18 week grandbaby died, questions

[KaroSnowQueen]

My son's fiancee was 18 weeks pregnant and went into labor Saturday afternoon. They went to the closest ER, not the one where she was going to deliver, an hour away. This ER said she was 4 cm dilated, that the bag of waters was protruding AND they could see the head. They broke her water, put her on a pit drip and sent her to L&D. When she got to L&D, they said she was only 1 cm dilated, and couldn't figure out why they broke her waterand stopped the pit drip. They then transferred her to the hospital she originally was supposed to be at.

To make a long story short, the baby God bless his little heart, lived inside her until 9 pm Sunday night, when we watched his little heart, which had been beating so strongly, always 130 or over, suddenly give out on the monitor. She delivered him at ten oh six.

Now a couple of questions:

1. How could she have been 4cm and half an hour later been 1cm? Is that really possible? Or is this ER, which is in a one horse town just full of idiots?

2. If they hadn't broken her water, could they have tried to stop the labor and do a cervical cerclage once she was stable, if she did stop laboring?

3. And they thought she was fine, out of danger, sent us home to sleep around 1 am Monday, she spiked a temp over 105, has a massive uterine infection, they sent her home last night anyway on many antibiotics, she is bleeding so hard she is wearing her peripad inside an adult diaper. How much chance is there this 18 year old girl will be able to have another baby, will this permanantly damage her uterus?

4. And finally, another family member has had a child in a huge children's hospital for several months, and said they saw a 17 week baby born, treated and go home after 5 months in the NICU. Is this really possible, or are they maybe hearing the baby was 17 weeks early instead of 17 weeks along????????????

Thanks for listening, and hopefully for answering.

[fergus51]

My last hospital's ER would cal us in L&D if a woman was 4 weeks pregnant.... even if the problem was a broken ankle!

[KaroSnowQueen, RN]

No I cannot tell you with any certainty that it wasn't because of managed care. They had Anthem, which was asked about ten times and before she even started into hard labor or before the baby died they were telling her she would go home four or five hours after the baby was delivered. I guess we are fortunate they actually kept her 18 hours after it came. Presumably bedrest and oral ABT can be given at home and the pt observed. Like the family is going to ask her how much she is bleeding, know to obs for shock, etc. And would they have enough sense to know to bring her back and for what symptoms? Not denigrating them, but your average person either panics over nothing or ignores everything, in my experience.

[NicuGal, MSN, RN]

I am so sorry for you all That is hard. And then all of this on top of it

First, I would be hauling butt back to the ER if I were bleeding that much..she may have some retained placenta if she is bleeding that much. It should be like after a regular delivery, not that much blood...that sounds like way too much. And as for the infection...I would really question that too...she sounds like she needs to be on IV antibiotics. Did she see her regular OB? If she was at a bigger center, I would really insist on seeing an attending, not a resident. Did they do a D/C after?

If her water was bulging thru the cervix, no they can't do a circulage. The best they can do is put you in head down. If they aren't contracting, just dilating, unfortunately, there isn't anything they can do

And I am sure that the others meant 17 weeks early, which would be a 23 weeker. No baby has ever survived at 17 weeks. Most of the time, they won't try to stop full blown labor until 21 weeks.

I am sooo sorry once again.

[OBNurseShelley]

We' have pt's come in that have a bulging bag of water, dilated 5+ and we put the min severe trendelenburg, put a rescue circlage in and start MGSO4, as well as antibiotics, we recently had someone at 16 weeks come in with twins like that and she made it to about 30 weeks, the babies are now home and fine, anyway, my point is....seems to me the ER had no freaking clue what they were doing, where i work at, the ER won't even LOOk at a pregnant person over 12 weeks gestation!

[KaroSnowQueen, RN]

OBNurseShelley, thank you. That is exactly what I thought should be done, not sure of the specifics, but seemed some course of action to at least ATTEMPT to save the baby would have been the proper course for them to take. Of course I wasn't there at the time, it wasn't my hospital, not even my daughter having the baby, but seems there could have been something like that done.

The OB said it could have been tried, wasn't sure it would have worked, but by the time she was consulted it was way too late.

My almost DIL is feeling somewhat better, her temp is down, still on bedrest for another 5 days, have postponed the memorial for the baby until she is up and about.

This all sucks. Bad. I want to break things.

[DIPLOMATICRN4HIRE, MSN, RN]

Im so sorry for your loss. I can say in my opinion this is one major cluster F%%%, with the amount of bleeding that you reported that she was having, she should have had a d&c done just to evacuate the uterus, if there were an underling infection it would have been located and treated immediately. The normal amount of bleeding would have been the same of a delivery its self, the clue of something going wrong is the fact that the bleeding is heavy, and saturating as you said. If it is possible I suggest that you get a certified copy of the chart which the patient can request for, and review it, find a ER and a OB nurse and go through every inch of it. Im sure you will find clues that may help you to better understand the care given. I do hope that she also recieves help with her grief.

Zoe

[hoolahan, ASN, RN]

{{{{{Karo}}}}, I don't know the first thing about OB nursing, but I want to tell you how sorry I am that this happened to your family. Sounds like some big-time negligence was done here.

{{{{Karo}}}}}

[KaroSnowQueen, RN]

I really appreciate all the information and support you guys are giving me. This has been one of the most horrific weekends of my life, and it has been so draining trying to be there for these kids when all I want to do is scream and break things and cry, but instead have to be strong and hold them up while they do those things.

[KRVRN, BSN, RN]

LAWSUIT

They shouldn't have broken her water OR started pit.

[BBnurse34]

Sorry for your loss.. my prayers are with your family.

At 17 weeks with bulging membranes and a visable head, I don't think the outcome would have been different without the AROM or pit. LD probably turned the pit off because the labor was progressing and they were thinking of the mother's comfort.

[KaroSnowQueen, RN]

But how could they have seen membranes and a head, claiming 4 cm, but half an hour later when L&D finally got involved, there was no presenting part and only 1 cm dilated?????????????

I think something is rotten somewhere in that ER.

They turned the pit off because they finally called the attending OB and she had a cow at them.

I appreciate your thoughts, BBnurse34, but it didn't happen the way they claim it did, I just don't see it.

[neneRN, BSN, RN]

I'm an ER nurse, have NEVER EVER seen pit started on an ER pt. I've also never seen membranes ruptured in the ER. Pregnant pts in the ER at my facility are initially examined by ER doc, with FHT by nurse. The OB is then consulted it the cc involves the pregnancy.

In a case like this at our hospital, the pt would have been rushed to OB immediately after physical exam findings. The only time ER does significant intervention is with the rare pt who presents crowning and we have to deliver RIGHT NOW. Even then, the LD nurses and any OB/CNM in house come down if they can get there in the few minutes we have.