detached from the uterus. It could be dangerous, possibly even fatal to both the mother and the baby. If the bleeding was severe, they’d need to do an emergency delivery.
‘Have you done an ultrasound?’ Lucy asked.
‘A machine’s on its way. Could you take a look at her?’ the nurse asked.
‘I’ll be right down.’ Though it was only courtesy to let her new boss know where she was going. She hated interrupting colleagues when they were with patients, but the only other choice was leaving a message with one of the midwives, and he’d probably think she was sulking and using any excuse to avoid him. She pulled back the curtain just enough to put her head through the gap. ‘Mr Alberici, I’m sorry to interrupt. Could I have a quick word, please?’
‘Of course. Please, excuse me,’ he said to the patient, then came to join Lucy in the middle of the ward. ‘What’s up?’
‘We’ve got a patient with a suspected placental abruption in A and E. They’ve asked me to see her.’
‘I’ll come with you—if it is that, we’ll need her in Theatre pronto. You’ll assist?’
Yeah, he would be a qualified obstetric surgeon. He could have offered to assist her. But, no, he had to take charge. ‘Sure,’ she muttered.
‘I’ll brief Mal and I’ll be right with you,’ he said.
Efficient, courteous—to the patients, if not to her—and drop-dead gorgeous. It was a tempting combination. A dangerous combination.
Stop it, she warned herself. You are not going to think about Nic Alberici like that.
Though in her mind’s eye he wasn’t wearing a formal white silk shirt, teamed with a silk tie and an expensively cut dark grey suit and topped with a white coat. He was wearing that half-open white shirt, tight black trousers, a hat and a domino mask. Sexy as hell. With a smile that promised—
‘Mal’s going to carry on with the rounds and page us if there are any problems,’ Nic said, breaking into her thoughts. ‘I’ll let him know if we go to Theatre.’
She flushed. ‘Right.’
‘I’m not checking up on the quality of your work,’ he added, misinterpreting the reason for her high colour.
‘I didn’t for one moment think you were.’
He sighed. ‘Oh, hell. Look, Lucy, we got off to a bad start. Let’s just forget it and start again, shall we?’
Forget what? That kiss, or what he’d overheard, or the dressing-down he’d started to give her? The second two, she could do, but the memory of the kiss firmly refused to budge.
Even now, she could still feel his lips against hers. Worse, she wanted him to do it again. In a much more private situation…
She’d only just got herself back under control by the time they reached A and E. ‘I’m Lucy Williams—you paged me to look at a patient with suspected placental abruption,’ she said to the receptionist.
‘Yes. Her name’s Mrs Andrews—Liza Andrews. She’s in room two,’ the receptionist replied. ‘Yvonne Roper’s with her.’
‘Thanks.’ Lucy led the way to room two and knocked on the door.
Yvonne answered the knock. ‘Thanks for coming, Dr Williams.’
‘It’s Lucy,’ Lucy responded. ‘Any time. This is Nic Alberici, the new consultant on River. Before we see the patient, what’s the presentation?’
‘She’s in constant pain, her uterus is tender and tense, she’s bleeding slightly—it’s dark red and clotted—and she’s starting to look shocky,’ Yvonne said.
‘Out of proportion to the loss?’ Nic asked.
‘Yes. Her blood pressure’s low.’
He and Lucy exchanged a glance. There were other causes of bleeding in pregnancy, but the symptoms Yvonne had described sounded very like placental abruption.
‘I’m not happy with the foetal heartbeat either,’ Yvonne added. ‘I think the baby’s getting distressed.’
‘Is the scanner here yet?’ Nic asked.
‘No. I’ll chase it up.’
‘Thanks. We’ll go and see her,’ Lucy said. She knocked on the door, walked in and introduced herself and Nic to Mrs Andrews. ‘Yvonne tells me you’re in pain and you’re losing blood. Would you mind if we examined you?’
‘Please. Anything. Just don’t let me lose my baby,’ Liza Andrews whispered brokenly. ‘I’m forty-three. It’s my first baby. We waited so long, and if I lose him…’ She choked. ‘I might not be able to have another.’
‘We’ll do our best,’ Lucy reassured her. ‘There are lots of reasons for bleeding in pregnancy so don’t assume it’s the worst.’ Lucy glanced at the observation chart. ‘Your baby’s heartbeat is still pretty regular, though your blood pressure’s a bit low so we’ll get some blood into you to help. Yvonne, can you cross-match and get me four units of O-neg?’ she asked as the nurse came back in.
‘We’re waiting for the portable scanner to arrive,’ she told Liza, ‘then we’ll be able to check what’s going on a bit better. It might be just that your placenta’s low-lying, what we call placenta praevia, so I’m not going to give you a vaginal examination.’ If it was placenta praevia rather than an abruption, a vaginal exam could cause a catastrophic bleed. ‘But I will give you some oxygen to help you breathe more easily.’ She unhooked the mask from the wall. ‘Just breathe in through this and try to relax.’ She set the output at fifteen litres a minute. ‘OK?’
Liza nodded.
Lucy gently examined the woman’s abdomen.
‘That hurts,’ Liza said, taking the mask off her face.
‘I’m sorry,’ Lucy said. ‘The good news is that your baby’s lying normally.’ She mouthed to Nic, ‘I’m almost certain it’s an abruption.’
Nic nodded and took Liza’s hand. ‘It says here you’re thirty-six weeks.’
Liza’s face screwed up in anguish. ‘And it’s too early for the baby to come!’
‘It’s quite normal for babies to arrive at thirty-seven weeks—so a few days earlier really isn’t as bad as it sounds,’ Nic reassured her, smiling. ‘You’re in the right place.’
‘So my baby’s going to be all right?’
‘We’ll do our best,’ Lucy said, gently settling the oxygen mask back in place. She listened to the baby’s heartbeat and didn’t like what she heard. Nic was watching her face and she gave him a very brief shake of her head to let him know.
Yvonne arrived with the scanner in tow and the units of blood. Lucy quickly set up an intravenous infusion while Nic put the scanner in place.
‘Lucy,’ he said quietly.
She took one look at the screen and her heart sank. The placenta wasn’t low-lying. And as Liza Andrews hadn’t been visibly losing that much blood, the chances were that most of the blood from the abruption was trapped, known as a ‘concealed abruption’.
‘Mrs Andrews, you have what we call placental abruption,’ Lucy said. ‘It means that your placenta’s started to come away from the wall of your womb.’
Liza blenched. ‘Am I going to lose the baby?’
‘Not if we can help it. But it’s too big for me to let you go home again,’ Lucy said. ‘And I don’t want to take any risks with the baby.’
‘I’d like to deliver the baby by Caesarean section,’ Nic said.
‘Now?’ Liza asked, horrified.