doppler at 16 weeksRegister Today!
- by crissrn27 Oct 17, '09Hi all!! Haven't posted here in a while, since I went back to LTC. Anyway, question! One of my friends, who currently works postpartum, is having trouble with a 16 weeker, in for dehydration. She has had her for around 48 hours, and no one has been able to get a FHT with a doppler. They are trying twice a shift, so basically QID. She does have an anterior placenta according to last ultrasound, and they can hear placenta noise, but no baby. The OB is reassuring her that it is normal not to hear for a prolonged period at that gestation and hasn't ordered an ultrasound or done a bedside at this point. My friend has been pp, and done L and D, forever, and has never not been able to hear for this long with a doppler. I've never not been able to hear and not have the OB order an ultrasound, at least for mothers peace of mind. Have any of you guys ever had this situation come up?
- Oct 17, '09 by jimeneti_MSNstudentSounds like its time for your friend to do some advocating for her patient. I don't see any contraindication to just doing the US, unless the mom is concerned about cost and would rather wait it out. Does the patient know that US is an option? In the end, it should be up to her and not the doc, I believe.
Thanks for the post!
- Oct 17, '09 by crissrn27I'm not sure what the big deal is with the ultrasound, and the moms not to worried, as she believes what the OB is saying. I think all the nurses have asked the OB for at least a bedside, but they haven't ordered it. I think my friend wants to be able to tell the pt that she has talked to some other nurses and they say its normal not to hear for this long of a period. So, basically, the nurses are more worried than the mom or OB.
Thanks for the replys!
- Oct 18, '09 by ElvishI have had similar situations come up and we've generally done u/s just to reassure. If I can't get tones with a doppler, I need reassuring as much as anyone. One other question though...is the doppler a good one?
I say this because we have a few at our hospital and the quality varies between machines. If they can't get tones with one, maybe try a different one? Or if there's a portable EFM machine, maybe they could use that to pick up a tracing just for a minute or so. I've had to do that before esp with a wiggly baby or an anterior placenta that's *right* in my way.
- Oct 19, '09 by crissrn27Sadly, when they did the US it was a fetal demise. Having just had a 15 week loss myself, I am sad they didn't do an US right away for this mom. My friend is also speaking with her supervisor to try to make a some kind of policy for this situation.
- Oct 19, '09 by ElvishOh.....I am so sorry. For this patient's loss and for yours. A policy change is probably a very good idea in this situation.
:icon_hug: to you.
- Oct 19, '09 by crissrn27Thanks elvish. It was...........a nightmare.
- Oct 20, '09 by sahm02Very surprised to read that the OB said this is normal and not order a U/S if nothing can be heard even after two sep attempts!! That poor mom, to have to go thru that for a couple of days!! Definite policy change should be put in place for everyone's sake!! I am so sorry for her loss.
- Oct 20, '09 by mortebut, the cold hard fact, would it have changed the care she was given, one little bit?