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Discussion

Chorio management

Hello, I am relatively new to L&D. I work in a very high risk unit. I see a lot of Chorio inductions on babies under viability. It is burning me out. I am allowed to opt out of terminations for fetal anomalies, but not Chorio.

Are there hospitals that won't do Chorio inductions before viability? Perhaps those patients are transferred? How do I identify those hospitals?

I really don't intend to start a debate.

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    Work at a hospital that doesn't do high risk pregnancy.

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    • Author

    Thank you. Are the "low-risk" hospitals not doing this? (generally speaking)

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    Generally no. I worked at a low risk hospital for several years and the only time I remember doing an IOL on a previable fetus was an 18-week PPROM.

    Generally we would transport those cases to the tertiary hospitals.

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    • Author
    Generally no. I worked at a low risk hospital for several years and the only time I remember doing an IOL on a previable fetus was an 18-week PPROM.

    Generally we would transport those cases to the tertiary hospitals.

    Thanks. High risk is all I have known and asking my coworkers about this is likely to raise red flags. Lately it seems like we are up to our ears with Chorio.

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    I know it's hard, but pre-viable chorio is a HUGE risk to the mother. HUGE. And carries almost zero chance of fetal survival. It's a terrible thing when a mother has to make a decision to abort a wanted child to save her own life.

    It wasn't clear from your post whether you felt that women with pre-viable chorio shouldn't be induced, or if you were just heartsick from having to deal with it all the time. If it is the latter, I can definitely relate. It SUUUUUCKS.

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    • Author

    I love L&D. I don't know if I'm cut-out for high risk OB. I think I will stick it out for a year and try to move to another facility. I feel really traumatized by some of the situations I have been involved with at work. I can't get them out of my head. I used to be a critical care nurse and dealing with death and dying there was much easier, and it helps me understand the grave matter of chorio. Can anyone else out there relate? I can't stop thinking about the ultrasound images of the babies I had to induce and the heartache if their grieving families.

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    • Expert
    I know it's hard, but pre-viable chorio is a HUGE risk to the mother. HUGE. And carries almost zero chance of fetal survival. It's a terrible thing when a mother has to make a decision to abort a wanted child to save her own life.

    It wasn't clear from your post whether you felt that women with pre-viable chorio shouldn't be induced, or if you were just heartsick from having to deal with it all the time. If it is the latter, I can definitely relate. It SUUUUUCKS.

    Having done my share of 18- and 19-week chorio inductions, I agree. It sucks royally. There is really no way around chorio that early except inducing. While there isn't a 'good' outcome here, I view chorio induction as a 'least bad outcome'. That is what helped me maintain my sanity when doing them, heartbreaking as they are.

    OP, I agree that the best way around this is probably going to be working at a smaller community hospital, the trade-off being that (sometimes, depending on the facility) there is less backup when other bad things happen. Best wishes to you.

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    I love L&D. I don't know if I'm cut-out for high risk OB. I think I will stick it out for a year and try to move to another facility. I feel really traumatized by some of the situations I have been involved with at work. I can't get them out of my head. I used to be a critical care nurse and dealing with death and dying there was much easier, and it helps me understand the grave matter of chorio. Can anyone else out there relate? I can't stop thinking about the ultrasound images of the babies I had to induce and the heartache if their grieving families.

    When things go bad in OB, it just feels so much more tragic than in other specialties. I had a cord prolapse a few months ago. The baby never so much as took a breath on her own. She is still on life support, and the parents are agonizing about what to do. I see that baby in my head every day.

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