Written Stories

Sunita Pun and Her Desire

28 Sep, 2016 By: Dr Kashim Shah

This is the story of Sunita Pun, a dress maker from Birbas, Gulmi District, Nepal. She is 30 years old and has been married to her husband, a businessman, for three years. In 2010, she fell pregnant for the first time and gave birth to a baby boy at 40+2 weeks. She had a normal delivery but her baby, unexpectedly, became very unwell shortly after her return home and sadly passed away.

Later that year, Sunita fell pregnant again. Three months into her second pregnancy she developed appendicitis and unerwent an appendicetomy at Lumbini Medical College, Palpa. An abdominal ultrasound was performed during her admission, and in addition to showing an inflamed appendix, it revealed a large uterine fibroid (8.4 x 4.3 cm). Sunita was advised to have a follow-up ultrasound scan, one month later, to reassess the fibroid.

Ultrasound Scan

This picture shows her follow-up ultrasound scan, a mass 11.2x8.3x10.4 is visible inside her uterus near the anterior internal os. Following the ultrasound Sunita was advised, by an obstetrician, to have a Caesarean-section to deliver her baby, with a simulataneous hysterectomy to remove the fibroid. Sunita was upset by this news as she wanted to have more children in the future.

Sunita was told by some friends that Caesarean-sections are performed by doctors at Gulmi hospital, Tamghas. She decided to visit the hospital to speak to the doctor. In June 2011 she made two hour journey, from her home village to Gulmi hospital outpatient clinic. She told me her distress at the prospect of having to have a hysterectomy, stating that she wanted to keep her uterus for further children. I started by asking Sunita how many babies she wanted to have. Sunita says this first question reassured her and she therefore felt she could trust us to help her through this difficult situation. During the consultation it was agreed that when the baby was due, we wouldperform an elective caesarean section. I explained to her about the limitations and difficulties of performing hysterectomy in our hospital set up and not going to do hysterectomy at all during surgery. And also explained not be able to remove the fibroid as the risk of bleeding was too great.

On the 20th August my team performed an elective caesarean section on Sunita Pun. During the operation I confirmed the presence of a large sub mucosal fibroid. After delivering the baby I looked more closely at the mass and noted that the fibroid was attached, fairly loosely, to the uterine wall and appeared to have just two supplying arteries. I ligated the arteris and then attempted detach the fibroid from the uterine wall. Surprisingly it came away quite easily and successfully removed the fibroid with minimal blood loss. The wieght of fibroid was 550 gm. Specimen was send to histopathology department of Lumbini Medical College, Palpa for its histopathological examination.

On 22nd August, Sunita Pun lies in the post operative room with her new born baby. She is smiling and her baby is fit and well. She tells us how happy she is with the result and describes a feeling of relief at being 'free from disease'.

The work of our team at Gulmi hospital has enabled this lady to fulfil her desire to be able to have more children.

Uterine Fibroids

Uterine Fibroids are benign tumours that develop in the uterus. They vary in size and are often asymptomatic. If large they may cause symptoms such as abdominal fullness or inter-menstrual bleeding. If problematic they can be treated medically or surgically. Medical treatments aim to shrink the fibroid whilst surgery (including hysterectomy) aims to remove the fibroid entirely.

Dr Kashim Shah
MDGP Consultant, NSI
Tamghas Hospital, Gulmi

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