I lost 17 units of blood, my womb, and my hair – but doctors missed the real problem

Everyone told Peninnah* how lucky she was to have survived the most horrific ordeal ever, but she could not summon the energy to argue. She sat back and listened to the chatter around her, wishing she could get back home and crawl into bed.

Her husband held their seven-month-old daughter as he mingled with the family, catching up with everyone and proudly showing off the energetic little one who babbled happily in her dad's arms. He would repeatedly glance at his wife to ensure she was alright, but even he knew that they were not going to be staying for long at the party.

The 35-year-old nurse was 35 weeks pregnant with their firstborn baby; excited to be a mum in a few weeks. She was driving home from work, happily thinking of the favourite part of her day, when she got to put her feet up, got a good foot rub from her little sister who was in college studying beauty; while eating her pregnancy favourite, ugali and omena.

Everyone made fun of her new dietary inclinations as she had never been one to even tolerate the smell of omena, yet here she was, living off it like it was the only meal available. As a nurse who spent the day on her feet, the evening was a welcome relief to her swollen and sore feet.

Also read: Failed by the system: Mothers we lost inside maternity wards

Lost in her happy thoughts while waiting for the lights to turn green at the intersection, she failed to see the looming disaster; a truck that should be slowing down to a stop careening off the lane to her right, heading straight at her. When she looked up, she froze. There was nowhere for her to escape to. As if in slow motion, she watched the truck attempt to swerve, swiping her car on the right, where she was seated behind the wheel.

Peninnah had taken a defensive position, head down on the steering wheel, hands over her head, trying to keep her head and baby safe. She heard the impact, heard the glass shatter all around her, and then saw black.

When she awoke, she had no recollection of the events at all. It took days for her to begin to piece everything together, but it took weeks for her to remember the ordeal. The impact left her unconscious; with the deployed airbag shoving her way back in her seat. Spectators were extremely anxious when they noted she was pregnant and bleeding. By the time the ambulance arrived, they had extracted her from the mass of metal and glass laying on her side on the road.

The evacuation led her straight to the maternity unit of the very hospital she worked in, and the whole team worked frantically to save her. She had suffered premature placental separation; causing her bleeding and threatening her daughter's life. She had also suffered brain swelling from the impact, knocking her brain around her skull, causing oedema.

Peninnah was rushed to surgery to try and save her baby, and long before her husband could arrive in hospital, the baby was already out and in the new-born intensive care (NICU), and the battle was now to stop the mother from bleeding out.

Placenta removed

In obstetrics, the saying 'When it rains, it pours", is one we always seem to breathe full meaning into. The bleeding from her uterus was expected to stop once the baby and placenta were removed. Instead, she went on to bleed a torrent; the true postpartum haemorrhage. Her uterus wouldn't let up. It refused to contract even in response to the cocktail of drugs.

The surgical team expanded intraoperatively in an effort to stop the tide, but all in vain. Eventually, the decision to save her life won over the fight to save her uterus and she had a hysterectomy to remove the offending organ; giving her a fighting chance. She was wheeled to the intensive care unit (ICU) while her family prayed for her survival.

Her recovery was anything but smooth. She survived two cardiac arrests in the ICU, had a total of 17 units of blood products transfused; fought recurrent infection, underwent dialysis for acute kidney failure and pretty much cheated death from all angles. It took three weeks to get out of the ICU, heralding the long road to recovery.

Peninnah first met her baby when she was five weeks old. She cried tears of joy that her baby made it; then cried for the lost time to bond with her little angel. She had no milk to breastfeed this late in the postpartum journey; but she was grateful the little one had taken to formula feeding well.

However, it became clear to her and her husband that things were not quite going the way they hoped. Being a nurse, she had seen many a patient bounce back from grave situations and reclaim their life; but here she was, feeling worse with every passing day. She could not quite put a finger on it, but she knew what she was feeling was not normal.

She sat across from me narrating her horrendous ordeal with such clinical detachment, and it was heart-breaking. She then went on to describe how she had been unable to get back to work all these months later and was considering quitting her job.

The patient was always tired. She struggled to wake up in the morning every single day irrespective of how many hours she slept. She had no appetite, eating when she was reminded, but she was gaining weight. Her hair was falling off, she was even losing her axillary and pubic hair. She had not been able to make any breastmilk, and despite not breastfeeding, her period had never come back. She was dizzy a lot, forgetful and with limited concentration.

Walking with her through the diagnosis of Sheehan's syndrome was tough. The hormonal tests needed cost a pretty penny; she needed an MRI of the brain; blood counts, monitoring of her electrolytes and her blood sugar levels. Thankfully, the tests began to paint a picture of what was ailing her.

Sheehan's Syndrome is a complication of severe postpartum haemorrhage. The intense blood loss that happens leaves body tissues under-perfused; with inadequate oxygen supply for prolonged periods of time as we fight to restore the blood volume.

Unfortunately, the pituitary gland is a fairly sensitive organ that does not have much tolerance for poor oxygen supply. This is the hormone control centre of the body; the one that determines the rate at which all hormone-producing organs in the body function. This tiny, pea-sized organ is the determinant of how much or how little hormone your thyroid or adrenal gland makes; and controls the ovarian cyclic production of oestrogen and progesterone.

In Sheehan's syndrome, the lack of oxygen leads to the death of the pituitary cells, effectively cutting off the hormonal control. All organs downstream fail to make their respective hormones. The patient was essentially experiencing the absence of her thyroid hormones that control metabolism; the adrenocorticotropic hormones that control blood pressure and growth; the cortisol that modulates the sleep-wake cycle, stress, metabolism, inflammation and indirectly influences blood pressure and blood sugar levels.

Unfortunately, this condition has no cure. Treatment is lifelong, with replacement of the missing hormones. Though she has gotten her life back together; she now takes daily hormones to stay functional.

One more reason to fight for our mothers against this monster called post-partum haemorrhage!

Dr Bosire is a gynaecologist/obstetrician