and the womb is empty. The scrub nurse and the anaesthetist came closer to confirm what they just heard and  were in awe. “This is just a joke right?” the anaesthetist said. “Your operation list said twin pregnancy, the scan she did what did it say?, where is the patient record let’s take a look at the scan again”. All questions asked in panic as the medical world was still trying to recover from the story aired about a patient with twins who was told after her operation that it was only one baby. The unit head was called and in few minutes he appeared in the theatre fully dressed in his theatre outfit. They checked between the mother’s legs if she might have delivered the baby herself while the operation was going on, though she was not in labour and should not be a possibility, but still that did not stop the checking.

SOLVING THE MYSTERY

 Exploration of the abdomen was done and a huge angry looking bloody mass was seen behind the womb. “This explains the reason why her blood volume does not increase as expected despite the 8 pints of blood transfusion” said one of the surgeons. More pints of blood were requested from the blood bank on seeing that mass and the general surgeons were called in to inspect the mass for removal. The surgery was temporarily halted while awaiting the arrival of the general surgeons. The lead surgeon decided to take a second look at the mass and as he moved the mass his finger poked it then, he notice fluid mixed with blood coming from the poked site. He said  this might be the baby, with the general surgeon on ground and enough blood made available he decided to open up the mass and there the missing twin was found. The second twin was then delivered and handed to the neonatologist though, he weighed slightly lower than the one from the womb. The second twin had been in the abdomen growing instead of the womb. This is a type of ectopic pregnancy called “heterotopic pregnancy”. This is a huge success story as far as ectopic pregnancy is concerned. That’s why an early scan is very important not only to know where the pregnancy is but also to know how many babies are there.

To know more about ectopic pregnancy, read here.