20 week twins PTL

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Specializes in nursery, L and D.

So I was wondering what would have been done where you work. I'll write this as a case study kind of thing.

G1 20 weeks 1 day twin pregnancy. No previous diseases or problems with pregnancy (except the twin gestation). Scant dark red bleeding. Mild contractions (irregular) SSE revealed 3cm, -3 station. Both FHT 140's, fetuses active. Membranes intact.

Would your docs have tried to stop this PTL, let woman deliver, or give pit, etc?

BTW, this is not a personal experience or anything, something I ran across at work, and wondered what other hospitals would do.

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At the hospital I use to work L&D at we would probably tried to stip the PTL and give steriods. Unless there were other issues there should be no reason not to at least try to stop the labor.

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Specializes in Community, OB, Nursery.

Where I am they would probably have tried to mag her into stopping the labor & then keep her in-house as an AP on bedrest until she's stable for a couple weeks.

What did your hosp do?

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Specializes in nursery, L and D.

They did pit to augment. No effort at all was made to stop the PTL. Sad.

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Specializes in midwifery, NICU.

So why did they augment at 20 weeks ?? Sounds like v bad mismanagement from the med staff!

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Specializes in nursery, L and D.

I go back tonight and will hopefully get more answers.......but from the info I have =no anomlies, no problems, just PTL at 20 weeks with twins......I know twin gestation is a serious complication of pregnancy but I didn't see any reason to augment........I'm not an OB/GYN though, they always remind us of that.

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Specializes in Community, OB, Nursery.
They did pit to augment. No effort at all was made to stop the PTL. Sad.

You have got to be kidding!

At least ship her out to be managed elsewhere, for Pete's sake!

And twin gestation is not THAT serious a complication so as to warrant pit augmentation!!

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

Here is what we would have done:

Bedrest and foley catheter placement

IV magnesium to stop labor

prophylactic IV abx if labor looked unstoppable/delivery probable in next 24 hours

steriods x2, 1 now and again in 12 hours (betamethasone)

if stable enough, ship to nearest Level III facility for NICU access at earliest possible opportunity---where they would do everything to keep babies in utero for longest period possible. Membranes not ruptured, reasonable chance to keep pt pregnant for quite a while, often!

NO WAY would we have pitted a case like this, but I have the strong feeling there is more to this story.

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Specializes in nursery, L and D.

Nope, no more to this story at least as far as I can find out. Just PTL, I am going to ask around and see if there is something I don't know, this is really bothering me. I'll let you guys know.

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Specializes in midwifery, NICU.

Criss.what are the parents doing re...going after the docs who made the decision?

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Specializes in OBSTERTICS-POSTPARTUM,L/D AND HIGH-RISK.

I was wondering also if something else was going on. Did the mom have a elevated temp? Did they suspect an uterine infection? If none of these things were occuring ,she would be on bedrest and given steriods times two doses.And a few times I have seen them put cerclages in at this gestation. She's not ruptured and the station is at -3. There are so many things that can be done to prolong pregnancies. That's the wonderful thing about this field of nursing. We get to see and help manage these pregnancy to a point where babies are being born and doing well. When not so many years ago babies didn't do well or even make it.That's what I love about being an OB nurse.:roll

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Specializes in nursery, L and D.

I have learned a little more about this situation. I looked at the ultrasound report. Obviously I don't want to say to much on here, but the gist is, no infection/no elevated temp. , babies looked fine on ultrasoound, no placental problems, mom dilated 2.5cm on ultrasound, suspected cerivical imcompetence. Md discussed options with mom and she chose to go ahead and deliver.So they augmented with pit and she delivered. Infants died several hours later. I am guessing our docs didn't give her much hope regarding the pregnancy, they usually feel like if they are in PTL at 20 weeks the pregnancy is doomed. I just have seen so many women make it longer and have health babies. So sad.

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