Published Apr 15, 2001
We had a patient Gravida 4 para (now 4) Her first child was born c-section, the rest vbac. Her labor was induced. While laboring she suddenly got short of breath, sats dropped to 80's pulse 120's the baby decelled into the 40's then the fhr was lost for a few minutes.(they prepped for an emergency c-section) The mother was given O2 via mask, repositioned several times. She complained of numbness in one hand and in the face. Also she was having continuous contractions even after pit was stopped. They put fluid up into her uterus and anyway, the fhr increased and the mother recovered and was able to have the baby without c-section by vaccum extraction. The baby was meconium stained but is ok. However, the mother, who is very healthy (a dietician) otherwise is still complaining about her heart occasionally racing and it is documented that it get's in the 110's 120's. I am not an OB nurse and really would like to know why this happened. Any replies would be very much appreciated.
I'm not an LDR nurse but sounds like a pulmonary embolis? or maybe an amniotic fluid embolis? Her body may have vaso constricted due to a PE and thus constricted the vessels in the placenta causing the decels?? I'd like to know, too. Did they do a scan on her for PE's? Did she have a mild stroke?
Originally posted by timonrn:I'm not an LDR nurse but sounds like a pulmonary embolis? or maybe an amniotic fluid embolis? Her body may have vaso constricted due to a PE and thus constricted the vessels in the placenta causing the decels?? I'd like to know, too. Did they do a scan on her for PE's? Did she have a mild stroke?
A PE was my thought too, They didn't do anything about it, as she seemed to recover ok, sent her home after 24 hours with the babe. I think we send people home too early!I am concerned about future effects she might still have (?) I am a new grad nurse so not too experienced. What are your thoughts? I'm not sure what an amniotic fluid embolism is, could you explain? Thanks for your reply. Also the pt. is 34 years old and does have family hx of stroke (mother at age 30)
I just have to tell you that you are really something. I enjoy your posts immensley.
I agree with you on all fronts. Probably amniotic embolis. Was wondering if they checked for a uterine window--good area for amniotic fluid to enter the maternal system. What do you think??
We would have called a "Dr. Stork" (C/Section treated as a type of code). That brings us the help we need to get the baby out really quick. We usually only have 2 nurses on our L&D unit.
I would truly be very concerned with the Mom even at this time. And yes, our patients go home way to soon for my comfort.
Oh, the fun of working L&D!!! I still miss it though
Thanks for your reply. This may seem like a DUMB question, not being an OB nurse, but what is a uterine window? I know everyone was talking uterine rupture because of previous c-section.Is that what it is? But the doc decided it wasn't. It was pandemonium and the patient was (needless to say) scared to death.
I just took neonatal recusitation and so I had asked to go in to observe during several births so I could get an idea of what goes on and what to do if I actually had to be in on a delivery. Our hospital is only 35 beds and only one OB nurse works at a time so if we happen to get two mothers delivering at the same time I may get called in to assist at a birth. (And I want to be prepared!) You have really helped answer my questions. Sometimes I think the experienced nurses where I work get awful tired of my "wanting to know everything" !
I agree with Kday! It is interesting to read the responses to your situation! I have been in OB, L/D, HiRisk AP/PP, SCN, NSY,and Perinatal Clinic since 1977 in some capacity.(We use to strap the mom's down and I even remember one time a mom getting ether!)
What I know now c/t then!
You really need to reevaluate your position at that hospital. You are not going to get the quality of experience that you need. Having only 1 L/D nurse explains why the pt. wasn't crashed. Your hospital probably depends on surgery to supply the personnel for the C/S? Sounds like the first hospital I was at! It's admirable for you to want to go to the deliveries because you are NRP certified. Go to all that you can and when a 28 weeker arrives you won't feel so at a loss. The best course of action is to go to a bigger hospital if possible. Ignorance in nursing is not bliss, it's a case for a lawsuit 18 yrs from now. It's great to have questions, and there is not a dumb one out there! I respect a nurse that want to know the WHY's. This is a great website to ask them if your peers don't want to answer or don't know.
You're right! The hospital depends on surgery for c-sections. What happens is when there is a possible c-section they alert the surgery crew to be on stand-by. (The surgery crew, by the way are all at home unless there happens to be surgeries scheduled for that day) so it takes time to gather everyone and prep the OR. Maybe this is why the pt. ended up delivering vaginally.
our RT supervisor got fired recently because he "choked" (didn't know what to do) during an emergency c-section because he'd never done one!
Where I work we average 250+ births/month; we always have Surgeons on site altho not always an OB; What prompted us to iniate our "OB STAT" idea (that is, any MD in the house must RUN to OB to possibly deliver the baby--if it is an OB doc the better, regardless if it is your pt or not) was about 10 years back a mom had a uterine window that ruptured at home and by the time EMS got to her she couldn't see--anyways the only MD in the house was the worst OB doc known to man--you know the type--ready to retire and everyone covers his mistakes--but he did the emergency c/s and couldn't find the baby for all the blood-went in up to his forarms in the abd. cavity and finally fished the kid out from behind the liver--both lives were saved but mom needed a hyst becuz she went into DIC. The moral of the story is work at a hospital with these on site--OB residents (God bless 'em), anesthesia, RT, surgeons, NICU NP's, on-call LDR nurses, etc etc. You'll feel much better knowing they are just an in-house phone call away--
KDAY I WILL HAVE A DRINK WITH YOU WHILE WE FIGURE OUT HOW TO GET THIS BABY NURSE OUT OF THIS HOSPITAL!!!!! I agree so much, get out of there before you sign another note on a chart in that "OB department". Only one OB nurse on at a time???? Give me a friggin break.
Go to work in a teaching hospital if you want good high-risk experience. Otherwise, go to a medium-size community hospital. I work at both and feel comfortable at both. Much more so at the university, where, as mentioned above, there are all disciplines available all the time.
But please get out before you get burned. We can't afford to lose good nurses. Good luck!! We're here for you!
They resuscitated the baby inutero, with the saline flushes into her uterus. This is a fairly new technique that is being done more and more with great success. The baby obviously recovered quickly. Have an experienced Ob nurse or doctor explain this procedure to you and why that is done, instead of racing to a c-section.
Also, if the mother has no other symtoms, I would say that the racing hrt rate is caused by anemia, which is common in postpartum women. RELAX!!
[ May 22, 2001: Message edited by: feistynurse ]
I can't give you any nursing advise at this time (just start nursing program in August), however, I can give you a PERSONAL experience. My son was born by c-section just over 10 years ago and my OB-GYN said any subsequent deliveries would have to be c-section because of the width of my pelvic bone. When I became pregnant with my daughter, (thanks to HMOs) I had to use a different OB-GYN. We agreed to try a vbac although I knew in my heart it wasn't going to happen. Well, my due date came and went and I had yet to dilate. I asked him to induce if we were still going to do a vbac. He advised me that he would not induce after a c-section, because of possible problems such as what you all are describing. Although she had delivered vbac, perhaps he shouldn't have induced in the first place...just food for thought.
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