What's your most interesting/scary case?

  1. We all know that working in this field can be exciting, touching, heart warming as well as heart wrenching. We know that strange and exciting things happen everyday. But every now and then something really strange, very scary and/or rare occurs. I think this might be a good opportunity to learn from other's about their most strange/interesting/scary experience. I have two:

    1. Primip, uncomplicated term pregnancy, had good PNC. Came into triage in labor, 4cm I think, intact membranes, good strong ucs. Pt admitted, 0 epidural, got to C/C/+2 station, doc was called to come for delivery. MD showed up and ruptured membranes......BLACKish/Brownish fluid came out. Baby born in severe respiratory distress, transferred to NICU. Infant dx with severe Primary Pulmonary Hypertension and the baby died. Apparently the OB theorized that several days prior to delivery a blood vessel on the fetal side of the placenta broke and bled into the amniotic fluid. The infants lungs and stomach filled with this old bloody fluid and the infant was unable to be ventilated. Very sad case.

    2. Multip, 37 weeks, good PNC, had numerous ultrasounds due to absent fetal movement on the ultrasound however everything else looked good except mom had bigtime polyhydramnios. AFI 59 , for the life of me I can't figure out why she wasn't admitted at 36 weeks(UH...hello doctor, isn't this a prolapsed cord or abruption waiting to happen???:smackingf ). Anyway she came in soaked from her waist down and in a lot of pain, EFM applied (baby looked good), 3 cm dilated. All of a sudden she had a complete abruption, blood pouring out, baby heart rate plummeted. Mom rushed to OR, not even an IV yet. Mom was crash sectioned, baby came out dead, but resucitated. Baby had neurological defects, no movment, no swallowing(hence all the fluid). I don't think the baby made it. It was so scary and sad for the family because they walked in and 11 min later baby was delivered, they didn't speak english and the only spanish speaking person on the floor was in the OR already. They had no clue what was going on.
    Last edit by LizzyL&DRN on Oct 30, '06
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  2. 40 Comments

  3. by   Jolie
    [QUOTE=LizzyL&DRN]

    2. Multip, 37 weeks, good PNC, had numerous ultrasounds due to absent fetal movement on the ultrasound however everything else looked good except mom had bigtime polyhydramnios. AFI 59 , for the life of me I can't figure out why she wasn't admitted at 36 weeks(UH...hello doctor, isn't this a prolapsed cord or abruption waiting to happen???:smackingf ).

    Just curious - Why is polyhydramnios a risk factor for prolapsed cord and/or abruption?
  4. by   RNLaborNurse4U
    Quote from Jolie
    Just curious - Why is polyhydramnios a risk factor for prolapsed cord and/or abruption?
    If you rupture with polyhydramnios, not knowing where the loops of cord are, you could have a prolapse. Especially if the fetus is at a high station, or there is a lot of the amniotic fluid below the head and in front of the cervix. Loose the cushion of the fluid, and poof! Cord compression.

    I can't think of the pathophysiology for relating poly and abruption risk though. Anyone else??
  5. by   elliebellie
    oops, duplicate
    Last edit by elliebellie on Oct 30, '06
  6. by   elliebellie
    Weirdest case for me in recent memory was a G2P1 at term, 1st baby was a c-section, 2nd baby successful VBAC. Nice delivery, variables at the end but she was complete & pushed the baby out quickly. Happy recovery, breastfed, mom & baby stable. We took mom back for a postpartum tubal about an hour after delivery and when they opened her abdomen discovered vernex in there. It quickly progressed to an fully open abdominal hysterectomy, many units of blood, ICU stay for mom.

    I just keep thinking if she had gone out to the floor & had her tubal scheduled for later that morning....
  7. by   elliebellie
    Quote from RNLaborNurse4U
    I can't think of the pathophysiology for relating poly and abruption risk though. Anyone else??
    Sudden decompression of a very distended uterus.
  8. by   LizzyL&DRN
    Quote from elliebellie
    Sudden decompression of a very distended uterus.
    Exactly! And that's exactly what happened. What puzzles me is at her last ultrasound several days before this horrible incident her AFI was 59. It was for sure more when she came in. Of course with all the running around we hadn't had a chance to look at her Prenatal record yet. She walked in soaked, I put her in a room and checked her, then about 3 minutes later, all hell broke loose.
  9. by   klone
    36-week G2P1, presented to the department in active labor. Spanish-speaking only pt (Mexican immigrant). No prenatal care. IV abx given for "GBS unknown" status. Labor progressed uneventfully. Baby came out and was 4 1/2 lbs, looking VERY small and NOT like a 36-weeker at all. Apgars were surprisingly good (7/9, I believe). In attempting to deliver the placenta, OB is sprayed with amniotic fluid, and it was then discovered that the pt. had undiagnosed twins. Twin B was delivered (6ish lbs) and it was discovered that there was twin/twin transfusion and Twin A also had a velamentous insertion.

    I'm glad I didn't know any of these complications and risk factors until AFTER the babies came out.

    Both babies went home after 3 days, doing well and breastfeeding without difficulties.
  10. by   htrn
    36 5/7 weeks, GBS negative from three days earlier. SROM 5 hrs PTD, clear fluid. Beautiful strip, great labor - dream patient for a nurse. Labor less than 7 hours. Infant born with resp distress, retracting, grunting, etc... Transferred to nsy without parents holding her. Progressively got worse with no known reason - good CS and temps, etc. increasing need for O2 and incresing WOB.

    Called for helo, baby kept getting worse and worse resp wise. By the time helo got there, team intubated her with fluid comming back out through ET tube. Team literally ran out of the birth center with infant to helo - they ALWAYS stop in mom's room to let mom say good by and reassure parents - but not this time.

    Infant died later that day of overwhelming sepsis - wasn't GBS, but some other nasty bug. Mom didn't make it to NICU until minutes after baby died.

    Lesson: Mom and Dad will ALWAYS see and if at all possible, hold baby B4 we take to nursery.
  11. by   LizzyL&DRN
    Quote from klone
    36-week G2P1, presented to the department in active labor. Spanish-speaking only pt (Mexican immigrant). No prenatal care. IV abx given for "GBS unknown" status. Labor progressed uneventfully. Baby came out and was 4 1/2 lbs, looking VERY small and NOT like a 36-weeker at all. Apgars were surprisingly good (7/9, I believe). In attempting to deliver the placenta, OB is sprayed with amniotic fluid, and it was then discovered that the pt. had undiagnosed twins. Twin B was delivered (6ish lbs) and it was discovered that there was twin/twin transfusion and Twin A also had a velamentous insertion.
    This is the most frustrating part of OB nursing for me. Why don't pts get PNC!!! You can get it at free clinics and they help you sign up with MediCAL. I had a 17 yr old pt the other day deliver a 28 weeker that had no PNC. And this was her second baby, and I know with her last baby only 1 yr ago she was given PNC information. This delivery was at my other job which is at a small rural hospital. Thank God the baby did okay til the helo arrived. I wish more education was made available to these people that don't seek out PNC. Afterall its not the baby's fault.
  12. by   33-weeker
    i wasn't there, but heard about it later.

    young couple, 20's, first baby. healthy pregnancy, term, nearly 8 lb. girl. mom was pushing. of course, there's always that point where you lose heart tones, but delivery is moments away. the cord somehow tore as mom was pushing baby out. by the time the doc could clamp what was left hanging, baby had bled out. neo team worked on baby for over an hour, but couldn't save her. there was just not enough blood left in her body for the rescusitation efforts to work. (not sure if they transfused, but if so it was obviously too late to do any good)
  13. by   Gompers
    Quote from LizzyL&DRN
    This is the most frustrating part of OB nursing for me. Why don't pts get PNC!!! You can get it at free clinics and they help you sign up with MediCAL. I had a 17 yr old pt the other day deliver a 28 weeker that had no PNC. And this was her second baby, and I know with her last baby only 1 yr ago she was given PNC information. This delivery was at my other job which is at a small rural hospital. Thank God the baby did okay til the helo arrived. I wish more education was made available to these people that don't seek out PNC. Afterall its not the baby's fault.
    I know that in my area, the reason many immigrants don't get prenatal care is that they are illegal and don't want to get deported. Plus the ones who are here legally often don't know about the free medical care available. I think prenatal care is very very different in other countries, too. We tend to overdo it in the US, no? I mean, yeah it's a good thing, but not every country has the same resources for prenatal care and it's normal for some women to not have any.
  14. by   Gompers
    Quote from 33-weeker
    i wasn't there, but heard about it later.

    young couple, 20's, first baby. healthy pregnancy, term, nearly 8 lb. girl. mom was pushing. of course, there's always that point where you lose heart tones, but delivery is moments away. the cord somehow tore as mom was pushing baby out. by the time the doc could clamp what was left hanging, baby had bled out. neo team worked on baby for over an hour, but couldn't save her. there was just not enough blood left in her body for the rescusitation efforts to work. (not sure if they transfused, but if so it was obviously too late to do any good)
    ...and this is why i should stop reading this forum.

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