Weird L&D story..

Published

Well I work at a high risk L&D unit and yesaterday I saw something I have never heard of! A 16 yr old came to the unit-ambulatory by the way- saying that her bag of waters was hanging out of her lady parts. She was very calm. The RN didn't really believe her-should've taKen her word for it-and assisted her to triage where she gowned. Once she was on the bed she took a peak under and sure enough the bag was halfway out! She was 25+2 weeks. Needless to say she ended up a stat section. Found out today that the baby + for drugs. I know we can't stereotype but this girl as young as she was- was crying in the section saying why would this happen to her and her baby and so forth. Definetely played the part..wouldnt have thought she was on drugs- heroine and cocaine to be exact,

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Specializes in Maternal - Child Health.

Yes, I've seen this before, and rarely with a good outcome.

Whether due to unrecognized pre-term labor, or an incompetent cervix, these patients experience rapid cervical dilation, often painless. Because they are so pre-term, and their babies are so small, it is not necessary for them to dilate to 10 cm in order for the presenting part of the baby to "push" the membranes down thru the lady parts, in hour-glass fashion.

I have seen attempts made to "reduce" the amniotic sac by gravity; basically standing the patient on her head in complete bed rest with both the hips and feet elevated. Sometimes it will work long enough to get some beta-methasone on board to improve the baby's outcome. Only once have I seen a patient get to term, and that poor woman ended up being induced for post-dates, after months of bedrest! She had a healthy baby, though, unlike many other patients who present with this scenario.

I can't say whether drug use predisposes one to this complication. Anyone else?

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Unfortunately, have seen this before. We've tried complete bed rest in trendelenberg but it never works for very long. The worst case we had was a 24 weeker with hour glassing membranes who ended up with chorio. :o It went from, we'll do all we can to keep your baby in, to, we have to induce you to get your baby out for your own safety. Sad, sad case.

And the ones I've seen are not r/t drug use. Usually just incompetent cervix, or very mild, unrecognizable (to mom) ptl.

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Had one very recently. Sad indeed.

steph

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Had one of these recently also. It was the second time for this poor girl. 21 wks both times. Ended up being induced due to increased WBC's over a 2 day period of time - no fever though. Baby didn't live but for an hour. Sad, sad case indeed. Negative urine drug screen.

Of course, I told her to be sure to tell the next OB doc she had incompetent cervix.

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Specializes in med/surg/tele/neuro/rehab/corrections.
Had one of these recently also. It was the second time for this poor girl. 21 wks both times. Ended up being induced due to increased WBC's over a 2 day period of time - no fever though. Baby didn't live but for an hour. Sad, sad case indeed. Negative urine drug screen.

Of course, I told her to be sure to tell the next OB doc she had incompetent cervix.

In this case, would the womans cervix be sewed closed on her next pregnancy? Sorry not sure what it is called.

Just wondering. Thanks for any answer anyone can give. (Poor babes:o )

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It's called cerclage. Sometimes it works, sometimes it doesn't. I can't tell you how many 24 weekers I've looked after who have been delivered despite mom having had a cerclage. It may keep the cervix closed, but it won't stop ptl.

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My son was born at 25 weeks and 3 days. Tuesday I cleaned my house top to bottom because my nesting mama instinct seemed to be kicking in and I went to sleep Tuesday night feeling a little funny "down there", almost like I had a tampon in or something. But of course I didn't think anything of it really. Wednesday I still felt funny but I just figured it was part of pregnancy since this was my first time past six weeks when I miscarried previously. By Wednesday evening I started having irregular contractions and went to the hospital because there were getting worse and worse and closer together. Once at the hospital I was examined and determined to be 6 centimeters and my bag of waters was beginning to come thru. I began to have light bleeding and was repositioned trendelenberg. I guess the doctor hoped gravity might help put everything back where it belonged! Well to make a long story short he was delivered Wednesday afternoon by emergency c-section because he kicked his foot thru my water down the birth canal and was trying to deliever himself foot first!

Honestly, if I hadn't started contracting I may have been 10 centimeters and delievery a baby at home before I knew what was happening!

I just wanted to share my story because I was not using any sort of drugs or alcohol to cause this. I've never even smoked a cigarette! I realize the baby in the original post was born positive for drugs but I just don't want anyone to believe this always the case. Until reading thread I never realized how lucky I am to have a healthy 25 weeker. I knew I was lucky to be a mommy and have a preemie without long term problems so far but now I feel super lucky.

Heather, nursing student

***I just started my LPN Program and I am so excited to be joining the nursing field.***

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"I just wanted to share my story because I was not using any sort of drugs or alcohol to cause this. I've never even smoked a cigarette! I realize the baby in the original post was born positive for drugs but I just don't want anyone to believe this always the case."

I was referring just to this case..This was her second pregnancy-1st one she had at 14 was full term. Her dr. ruled out incompetent cervix. The girls mother was threatning to sue, and I guess as a last resort he ordered the toxicology tests, and consulted with a perinatologist who believe that is the reason for this particular pt...Please do not think I sterotyped this as there could be a multitude of reasons for this happening :(

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"I just wanted to share my story because I was not using any sort of drugs or alcohol to cause this. I've never even smoked a cigarette! I realize the baby in the original post was born positive for drugs but I just don't want anyone to believe this always the case."

I was referring just to this case..This was her second pregnancy-1st one she had at 14 was full term. Her dr. ruled out incompetent cervix. The girls mother was threatning to sue, and I guess as a last resort he ordered the toxicology tests, and consulted with a perinatologist who believe that is the reason for this particular pt...Please do not think I sterotyped this as there could be a multitude of reasons for this happening :(

I'm sorry I didn't want my post to seem so defensive and I realize there are many reason for this to happen...but it can be tough never knowing why!

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Most of the early problems with this kids end up with hypoplastic lungs even if mom makes it. Sad indeed.

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Specializes in NICU/Neonatal transport.

It's actually really important for moms with competent cervixes but preterm labor to NOT get cerclages.

I go into labor at around 19 weeks. My cervix behaves exactly as it is supposed to in the presence of contractions, opening. Giving me a cerclage would actually make my situation worse because it would further irritate my uterus/cervix. Cerclages only work for people whose cervixes open without contractions, through the pressure of gravity.

Unfortunately too many people, including OBs, think that a cerclage is the answer to preterm birth, which could make the mom much more likely to not only deliver preterm, but also to damage her cervix.

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