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.
Geez, we had a mom in AP who ROM'ed at 14 weeks. Baby delivered at 25 with pretty hypoplastic lungs but he made it and he's home now.
For all the sucess stories, I'm sure that we in the NICU don't hear about a lot of the other ones. Though I did get called to the ED for 20 week twins. EMS reported that they were term. Maybe if you add them together! Needless to say, they'd passed en route and were still attached to mom. Placenta hadn't delivered yet. And thus is my one and only experience with 20 week twins.
In my facility, we would have magged, tapped and evaluate for a cerclage. 2-3 is nothing if she is not infected, and we could slow the contractions down. At least we could have tried a delayed interval delivery if not infected. but a 20 wks, they are not considered viable, and parents still have an option.
I'm not a nurse, but I went into labor w/ my second son at 21 wks. They did everything they could to stop my labor and luckly they kept my kid in until 35 wks 2 dys. I couldn't imagine me letting any doctor induce me at 20 wks just because of PTL, I would have left that hospital RUNNING if anyone even suggested that.
Who knows why that mom let it happen or even wanted it to happen.
Like I said, there has to be more to this story, even more than we have heard so far.
There really isn't anymore to this story. I know how you feel though, thinking, this just isn't right, there has to be something else going on. I wasn't in the room with the doc when he told her about options, I wonder what was said. The only other thing that I found out by talking to some of the nurses that cared for her (I left early the night she delivered, do I didn't take care of the babies) is that her amniotic sac was hourglass, but not bulging upon SVE. Not ruptured. Maybe it was an unplanned pregnancy and she really didn't want the babies, maybe the doc scared her into it? Who knows, it just got to me for some reason.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Unless we know this patient's mind and heart, I suspect there are things we don't know. That is what I am saying. Otherwise much about this situation troubles me deeply.
Unless we know this patient's mind and heart, I suspect there are things we don't know. That is what I am saying. Otherwise much about this situation troubles me deeply.
This is true, we don't know what she was going though, what she was thinking, etc. I wish I knew what the doc said to her. There have been many situations like this that have troubled me, stayed on my mind and bugged me for months, at this hospital. I am seriously thinking about changing hospitals as soon as my husbands insurance kicks in (he just changed jobs). Thanks for all your responses, it is always good to hear what other places do. I think I might go into L and D, instead of mother/baby! We had another situation a couple of years ago that really, really bothered me (can't say much hear, litigation is very possible) and the doc is still working with us, and I want to punch him in the face every time I work with him:lol2: , seriously it is hard to continue working with someone when you know they don't care about their Pt's. I have totally went off topic here, lol. I will let you guys know if I learn anymore about this, maybe something that will put my mind to rest about it.
There was a story in the local paper a couple of years ago about a woman who delivered one twin at 18 weeks. They were then able to stop her labor and she got to 35 weeks with the second baby. The mom was admitted with PTL and the first baby ruptured shortly after she went to the hospital.
At my hospital, we would have done whatever we could to stop the labor including, if possible, a cerclage. We aren't always successful, but at least we know we did everything we could. Barring any threat to mom's health, we would not be augmenting preterm labor at 20 weeks.
2curlygirls
220 Posts
Geez, we had a mom in AP who ROM'ed at 14 weeks. Baby delivered at 25 with pretty hypoplastic lungs but he made it and he's home now.
For all the sucess stories, I'm sure that we in the NICU don't hear about a lot of the other ones. Though I did get called to the ED for 20 week twins. EMS reported that they were term. Maybe if you add them together! Needless to say, they'd passed en route and were still attached to mom. Placenta hadn't delivered yet. And thus is my one and only experience with 20 week twins.