OB Emergencies

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Okay, this is kind of long but I wanted some input on this. Let me give you some back ground. I work in a rural ER( level 4 and 9 beds). We triage all OB's that come in except scheduled inductions or scheduled sections. We call L&d if they are greater than 20 weeks with + ROM, vag bleeding, contractions, or HTN. We MUST give report to the L&D nurses and get an OK BEFORE we bring them to L&D. This afternoon we got a call from the ER clerk for a w/c in the parking lot. One of the medics and the ER tech went out with a w/c. The came back in with a VERY pale BF, extremely diaphoretic and near syncopal( eyes rolled back and head lolling). He said he needed a room NOW. I pointed at the trauma room and he said no OB :eek: We get her into the gyn room and I noticed that she had lost ALOT of blood lady partslly and there was clear fluid mixed in. While getting her into a gown and assessing her she begins to vomit and complain of sharp pelvic pain. I find out that she is G2P1 7month OB. While we are getting her in the bed I send for the ER doc. He checks her pelvicly while I get VS. She is not dilated but the blood IS lady partsl. VS tachy at 119. BP 140/100 sat 100%. We get a line and the OB shows up and asks WHy she is still in the ER. I told him she had just got there 5min ago and that I felt she was not stable enough for me to transport before getting vs and stablizing. He wants her in L&D so I call report and get her to L&D. She was in ER 13 min. I called the House super to get and update and she said she would callme. 30 min later she called and asked how long the pt was in the ER and I told her. She told me that the pt had gone for and emergency section. She had total abrutio and the baby had not made it. Apparently some of the staff in L&D had made some negative comments about me not bringing the pt immediately back to L&D. I was taught that we stabilize first and we treat mom first. I feel like I did what I could and was supposed to do but I would like your opinions about what you would have done. Thanks. BTW I am NOT an OB nurse I REALLY don't like OB very much at all. I like one pt in one body. I have all the respect for all the ob nurses. more power to ya.

Do you have any advice for an ER nurse with an OB emergency and no OB services. I, too, work in a small rural hospital , but we have no OB service. The nearest facility is 30 minutes away and the only OB patients we get are usually young and with no prenatal care. I know this is a disaster waiting to happen and we do the best we can, but the last two we had did not turn out very well.

The one yesterday was bleeding and 4cm dilated. We contacted her OB and he declined her because she was less than 34 weeks pregnant and they do not deliver less than 34 weeks. We had to fly her to a larger hospital who delivered her by C-section within 30 minutes after her arrival to their facility. She was, by their ultrasound 33 weeks.

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Do you have any advice for an ER nurse with an OB emergency and no OB services. I, too, work in a small rural hospital , but we have no OB service. The nearest facility is 30 minutes away and the only OB patients we get are usually young and with no prenatal care. I know this is a disaster waiting to happen and we do the best we can, but the last two we had did not turn out very well.

The one yesterday was bleeding and 4cm dilated. We contacted her OB and he declined her because she was less than 34 weeks pregnant and they do not deliver less than 34 weeks. We had to fly her to a larger hospital who delivered her by C-section within 30 minutes after her arrival to their facility. She was, by their ultrasound 33 weeks.

EEEKKK! That is a bad siuation. My advice to you is to research emergency treatment for OB's in your TNCC courses. Also I would recommend NALS as well as PALS these have some really good neonate info in them. Also do you have round the clock ER docs? Most ER doc have experience with OB (I said most NOT all). Anyway, as with any other trauma's you have to treat the symptoms as well as get to the bottom of the cause. Remember, as an ER nurse, you treat MOM first then try to work on baby. If mom goes bad so does baby. I know the OB nurses have differing views on this but in the ER we usually don't have tocometers or continuos FHT monitoring. If you are like us you have a little hand held doppler and that is it. You have very little ability to really monitor baby. Your best bet is to stabilize and ship. Like what happened to me, even with OB/GYN on the premises you can still get bad OBs in the ER you still stabilize and ship( TO L&D) Good luck!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
EEEKKK! That is a bad siuation. My advice to you is to research emergency treatment for OB's in your TNCC courses. Also I would recommend NALS as well as PALS these have some really good neonate info in them. Also do you have round the clock ER docs? Most ER doc have experience with OB (I said most NOT all). Anyway, as with any other trauma's you have to treat the symptoms as well as get to the bottom of the cause. Remember, as an ER nurse, you treat MOM first then try to work on baby. If mom goes bad so does baby. I know the OB nurses have differing views on this but in the ER we usually don't have tocometers or continuos FHT monitoring. If you are like us you have a little hand held doppler and that is it. You have very little ability to really monitor baby. Your best bet is to stabilize and ship. Like what happened to me, even with OB/GYN on the premises you can still get bad OBs in the ER you still stabilize and ship( TO L&D) Good luck!

good advice.

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Specializes in L&D< Obstetrics , Med surg, Manager.

As all nurses know, you can't be knowledgable witrh every aspect of medicine. I think the idea of OB patients being triaged in the ER is very dangerouos at any gestation because of the scenario that happened to you. If your hospital is going to continue with this, a L&D nurse should be in the ER when any OB patient comes in. I have worked in OB for 17 years, when you get a call that a probable abruption is coming in , you are getting everything ready on your unit to get her delivered. That may be what happened at your hospital and why they didn't call you.

Okay, this is kind of long but I wanted some input on this. Let me give you some back ground. I work in a rural ER( level 4 and 9 beds). We triage all OB's that come in except scheduled inductions or scheduled sections. We call L&d if they are greater than 20 weeks with + ROM, vag bleeding, contractions, or HTN. We MUST give report to the L&D nurses and get an OK BEFORE we bring them to L&D. This afternoon we got a call from the ER clerk for a w/c in the parking lot. One of the medics and the ER tech went out with a w/c. The came back in with a VERY pale BF, extremely diaphoretic and near syncopal( eyes rolled back and head lolling). He said he needed a room NOW. I pointed at the trauma room and he said no OB :eek: We get her into the gyn room and I noticed that she had lost ALOT of blood lady partslly and there was clear fluid mixed in. While getting her into a gown and assessing her she begins to vomit and complain of sharp pelvic pain. I find out that she is G2P1 7month OB. While we are getting her in the bed I send for the ER doc. He checks her pelvicly while I get VS. She is not dilated but the blood IS lady partsl. VS tachy at 119. BP 140/100 sat 100%. We get a line and the OB shows up and asks WHy she is still in the ER. I told him she had just got there 5min ago and that I felt she was not stable enough for me to transport before getting vs and stablizing. He wants her in L&D so I call report and get her to L&D. She was in ER 13 min. I called the House super to get and update and she said she would callme. 30 min later she called and asked how long the pt was in the ER and I told her. She told me that the pt had gone for and emergency section. She had total abrutio and the baby had not made it. Apparently some of the staff in L&D had made some negative comments about me not bringing the pt immediately back to L&D. I was taught that we stabilize first and we treat mom first. I feel like I did what I could and was supposed to do but I would like your opinions about what you would have done. Thanks. BTW I am NOT an OB nurse I REALLY don't like OB very much at all. I like one pt in one body. I have all the respect for all the ob nurses. more power to ya.
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Specializes in med surg, SICU.
She obviously didn't take care of herself or she wouldn't be 5'4" and 250 pounds.

Because all people who are 5'4" and weigh 130 lbs are healthy...

Not defending obesity, just saying... As a shall we say "voluptuous" woman who happens to be pregnant myself, I can vouch for the fact that overweight moms can have good blood pressure, normal blood glucose, normal lipid panel... you get the picture. This mom should not have waited to come in, but a skinny lady in the same situation could have been equally as unfortunate... :madface:

Sorry to be a little off topic, but I felt this needed to be addressed...

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Specializes in Pediatrics, Nursing Education.
The patient also should not have waited to come in. She obviously didn't take care of herself or she wouldn't be 5'4" and 250 pounds.

What are you saying? That it was her fault, she did it to herself? That's awful hateful and uncaring response... there are other reasons people gain weight in their pregnancies. Undetected or untreated gestational diabetes is one.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Weight issues, aside, wouldn't you all say the OP handled this situation amazingly well????

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Specializes in Case Management.
Weight issues, aside, wouldn't you all say the OP handled this situation amazingly well????

Yes she did! and I sincerely hope she never looks back on the situation without feeling very proud of herself. As many posters have said, she saved Mom, and baby was probably gone before she presented to the ER.

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I briefly read through the notes but I think two things are getting lost.

1. First, RN's don't diagnose medical conditions (abruption) they can have their suspicians they also can't treat it (do surgery)

2. No amount of "stableization" could have helped either mother or baby. Sure there is getting them ready for surgery but I would call that stableizing. You could have "stableized her all anyone wanted" given her Oxygen, pumped her full of fluids and blood and she would have still bled out until a C-section was performed. She would have died.

The fact that you attempted to doppler and couldn't get anything probably determines the baby was already dead. The only thing more conclusive would have been an US but then again that is time she didn't have. i think you did fine. I do agree that some sort of a meeting has to happen with ER and L&D to solve issues from this happening again.

When things like this happen time is of the essance. I know you said small rural hospital. I know OB's don't have to be In-house I'm assuming one was there but they might not have been. In my opinion there should be someone there always who could do a C-Section in an emergency wether it is an OB or a surgeon in the ER.

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