Published Dec 11, 2002
A while back I posted about a 17 year old girl who was in the ICU comatose following a c-section. The monitor showed fetal distress and the stat-c-section went smoothly but the pt never woke up and later went into DIC. She had been dx with Hellp Syndrome. Later on, it turned out that it wasn't HELLP syndrome, but that it was fatty disease of the liver. After 2 months on a ventilator, I am sad to say that she passed away last week. Her baby girl passed away a week later(she was initially OK then wound up coding a few weeks later and then she was OK again and then she went downhill) and her family is understandably devasted as are the LDRP nurses. What I want to know is this: Is there any way this could have been prevented or at least screened for? She had prenatal care at our clinic and her pregnancy was uneventful, however, she came to the ER several times throughout her pregnancy with complaints of "not feeling right". Nothing significant was ever found. A week before the c-section, she was treated for a UTI.There was never any evidence of PIH. This is the most horrible thing I have ever seen and I never want to see it again. Are there any subtle s/s or any screening tests? Also, is it genetic? Has anyone else seen this?
That is horrible!!!!
So VERY sorry....Fatty disease of the liver is often terminal..It is easily missed, and liver panels wouldn't have been routine in a normally healthy teenager UNLESS she demonstrated symptomology...Interestingly, not long ago we had a young pt who was a frequent flyer with similar complaints exCEPT she complained of epigastric discomfort and flank pain. One very astute RN (not me) encouraged the OB to draw a PIH panel, and Bp was ok-she had been ruled out for UTI as well...Sometimes you have to look past the frequent flyer thing, or that they are teenagers who are SUPPOSED to be self absorbed, and look for zebras. Please tell those nurses that they did the best they could possibly do, and if any good whatsoever can come from this awful tragedy, it is that they may NEVER dismiss routine or vague complaints in a pt...These things teach and form us into good nurses.....Mom and babe are most likely together in heaven.....Thankyou for the update....
Yeah, I think everyone kind of chalked her up to being young and frightened since she was so young. I guess it pays to listen to your patients.
HOW SAD> really makes you think, doesn't it. I feel SICK for her family. What a tragedy.
Yeah, it looked like the baby was going to be OK so at least even though they lost her they still had a part of her. But then the baby took a turn for the worse Now they feel they have nothing.
that is so awfil. i am sure your staff did everything they could for her. poor family. i hope they take the time to have the staff sit down in groups to let them talk about it. i had incident once where baby died during svd. staff involved were devestated. it was good to sit down and talk about it. physician wasn't part of the debriefing. should've been. there was a lot of emotion there. no one's fault. i don't want to detail it here, but your staff need to talk about it.
how awful it is to lose a patient.....it makes you rethink your whole career choice. esp a young person. i feel for you. i have been there recently, myself. it is pure hell. hang in there.
KRVRN, BSN, RN
Oh MAN! The baby died too? How awful. I'm so sorry for that family.
I don't recall... was the baby a preemie? Do you know why she coded and died?
Yeah...it was worse because the baby seemed to be doing OK so it was unexpected.
No, the baby was full term. She went into respiratory distress and stopped breathing. I don't know much about fatty liver except that the disease affects the baby ,too. I just don't know how. I haven't had time to do the research yet.
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