Trauma in Pregnancy : Diversifying Obstetric Retrieval Service in Sabah

Abstract

The Obstetric and Gynaecological Retrieval Service in West Coast Sabah has been well-established since year 2015, parallel to the global advancement of Emergency Retrieval Service. The decision to transfer a patient or to deploy team to the patient lies in the hands of Retrieval Unit. Additionally the mode of transportation, surgeon availability, weather and travel time have to be taken into account. Even though the structure of the program is steadfast in diversifying retrieval services, there are still insufficient studies available to decide its worth. We report a case of a 19-year old primigravida at 27 weeks; involved in a high-impact motor vehicle accident and sustained class 4 hemorrhagic shock. Evaluated in a district hospital, uterine rupture was diagnosed. Hence, the dilemma was either to deploy a team to perform the surgery in district hospital, or to put the patient through a perilous journey back. We would discuss on how we had organised and coordinated a team of obstetrician and anaesthesiologist, along with the Retrieval Team, to perform an Emergency Exploratory Laparotomy in district hospital. Nevertheless, the best method of care is still debatable as astute judgement is crucial and this approach has to be taken on a case to case basis. Ultimately, the patients well-being is the utmost priority.