Hyperstimulation?

  1. I brought my friend into L&D the other night cx about 2-3 minutes apart with lots of back pain. First VE 3/60/-2 37weeks, 4th child. They do a 20 minute monitor and then let her get into a tub to hopefully relax her a little. After an hour her cx are 45 sec to 1 minute apart lasting 60-70 seconds. They check her again still 3/60/-2, so she gets sent home with 10mg of Ambien. As we leaving her cx are now coupling on the monitor nurse says to come back when their is more pain.
    She wakes up 3 hours later blood everwhere. She calls me, I take her to L&D they check her and she is a 9. From the time we got to L&D her baby boy was born 14 minutes later. She was also group B +, they did even get an IV in her before she delivered.
    Is this typical? I find it very disturbing, I am just starting school for my RN hopefully to work in L&D. She is thinking about writing a letter to the boss of the MD on call, do you think that would be warranted?

    Thank You All!!
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  2. 10 Comments

  3. by   USC2001
    We usually send people home that do not make a cervical change. HOWEVER, I would not have sent your friend home, nor would any of my charge nurses have let me. One of the reasons is it was her 4th child and that makes her have the potential for a fast labor. That combined with the fact that her ctxs were that close together would make me uncomfortable with sending her home. The very least that I would have done was have her walk to encourage dilitation or just watch her another hour or so to see if she dilates.
    I am sorry that happened and I think a letter is called for.
    Good luck in school!
  4. by   Jolie
    Quote from GeriL
    I brought my friend into L&D the other night cx about 2-3 minutes apart with lots of back pain. First VE 3/60/-2 37weeks, 4th child. They do a 20 minute monitor and then let her get into a tub to hopefully relax her a little. After an hour her cx are 45 sec to 1 minute apart lasting 60-70 seconds. They check her again still 3/60/-2, so she gets sent home with 10mg of Ambien. As we leaving her cx are now coupling on the monitor nurse says to come back when their is more pain.
    She wakes up 3 hours later blood everwhere. She calls me, I take her to L&D they check her and she is a 9. From the time we got to L&D her baby boy was born 14 minutes later. She was also group B +, they did even get an IV in her before she delivered.
    Is this typical? I find it very disturbing, I am just starting school for my RN hopefully to work in L&D. She is thinking about writing a letter to the boss of the MD on call, do you think that would be warranted?

    Thank You All!!

    If her contractions were truly 1 min. apart, lasting 60 sec each, then she was in need of continued monitoring, not a sleeping pill! I assume that her membranes were intact at the time of discharge, but even so, I agree that discharging a patient with such a high potential for a precipitous delivery was a bad idea. Especially since the baby needed antibiotics prior to birth, which probably didn't happen in the 14 minutes she was there prior to delivery.
  5. by   rpbear
    I had my first child almost the exact same way! Except I came back to the hospital in an ambulance becasue my hubby was a little freaked out by all the blood so he called 911, by the time they got there my water broke and when they went to do an exam they could see the head, so I was rushed in and delivered about 15 minutes later. I too was strep B+ I go t one fast dose, but I doubt it did any good. My baby was fine.

    I now work L&D (I am very new though), labor is hard to predict, but I agree that 4th baby and contractions close together is something to be very cautious about.

    Some hostipalts have policies that they will not admit until 4 cm dilated or water has broken, maybe that was the case.
  6. by   Darchild77
    I work the night shift, and so we have all the responsibility as to decisions with patients because our docs don't want to be bothered. A nurse with 1.8 years training on OB by herself at night, I get the responsibility of deciding what to do with a patient. I would have definately kept this patient, but then again we usually keep anyone that's a 3. Or, we give them the option of staying if they are too painful, or if they are just uncomfortable leaving. Sorry I rambled.
  7. by   nrsnan_1
    Hindsight nursing here, but contractions every minute/lasting a minute even without cervical change is not something you send home. It is something that causes one to say, "is this an early abruption"? I think I would have opted for a little stadol/phenergan therapeutic rest.
  8. by   GeriL
    Thank you all for your insite.. If she did possibly have an abruption, she was bleeding pretty badly at home. Would her being RH - cause any problems?
  9. by   L&D_RN_OH
    Quote from GeriL
    Thank you all for your insite.. If she did possibly have an abruption, she was bleeding pretty badly at home. Would her being RH - cause any problems?
    I assume she got Rhogam? If so, then no, it wouldn't cause a problem. Generally in our unit, if a pt hasn't made cervical change after an hour of ambulating, then we send them home. Generally though, their contractions are not that close together. In the case of a multip, with ctx that close, I think keeping her a little longer would have been smarter, obviously.
  10. by   OBNURSEKAREN
    I would have definitely not sent that patient home, and I know that none of my co-workers would have either. Yes! I do believe a letter should be written! The fact that she was a gravida 4 alone warrants more observation time. I can't believe that she was sent home with contractions that close. Just be thankful that things turned out okay.
  11. by   Baby Catcher
    I don't know anyone that would have sent her home either. Good thing it turned out ok.
  12. by   SmilingBluEyes
    I would definately have kept her under observation, hydrating either by PO or IV means, to calm uterine activity ----and then possibly administer Brethine SQ to stop that run of hyperstim. if it did not abate or baby began to show signs of stress. This patient would be tightly monitored where I work. NO way would we have discharged her. Often hyperstim. means trouble underlying and needs investigation.
    Last edit by SmilingBluEyes on Mar 12, '04

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