A week after she pulls placenta out at home, thinking that all was well, new mum says:I FELT GUSH OF BLOOD
S'PORE MUM'S BIRTH PAINS
IT was her first baby, and the young single mother-to-be was so excited that she called KK Women's and Children's Hospital and asked for its 'top doctor'.
Posed picture
She wanted the best care for herself and her unborn baby.
But she ended up having a difficult experience, said Ms Lafone Ching, 21, a hotel reservations officer.
It included bleeding episodes at home, having to pull something out of her womb by herself and having her womb poked during a procedure.
The hospital said what happened to her is not uncommon and normal procedures were followed.
Ms Ching was first seen by Associate Professor John Tee Chee Seng, senior consultant & chairman, division of obstetrics and gynaecology at KKH. She said she had seen him 10 to 12 times, paying about $80 for each visit.
'Just before my delivery, they asked which ward I wanted to be in. I said class B2 plus,' said Ms Ching.
She was told that if she chose that ward, she could not choose the doctor who would deliver her baby.
'I was told by a nurse that chances are, I would be delivered by a midwife.'
Precious gift: Ms Lafone Ching went through a tough time to deliver her newborn Le-nel. -- picture| david tan
Ms Ching said she did not mind and stuck to her B2 choice, as she had some financial concerns.
'I am the only one working to support myself and my baby, so I did not think I could afford an A class ward,' said Ms Ching.
In KKH, as in all restructured hospitals, low-risk patients who do not opt for personalised private care get team care.
But Ms Ching's senior consultant specialist, Assoc Prof Tee, remained in charge and was responsible for her overall care, together with his team of doctors and nurses, the hospital said.
On 27 Jun, Ms Ching gave birth to a healthy baby girl. She was delivered by a midwife.
Soon after, she said she noticed the midwife looking worried.
'She told me my placenta had not come out. Then she called a doctor whom I had not seen before to help.'
The doctor said he needed to put his hand into her womb to remove her placenta. 'He did that two or three times,' MsChing said.
'I said I wanted to see the placenta to make sure he got it out.'
And she did see it.
Troubling: Ms Ching's scan, done by Dr Tanny Chan on 1 Aug, showing that her womb was still not clean. The dark area are tissues left in the uterus.
'The midwife and doctor both told me that all the placenta had been removed,' Ms Ching said.
The hospital confirmed the placenta did not come out spontaneously.
'It had to be manually removed by our medical officer on duty,' a KKH spokesman said in an e-mail reply to The New Paper's queries.
The removed placenta was checked, and as it appeared complete, Ms Ching was discharged on 29 Jun.
Almost two weeks later, on 10 Jul, she had a shock when she went to the toilet and found something hanging between her legs.
'It looked like a ball of something red had dropped out of my womb and was still attached by something which looked like a string,' she said.
She rushed out and asked her grandmother to look at it.
'My grandma used tissues and touched it but she also didn't know what to do,' said Ms Ching.
It was around 11.30pm then, and MsChing called KKH for help.
KK ASK-A-NURSE HOTLINE
She was told to call the KKAsk-A-Nurse hotline - quickly before it closed at midnight.
'The nurse on the line told me to pull it out myself,' she said.
She said she repeatedly asked the nurse if that was safe.
'After she reassured me that it was safe, I went and pulled it out. The string-like thing kept coming and coming. I had to pull quite a lot before it all came out,' said Ms Ching.
The KKH spokesman said the nurse had advised Ms Ching to go to the Women's 24-hour clinic if she was bleeding. As Ms Ching was not bleeding, the nurse then advised her to use a mirror to have a closer look at what it was and to pull it out if she felt comfortable.
Dr Tan Kok Hian, senior consultant, maternal and fetal health at KKH, said: 'Simple removal of the tissue from the vagina would be the best thing to do and does not cause any harm to the patient.'
STAINED CHAIR
On 19 Jul at around 8pm, Ms Ching felt a gush of blood flowing out when she was sitting down at home.
'I got up and noticed I had stained the chair,' she said.
When she felt another gush, she called KKH again and was told to go to the A&E immediately.
She took her baby and, along with her younger sister, rushed to the hospital.
By the time they got there, she knew she had bled some more.
'When I left the taxi, my pants were wet with blood,' she said.
Her mother, Madam Adelina Ong, 47, a customer service officer, met her at the hospital.
By the time she was wheeled to a doctor's waiting room, there was a puddle on the wheelchair and a trail of blood on the floor, Ms Ching said. 'I kept asking everyone if I would have enough blood left in me,' she said.
The doctor who saw her said they needed to do a 'wash', or evacuation of her womb.
'He told me there might be some placenta left behind,' she said.
This is not uncommon, the hospital said.
Dr Tan said retained placenta or incomplete extraction of placenta or membrane tissues occurs in two out of every 100 cases.
These women would need to go for an evacuation process in which doctors scrape the lining of the uterus to remove all the placental and membrane tissues.
The next day, this was done. MsChing had her womb 'washed'.
When she woke up, Ms Ching said she felt a terrible pain in her abdomen.
'I did not expect the pain. The doctor said everything would be done through the vagina,' she said.
She asked her sister to lift her shirt to see what it was, and her sister was shocked to see that Ms Ching had two puncture wounds, one in her belly button and one on the side of her abdomen.
'I could not see, so my sister had to use the handphone to take a picture to show me,' said Ms Ching.
Soon, the doctor who performed the procedure arrived.
'She told me that during the washing procedure, one of their instruments had poked something, so they had to check what it poked. It turned out that a part of my womb was poked,' said Ms Ching.
Perforation (cutting) of the uterus during an evacuation occurs in one out of 100 cases, the hospital said.
The KKH specialist doctor on duty immediately performed a diagnostic laparoscopy. That is, instruments allowing the doctor to see the affected area were inserted into MsChing's abdomen.
The doctor confirmed a very small cut.
Deep tissue heat treatment was then applied to the cut to ensure that no bleeding occurred and to allow the uterus to heal well, the hospital said.
This time, Ms Ching stayed in hospital for five days.
'Now I am worried about my future chances of having babies,' she said.
However, Dr Tan said: 'Small uterine perforation that heals well is unlikely to affect a woman's childbearing ability.'
WOMB STILL UNCLEAN
On 1 Aug, Ms Ching told her mother she wanted a second opinion.
'I wanted another doctor to tell me I was all right,' she said.
Her mother took her to Gleneagles Medical Centre.
'We went to see Dr Tanny Chan, the doctor who delivered all my four daughters,' said Madam Ong.
Dr Chan did a scan for Ms Ching and it showed that her womb was still not clean.
The scan cost more than $350.
'Dr Chan called Assoc Prof Tee for us. He asked us to see him straightaway that day,' said MadamOng.
Dr Chan confirmed this.
Back at KKH, Assoc Prof Tee saw Ms Ching, five weeks after her delivery, and the next day, performed another evacuation, the second in two weeks, to clean out her womb again. She got another scan on 6Aug.
KKH said one in 20 of the women who have the evacuation procedure done would need to go for a second one.
'This is because the risk of an incomplete evacuation is quite high,' said Dr Tan.
As the placenta was noted to be complete before Ms Ching was discharged the first time, no ultrasound scan of the uterus had been done then.
However, sometimes, even if the placenta appears complete to the trained eye, small pieces of membrane or placental tissue may remain in the uterus, KKH said.
After Ms Ching returned on 19 Jul with heavy vaginal bleeding and a history of having passed out a piece of placental tissue, Assoc Prof Tee personally gave the medical team on duty the approval to proceed with the evacuation of the uterus followed by the deep heat treatment of the uterine cut.
He has apologised to Ms Ching that due to unforeseen circumstances, he was unable to personally speak to her in the ward. He has also given her a detailed explanation.
Said Assoc Prof Tee: 'I fully empathise with her distress. We should have provided her with a more detailed understanding of the events that occurred and the steps that we needed to take.'
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Hospital says:
*Incomplete removal of placenta happens in 2% of cases
*If there is no bleeding, it's safe for patient to pull it out herself
*Some will need womb to be cleaned more than once, and may have small cuts when it is done
taken :
http://newpaper.asia1.com.sg/news/st...38547,00.html? 
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