How a divided uterus cut short a young blossoming life!

Eva Abwola Mugabi was a pastor of youth and young adult’s ministry at Watoto Church, a worship leader who moved with the Watoto choir across the world, an astute businesswoman, a wife, mother, daughter, sibling and friend to many.

At 38, she was still vibrant and full of life, but, on Thursday, March 21, 2024, at Bethany Women's and Family Hospital in Luzira, a Kampala suburb where she leisurely went for a minor surgery she breathed her last leaving so many people wondering what could have happened to a young soul that had given so much hope and purpose to both the young and older people who had crossed her path.

Dr. Gonzaga Andabati the Fertility, IVF and Laparoscopy Lead Specialist at Bethany Hospital on Monday morning at Watoto Church along Kampala Road addressed a fully packed room of mourners including family, friends and well-wishers. So what really took a young life that still had so much to give to humanity writes Jacky Achan

It was approximately three years when I first met Eva Abwola Mugabi. She was referred to me because she had gone to some clinic and they had diagnosed that she had a gynecological problem which in medical terms is called a septate uterus

A uterus is what in common language we call womb, a female organ where the baby grows.

Eva with her family

So she had a small problem called septate uterus which means there was a small division in the space inside the womb, which was dividing the womb into two spaces inside.

This was not affecting her life in anyway but it would affect her ability to conceive

That was the alarm which was raised and that was the reason  she came for the surgery.

I saw her, with all the tests done, a number of them, I reviewed her and then I requested for more tests to confirm and the condition was confirmed.

At that point, by all standards I was supposed to go ahead and do the procedure (operate her)

I have been in practice, this is my 25th year in medical practice and as a Consultant Gynaecologist and a fertility specialist, and also a certified laparoscopic surgeon certified by the European Academy.  I have been practicing for long and when you reach that level of practice some of the decisions are outside the book.

So, I took a decision that I wanted to do an extra test to help me map out the procedure and that was an x-ray test.

Now this x-ray test could only be done when she had gotten out of her menstrual period. So, I had to postpone the procedure because it was just one week to her next menstrual period.  So, we postponed as we waited for her menstrual period to come and then we would do the test later, and then we would do the procedure because it was supposed to be a straightforward procedure.

We waited, one week there was no menstrual period, two- three- four weeks no menstrual period, she went ahead and did a pregnancy test and for sure she was pregnant. This was red pepper mixed with some salt, we were happy she was pregnant but we also worried knowing she could end up having a miscarriage.

So, she comes over and we have a chat with her, this was my word; diseases don’t read books you can’t be sure if the pregnancy will go out but our hope is that it will stay.  We started following her up and thankfully she gave birth to a daughter normally and I saw her through, up to the end.

Eva on her wedding day

We thought we had put the devil to rest, and we were all happy and I remember announcing to her that you know what this is a miracle and I can tell you there is another miracle.

I started behaving like a prophet and that is most likely this condition has gone and she was happy and the husband too. So, we said okay let’s give it one year.  When she came back and we reviewed unfortunately the condition was still there.

So the issue was, should we wait for another miracle or should we go ahead and do this procedure it was difficult to decide but, literature shows that you have to correct the condition because it can lead to miscarriage so we decided we would go ahead and correct the condition. But I told her to come at her leisure time, this is not an emergency you will come over when you have time. She waited.

A decision that would end her life

On Monday March 18, 2024, she calls and says you know what doctor I think I need this done. I said its okay don’t worry come over to the hospital and we do the assessment because I do my procedures on Thursdays.

She comes over and we do the tests everything was normal and it was supposed to be easy.

Thursday morning, she reports to the hospital and we do the final assessments, and then they bring her over to theatre that was at around 11, that was when she was in theatre.

Everything was in routine, pray and then she requested to do her own prayer we allowed her and then we also added ours. The place was electrified with gospel music and everything was okay.

Next step she was supposed to be put to sleep and she was put to sleep and I took my position with my team and we started the procedure because it was supposed to be simple and I gave not more than 30 minutes to it and for sure in 20 minutes we were done.

Because I was the lead surgeon as a protocol I was supposed to announce which I did I announced ‘procedure finished anaesthesiologist please reverse’ and gave instruction to the nurses please prepare the next client (patient) and we are done.

Then at that very moment the anaesthesiologist makes an unexpected announcement that Doctor you know what the heart beat is going down and the first response was maybe one of the sensors had gotten off and we were not picking the signals she checked quickly everything was in place, checked the lungs everything was okay, check the heart again, heart beat going down.

In the next two minutes she was calling for resuscitation protocol. So as it is usually the case when resuscitation is announced everybody has to come in. So I summoned all the gynaecologists, we were four gynaecologists now in action with two intensivists, and anaesthesiologists, we swung in action.

In the next five minutes the anaesthesiologist announced the first heart attack (the cardiac arrest), we continued to gain some little positive results. Another two minutes, another heart attack and this was the last, and from our assessment that was when we think she passed on. This was in a spell of about 10 minutes.

From our review of the process over and over with even extensive consultation we could not come to a conclusion on what could have killed her apart from knowing that it was preceded by a period of rapid drop of heart rate that was all we could know.

We were anxious waiting for the postmortem report to tell us what exactly could have caused her death. In the evening on Sunday March 25, 2024, they sent a report that they could not establish the cause of the death.

That leaves us just like you in a big dilemma.

But for us who are believers, we believe there is a greater power and that gives us comfort, but we still have the question why?

 Understanding a septate uterus

A septate uterus is when your uterus is divided into two parts by a membrane called the septum.

According to Cleveland clinic, this septum or membrane can vary in thickness and length.

It starts at the top of your uterus and can extend to your cervix (bottom of the uterus) and occasionally to the vagina.

A septate uterus is rare, but it's one of the more common uterine anomalies.

Causes?

It is congenital. Reports show that it happens when developing in your mother's womb.

The septate uterus estimated prevalence is 0.2–2.3% in women of reproductive age. Prevalence of septate uterus is 18% after two miscarriages and 17% after three, reports show.

The symptoms

Most people with a septate uterus are asymptomatic, according to medical experts.

It typically does not give you symptoms and you only become aware of your condition when your healthcare provider starts to examine the cause of repeat miscarriages.

Some potential symptoms are frequent miscarriages, painful menstruation and pelvic pain.

Diagnosis

Imaging tests are used to diagnose a septate uterus including ultrasound, MRI (magnetic resonance imaging) and hysteroscopy.

Risks of removing septum

Reports show the risks associated with removing the septum dividing the uterus include abnormal bleeding, infection, perforation of the uterus and damage to the cervix.

It's a condition present at birth that can only be corrected with surgery. A septate uterus can cause pregnancy complications and miscarriage.

Having a septate uterus isn't necessarily bad and doesn't cause any long-term health complications.

However, it may increase your risk of miscarriage and is a possible cause of frequent pregnancy loss.

Is it possible to have a normal pregnancy with a septate uterus?

Reports indicate it's possible to have a normal pregnancy with a septate uterus. However, there are several risks if a woman is pregnant and has a septate uterus including restricted growth or low birth weight, miscarriage, preterm birth, premature labor and baby being breech.

The healthcare provider will consider the pregnancy high-risk and want to monitor the baby's growth closely throughout the pregnancy.

The Treatment

Experts say a surgery can be used to cut or shave off the septum. By cutting the septum, the uterus is no longer divided into two parts.

The procedure is regarded as a minor outpatient surgery. The doctor will allow the patient to return home on the same day as the surgery.

If the case is more complicated, the doctor may advise overnight stay in the hospital for observation. But in most cases, the procedure is simple and has a good outcome.

Side effects

The most common side effects from the surgery are period-type pains and some bleeding for one to two days. Make sure to consult your doctor if you have a lot of bleeding, pain, or concerns after your surgery.

Can a septate uterus grow back?

According to available medical literature a septate uterus can't grow back once it's surgically removed.

Eva Abwola Mugabi’s biography

She was born on December 24, 1986, to Andrew and Rose Nyeko. She was born on Nakasero Road. She was the third girl of the family.

Abwola went to Kampala Kindergarten for nursery schooling, she then joined Kampala Parents were she completed her primary seven. Thereafter she joined Vienna College in Namugongo for O level studies and then joined Taibah High School where she completed her A level studies. Abwola graduated from Makerere University with a Degree in Information Technology.

As Eva grew it was very clear that she was not going to go for employment, her auntie Winnie Lawoko Olwe revealed

“Even before she completed Makerere she had already started stringing along with her mother and selling some of the beauty products that her mother was selling at her shop,” she disclosed

“Eva was then straight away plunged into Black Abba where she worked to grow the brand and continued to grow the brand until her sudden demise.

But Eva pursued education as well, she continued to advance herself. Eva took a two-tier way of education. She did the theologies she went and pursued the understanding of what God says but also did an MBA which she completed.

“Eva introduced to us a lovely son Pastor Zane Solomon Mugabi and on August 20, they wedded and they have a lovely daughter Chelo White Mugabi.

“Eva lived a purposeful life,” her auntie reechoed what so many other friends and family said of her

She says two big assignments Eva completed assigned by God was to see her mother and father have holy matrimony, and the other was to stand with her husband when he laid his mother to rest in December.

Abwola passed away on Thursday March 21, 2024, and was laid to rest on Wednesday March 27, 2024 at her father’s residence in Karuma, Kiryadongo district.