Your freakiest OB patient?

  1. I mean CLINICALLY freaky. I was reading about the pt with Sheehan's syndrome (never heard of it) and it got me thinking of the ones that have really stumped everyone over the years. If you're like me, I forget what goes on at work when I punch out, but we did have a postpartum pt a few weeks ago who had some of the s&s of worsening toxemia except her blood pressures were normal. Liver enzymes hit sky-high numbers, her labs were all whacked, she became disoriented most of the time. She had every kind of consult we have available, a zillion tests, and no one could figure out what was wrong with her. We finally shipped her (we are a level one) and kept tabs on her -after a few days we were told she may need a liver transplant but probably wouldn't live to get one. BUT she finally started to improve and FINALLY they found the culprit - herpes that she didn't know she had. She had never ever had an outbreak. Isn't that weird? I have never seen the herpes virus attack that way.
    The story had a happy ending eventually and she went home good as new.

    The other one I thought of was years ago -- a pt on her 3rd pregnancy, became a "frequent flyer" in L&D with her c/o abdominal pain that we could never find a reason for. I am ashamed to say that we all started to blow her off as a fruitcake. Well, after her delivery she became very ill- I don't remember now what all of her symptoms were, but I do remember persistent fevers, and they treated her for unknown infection. She got worse and worse with no one able to figure out why, and finally was transferred to a large medical center where she was diagnosed with some rare form of cancer that originated in the placenta. She died without ever going home, leaving 2 small children, a brand new baby and a husband behind. I learned a valuable lesson from that case.
    Linda
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  2. 21 Comments

  3. by   babynurse7
    Hey, Kday and others! I work on a heme/onc floor right now but I am very interested in OB which is why I visit these boards. Anyway, I saw the dicussion about the woman who had cancer from the placenta-- If it is the same thing as what I am aware of it is called choriocarcinoma, and it develops after a woman has had a baby and a piece of the placenta somehow stays in the body and becomes cancerous. I 'm not sure if this is what that woman who died had--She got sick awfully fast after delivery, but there is such a thing. I guess it is pretty rare. Just thought I would pass on what little info I have.
  4. by   mzjennifer

    I just had a postpartum mom yesterday -- dx w/ stage 3 breast CA at about 28-30 weeks gestation. 10cm by 5cm tumor in one breast (wow!). Cancer is estrogen sensitive...pregnancy seems to have triggered it, or made it worse. Had mastectomy very soon after. Induced at 36 weeks so she could start chemo. Baby born with respiratory distress (not sure if betamethasone was given antenatally??). Baby was put on c-pap yesterday, and was transferred out to a higher level NICU (we are level 1). Mom seems very shell-shocked (who wouldn't be??). Dad doing a lot of crying. Was a very tearful night at work last evening. I left after working 13+ hours, just as the baby was being transported to level 2 NICU at the other local hospital.

    And yes, I started to tear up too. Very sad to see. Can only hope and pray that mom and baby will have good outcomes.
  5. by   prmenrs
    I did Infection Control several years ago, and there was a ob pt that grew M. tb from her placenta. That's pretty uncommon!
  6. by   rdhdnrs
    I had a patient come in from our teen clinic that our midwives use. She was "acting wierd" and uncommunicative. She was seventeen and very paranoid acting. She wanted to hold her chart all the time and see what we were writing about her. Got psych in on it and now she is diagnosed as paranoid schizophrenic vs bipolar. Strange. She's 27 weeks and this started happening at 17 weeks.
  7. by   jamistlc
    Greetings All Nurses,


    I once had a client as her Doula who had Ehlers-Danlos syndrome, she could not have a epidural becuase there is a risk of bleeding out at any site with truama. She had a heart condition (I do not recall what exactly but it was a valve thing), she was prone to fractures and easily developed hematomas... the list goes on and on. Any way she wanted a trial of labor rather than what was her option of a General and C-Section. She did get a IM Demerol and a hep lock (do not figure why she could not have an Epi, not complaining as I do not like them anyway). She wante to tear, no episisotomy but as the Doc (who is Midwife trained OB and female) said I know what your plan is but if I cut now on the next push you will have a baby in your arms. So she did and when she pushed the next contraction she broke her cocyxx! OUCH, I was holding her right leg to her chest and felt/heard the snap

    So for me this was my freakest client and my first client as a paid Doula!
  8. by   LDRN697
    My freakiest ob pt was a 19 yr old who came in around 26-28 weeks with a blue toe. Her big toe was as blue as could be. Sent her out to med/surg ran test after test and about 5 days later discovered she had a large flap of tissue that was hanging from her aorta and pulsated with every heart beat. Kept in hospital until 35 weeks, sectioned her then the cardiologist came in and took the flap out(which they were afraid was going to break off on its own). It was downhill from there. Stents were placed, they leaked, back to surgery, infection, etc. Unforunately she died in ICU. We were so afraid that she would die from that flap of tissue breaking and felt so relieved when they removed it. It is so sad she died of complications afterward. Grandma is now raising the baby.
    LDRN697
  9. by   jamistlc
    Originally posted by LDRN697
    My freakiest ob pt was a 19 yr old who came in around 26-28 weeks with a blue toe. Her big toe was as blue as could be. Sent her out to med/surg ran test after test and about 5 days later discovered she had a large flap of tissue that was hanging from her aorta and pulsated with every heart beat. Kept in hospital until 35 weeks, sectioned her then the cardiologist came in and took the flap out(which they were afraid was going to break off on its own). It was downhill from there. Stents were placed, they leaked, back to surgery, infection, etc. Unforunately she died in ICU. We were so afraid that she would die from that flap of tissue breaking and felt so relieved when they removed it. It is so sad she died of complications afterward. Grandma is now raising the baby.
    LDRN697







    So Sad
  10. by   finallyRN
    We recently had a pt came in for induction, labs were drawn and her platlets were very low (don't remember the number but low enough to start meds) Started Magnesium. About 6 hours later she delivered a healthy baby girl. Didn't really stop bleeding. Fundus appeared firm, bladder empty. Ended up being transfused with 3 units of platlets and 1 unit of prbc's. Still unstable. finally went to OR when even with manual cuffs, bP 0/0. Ended up having a hysterectomy for prolapsed uterus. really shook up the unit.
  11. by   BugRN
    IAbout 10 yrs. ago I was working L/D that had an onsite free-standing birth center. We only got them if there was a problem. One night we got a 32 wk. primip w/ heavy vag. bleeding. Fetal heart dropping like a rock. Midwife stated unremarkable prenatal course other than a first trim. bleed. Of course no u/s done or amnio. We did a crash c/s and I was scrubbing. The doc did the abd. incision and then yelled out " where the F--K is her uterus?"
    We were looking at a fetus free floating in her abd. space w/ cord going through the uterus which had abrupted and attached at the fundus. The fetus was about 27-28 wk. size and was not doing well. The you-know-what hit the fan. We called in anyone that could help. Her uterus was about 4 mnth. size with a small tear at the top. The doc figured she abrupted early and the fetus simply floated out, sac and all and grew extrauterine for the remainder of her preg. Because she never had an ultrasound all they were doing on her was external palpations and she must have seemed ok to them. The documented FH was always good. other than that first bleed she had no other problems in her pregnancy. The baby got shipped out and I'm sorry to say I don't remember the outcome. But this was hands fown the freakiest thing I had ever seen!!
  12. by   moonchild20002000
    We once had a patient that we did a STAT section on that was about 33 weeks with and abdominal pregnancy!She had not gotten any prenatal care,the baby was stillborn.She presented with severe abdominal pain and very heavy vaginal bleeding.

    I took care of another patient that ended up with appendicitis!She went through labor and delivery!She had her appendectomy a few hours post partum!
  13. by   finallyRN
    Had a pt not really in labor, had PIH and was to be sectioned the next afternoon at about 34 weeks. She had been on Mag but did not tolerate the Mag, were trying oral meds to keep her pressures under control till the betamethasone kicked in. Anyway she was to be monitored every four hours, i walk in the room put her on the monitor, she is having UC's every 3-5 mins and her pressure is now 180's over 100's. Page the Doc. Mag is ordered again to try to stop the UC's and keep her under control till am. Start the mag. an hour into it the UC's are now stronger and more frequent, now complaining of upper abd pain and difficulty breathing. Mag off, doc paged again, in for stat c-section.
    Get in 50% abruption!!! Baby is good for 34 weeks. Only that wasn't the last of it. She comes back from pacu at change of shift. come back that night. She is in CCU. NO urine out put x 10 hours. Eventually ends up on dialysis. platlets drop to 20's and has several transfusions. She stayed in the hospital x 3 weeks. Poor thing, this was her first baby and had been trying for 10 years. Probably be an only child.
  14. by   JenniferNRN
    We had a pt a few months ago, 37 wks, with an abdomen that was growing bigger as the hours went by throughout the night. They kept measuring her abdomen and noting the change, and she felt pain that were not UC's. Increasing temp as well. NG was inserted and surgery did a lap on her. Ruptured appendix, really nasty infection.

    They did an appendectomy and had her on the med-surg floor with NST every 4 hrs (I think). One NST turned up UC's. SVE showed cervical change, ended up delivering...vaginally... on the same day as her appy. Everything turned out well in the end. I was impressed!

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