Unethical or just plain dumb or am I missing something???

Elvish, BSN, DNP, RN, NP · Mar 22, 2011

18 weeks and they magged her?? I have never ever heard of anything like that. I am dumbfounded right along with you.

The only thing I can see is if they scanned her and the scan didn't match up with her dates and they are doing it because they think she's more than 18...that still leaves a LOT of room for doubt but it's the only possible scenario I can imagine that might justify it.

Jolie, BSN · Mar 22, 2011

Perhaps it is the uncertainty about the ROM that led to MgSO4 treatment?

As a side note, I was contracting and dilating (though not to 4cm) at 16 weeks with my third pregnancy. Membranes were definitely intact, though.

She just turned 13 last month :)

steelcityrn, RN · Mar 22, 2011

What do you feel they should have done at 4cm's?

L&DRN03 · Mar 22, 2011

She was IVF so I'm guessing the dates were pretty accurate. It's an unfortunate situation but we can't attempt to save every baby by putting mother's health on the line. I felt that they should have made her as comfortable as possible and let what will inevitably happen anyway. My facility just attempted this a few weeks ago when we magged a 22wkr that SROM and she got infected not to mention her mg level rose to a 9. I'd hate to see a rise in maternal mortality when trying to save non-viable babies.

bagladyrn, RN · Mar 22, 2011

I saw this done in a high risk antepartum unit with a G8 P0 in her late 40's who was willing to do whatever it took to have a child, having already gone through multiple interventions just to become pregnant. Other measures were employed along with the mag.

Since I'm a traveler I don't know the ultimate outcome, but when I left there she was past 30 weeks, with a live fetus with a fairly decent FHR pattern (considering the meds)

NurseNora, BSN, RN · Mar 22, 2011

If this pregnancy was the result of IVF, the parents might be willing to take any chance at all of getting a baby. If she was given full information as to the risks to her, the chances of getting a live baby, the quality of life that baby might expect, then I think it's her decision. (Who should be expected to pay for such over the top treatment is not part of this discussion at this time).

When I worked in a Level 3 place, we often did some non standard things and sometimes they worked. With a pregnancy that immature, the perinatologist would talk very seriously about risks and benefits and have all the numbers at his fingertips to give the couple to help them make the decision. A neonatologist would also visit and go over the same information with specific reference to the baby. At some point, a nurse would take her to NICU (on a stretcher if necessary) and let her see babies at various gestational and birth ages.

Since they're not sure if she's intact or ruptured, perhaps they are considering doing a cerclage. Ten years or so ago when I worked high risk, we would sometimes do an amniocentesis and inject dye and then put in a tampon to see if she was leaking.

What's her history been? Has she just been unable to conceive, or has she also had fetal losses? Perhaps she just has an incompetent cervix. If so, put her in Trendelenburg, put in a cerclage and it could work--if she's not ruptured. If she is the baby's lungs will probably not develop.

NPinWCH · Mar 22, 2011

Perhaps she just has an incompetent cervix. If so, put her in Trendelenburg, put in a cerclage and it could work--if she's not ruptured. If she is the baby's lungs will probably not develop.

Had a patient in this situation walk into our level 1, but she wasn't ruptured as she had hour glassing membranes. She had been trying for YEARS to get pregnant and finally had an IVF that took. She was visiting friends in our area. We magged her and transported her to the university hospital. They continued the mag, put her in trendelenburg and when the membranes reduced they put in an emergency cerclage.

She managed to maintain her pregnancy until she was 30 weeks. She sent us a picture of her baby's first Christmas. So, sometimes there is hope. Now had she been ruptured the outcome probably wouldn't have been so good.

klone, MSN, RN · Mar 22, 2011

What was her AFI? If it was a good number, it's possible they can get her to viability. I don't know that an emergency cerclage would work at 4cm, though.