Premie vs. "Miscarriage"

mother/babyRN, RN · Nov 23, 2003

Sometime ago we had a couple with ruptured membranes and 21 week twin gestation. They insisted everything be done and they would sue if we didn't...Once the membranes are ruptured, this is all they can do...The doc was wonderful at attempting to explain the fruitlessness of the thing, but they threatened to sue all of us anyway...Sadly, no amount of information provided did anything to disuade them as their grief was too huge..Of course the suit was thrown out...

TonyafutureRN · Nov 23, 2003

Just wondering what the protocol is with very early women and ROM. At the hospital where I delivered I was in at 32 weeks with contractions and put on magnesium (I ended up delivering a week later when my water broke). My nurse was telling me about a patient they had just had who came in at 22 weeks with ROM and they kept her in bed on antibiotics and every measure to prevent infection and said she made it to 33 weeks and her baby was fine. Does it depend on if the bag only has a small tear or a "gross rupture" (what they called mine)? I am curious. I plan to go into L&D after I get my nursing degree so I may ask a lot of questions. Sorry! Tonya

mother/babyRN, RN · Nov 24, 2003

Congrats on you and a healthy baby....Sometimes we see problems with hypoplastic lungs when the membranes have been ruptured so long as you mention with the 22 weeker...I have seen them try to do that for 24-25 weeks and beyond because if you can get someone to 28 -29 weeks they have a better chance of survival....I don't think it is ever an easy call...

L&D_RN_OH · Nov 24, 2003

Originally posted by TonyafutureRN
Does it depend on if the bag only has a small tear or a "gross rupture" (what they called mine)? I am curious. I plan to go into L&D after I get my nursing degree so I may ask a lot of questions. Sorry! Tonya

yes. this pt had no sac around baby a, on us.

TonyafutureRN · Nov 25, 2003

Oh, OK. Thanks. I figured how much amniotic fluid was around the baby would play a role. And thank you to the other poster for the congrats on the healthy baby. She was very healthy. Even though she was only 33 weeks, she went straight to the newborn nursery after being examined by the NICU team. She was 4 lbs and 15 oz, and she was breathing, nursing, and keeping up her blood sugar well on her own, so she didn't need any assistance. She was just little. Now she is turning 1 and she's about 19 pounds, and she's very healthy, just one mild case of sniffles so far .

L&D_RN_OH · Nov 25, 2003

Originally posted by TonyafutureRN
Now she is turning 1 and she's about 19 pounds, and she's very healthy, just one mild case of sniffles so far .

My 7 pounder is turning 1 next month. She weighs 18 lbs. Sounds like your "little" preemie has caught up. :)

TonyafutureRN · Nov 25, 2003

Wow! My first daughter was 7lbs 3 oz at birth and over 20 lbs at 9 months. Good old mama's milk LOL. Tonya

crankyasanoldma · Dec 1, 2003

Our survival rate at 23 weeks is 50%. I understand the nat'l average is 10-30%.

dragonfly954 · Dec 1, 2003

I am not a NICU nurse,but had a recent family experience with a micro preemie(as I've heard them called?).My niece was 22 weeks(via ultrasound and amnio) when she developed severe toxemia last june 1.At 20 yrs,no health Hx or pregnancy complications at all until that morning.She woke up swollen everywhere.Admitted to hospital,flown to another hospital,crash section within a couple of hours.She was told the baby would not survive.Mother in renal failure,cardiac problems,etc.NO time to hold off the delivery.No support staff in OR for the baby because she wasn't expected to be viable and if born alive die within a few minutes.She wanted the child to peacefuly go without all the trauma.Well the little person had other ideas.She came out wiggling and squeaking and trying to breath on her own.MD and nurses ran like he$$.She came home the day before thanksgiving.We were told she is a miracle to be here at all.:)

TonyafutureRN · Dec 28, 2003

Wow, that is an amazing story. I remember reading another story a while back about a baby that survived after being born before babies were considered viable ( I think it said 4 1/2 months after conception, not sure of the weeks). Tonya

NicuGal, MSN, RN · Dec 30, 2003

I hate to be the cynical one, but those little 22 week miracles most likely have some problems down the line. We have had a huge influx of just barely 22 weeks.....they are all pretty much a mess at some level or another. Most of them have some form of CP, eye problems, deafness, bad lungs, bad CHF, you name it, they get it.

We are pushing the limit, that is for sure!

fergus51 · Dec 30, 2003

You;re not the only cynical one! Since I took a job in the NICU, I think I would not want them to treat my child if I had a 24 weeker. 22 weeks and I wouldn't even go to the hospital. I think doctors who agressively rescusitate at 22-23 weeks should be shot.