doppler at 16 weeks

Published

Specializes in nursery, L and D.

Hi 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?

Up Vote Up Vote ×
Specializes in Nurse Manager, Labor and Delivery.

Holy Cow!! I think by now I would be getting an ultrasound to make sure there is activity going on in there. Why torture a mom like that?

Up Vote Up Vote ×

Sounds 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!

Up Vote Up Vote ×
Specializes in nursery, L and D.

I'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!

Up Vote Up Vote ×
Specializes in Community, OB, Nursery.

I 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.

Up Vote Up Vote ×
Specializes in nursery, L and D.

Sadly, 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.

Up Vote Up Vote ×
Specializes in Community, OB, Nursery.

Oh.....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.

Up Vote Up Vote ×
Specializes in nursery, L and D.

Thanks elvish. It was...........a nightmare.

Up Vote Up Vote ×

Very 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.

Up Vote Up Vote ×

but, the cold hard fact, would it have changed the care she was given, one little bit?

Up Vote Up Vote ×
Specializes in nursery, L and D.

Maybe not her medical care but I know for me, knowing, even though it was bad, was better than the anxiety of questioning.

Up Vote Up Vote ×
+ Join the Discussion