What's your most interesting/scary case?

[LizzyL&DRN]

We all know that working in this field can be exciting, touching, heart warming as well as heart wrenching. We know that strange and exciting things happen everyday. But every now and then something really strange, very scary and/or rare occurs. I think this might be a good opportunity to learn from other's about their most strange/interesting/scary experience. I have two:

1. Primip, uncomplicated term pregnancy, had good PNC. Came into triage in labor, 4cm I think, intact membranes, good strong ucs. Pt admitted, 0 epidural, got to C/C/+2 station, doc was called to come for delivery. MD showed up and ruptured membranes......BLACKish/Brownish fluid came out. Baby born in severe respiratory distress, transferred to NICU. Infant dx with severe Primary Pulmonary Hypertension and the baby died. Apparently the OB theorized that several days prior to delivery a blood vessel on the fetal side of the placenta broke and bled into the amniotic fluid. The infants lungs and stomach filled with this old bloody fluid and the infant was unable to be ventilated. Very sad case.

2. Multip, 37 weeks, good PNC, had numerous ultrasounds due to absent fetal movement on the ultrasound however everything else looked good except mom had bigtime polyhydramnios. AFI 59:uhoh3: , for the life of me I can't figure out why she wasn't admitted at 36 weeks(UH...hello doctor, isn't this a prolapsed cord or abruption waiting to happen???:smackingf ). Anyway she came in soaked from her waist down and in a lot of pain, EFM applied (baby looked good), 3 cm dilated. All of a sudden she had a complete abruption, blood pouring out, baby heart rate plummeted. Mom rushed to OR, not even an IV yet. Mom was crash sectioned, baby came out dead, but resucitated. Baby had neurological defects, no movment, no swallowing(hence all the fluid). I don't think the baby made it. It was so scary and sad for the family because they walked in and 11 min later baby was delivered, they didn't speak english and the only spanish speaking person on the floor was in the OR already. They had no clue what was going on.

[km5v6r, EdD, RN]

Ok this is funny and old but my Mom tells of being in the final weeks before my brother was born. Her mother was in the hospital and she went to visit. Dad dropped Mom off at the ER entrance while he went to find parking. It was a hot July with temps over 100 and no air conditioning. Mom said she "waddled" in (her word not mine) and stopped to catch her breath and wait for Dad. The ER staff saw this over heated, short of breath, extremely pregnant woman standing near the doors and decided she must be in labor. They had Mom in a wheelchair and on the way to L&D before anyone would listen that she was just visiting. Of course they wouldn't take Mom's word she wasn't in labor they made the L&D nurses tell them to let her out of the wheelchair. ER was just a little paranoid about even the possibility of delivering there.

[33-weeker]

Another night we get a call form the ER, mom is about to deliver in the ER and they need us to come get her. We go running down with all of our stuff, mom is on a stretcher in the resucitation room, baby on her chest, crying, wet with no blankets. The ER staff is bagging the obviously pink crying baby. Not the people that you want at your birth, a heartattack or a trauma yes, but birth is definately not thier thing!

Yes. For some reason ER doesn't get the baby thing very well. I haven't seen our's go so far as to bag a pink baby, but they don't keep them warm very well.

I did go down once to find them intubating bad baby between mom's legs with a warmer sitting 3 feet from them. However, considering that the cord was still pulsing, and the placenta can remove CO2 that we can't do with bagging alone (reducing the risk of brain damage) this was probably not all bad. I did promptly move the baby to the warmer when they cut the cord.

[33-weeker]

Okay, some has to tell some funny stories too. We don't want to lose our loyal readers......due to all depressing stories.....

The OP did say 'scary case'.

[Gompers, BSN, RN]

The OP did say 'scary case'.

She also said interesting.

[kate1114]

She also said interesting.

OK, a nice, interesting, heartwarming case from the NICU side.

I took care of a baby who was a 24 weeker. His parents were wonderful people and had tried fertility treatments to have a baby, but were never successful. After a few years, they stopped and decided to live their lives without children. The wife was 44 when she started having some breast pain. She was a little paranoid (by her own admission) about breast ca since a coworker had recently been diagnosed. She went to her doctor who asked if she could be pregnant. She had a laugh at this, but the test came back positive. She was diagnosed around 16 weeks, so she had a whole 8 weeks of known pregnancy to enjoy LOL. They were just the most delightful couple and they doted on that baby

[OB_or_NICU_hopeful]

OK, a nice, interesting, heartwarming case from the NICU side.

I took care of a baby who was a 24 weeker. His parents were wonderful people and had tried fertility treatments to have a baby, but were never successful. After a few years, they stopped and decided to live their lives without children. The wife was 44 when she started having some breast pain. She was a little paranoid (by her own admission) about breast ca since a coworker had recently been diagnosed. She went to her doctor who asked if she could be pregnant. She had a laugh at this, but the test came back positive. She was diagnosed around 16 weeks, so she had a whole 8 weeks of known pregnancy to enjoy LOL. They were just the most delightful couple and they doted on that baby

Did the baby make it?

[BSNtobe2009]

I'm wondering what the chances of a 21 weeker are...has anyone seen this?

When I brought my daughter home from the hospital in Sept there was a 21 weeker that had been there since June 21 (my birthday, ironically). He was born at a hospital the next city over (it was labor they couldn't stop), and the doctor told the mother the baby would die, well, it didn't, so they rushed it to a level IV NICU.

I have thought about that baby most every day.

[Jolie, BSN]

I'm wondering what the chances of a 21 weeker are...has anyone seen this?

When I brought my daughter home from the hospital in Sept there was a 21 weeker that had been there since June 21 (my birthday, ironically). He was born at a hospital the next city over (it was labor they couldn't stop), and the doctor told the mother the baby would die, well, it didn't, so they rushed it to a level IV NICU.

I have thought about that baby most every day.

For the baby to have survived 3 months, I suspect that it was probably NOT a 21 weeker. The baby was probably an older, SGA baby that "looked like" a 21 weeker.

At 21 weeks, there is essentially no alveolar development in the lungs. Without these air sacs where 02 and CO2 exchange take place, there is no way to oxygenate the body. No amount of ventilation or oxygen therapy will be effective.

By 24 weeks, many babies have sufficient alveoli to oxygenate their bodies with the assistance of available technology. The trick is to support their bodies' needs without damaging these alveoli. (Both oxygen and the pressure needed to deliver it into the baby's lungs are damaging to the delicate alveolar tissue.) Babies can "outgrow" lung disease because they continue to develop new (healthy) alveoli until about the age of 12.

It's impossible to know what this baby's outcome will be, but bless you for caring so much about that child.

[Gompers, BSN, RN]

I've never seen a true 21 weeker survive. I have seen two 22 weekers make it, but both had horrible lungs - one went to a nursing home vented with a trach, the other was on over 1 liter of oxygen. Both had g-tubes for feedings and significant brain bleeds.

Sometimes they can confuse the dates, thinking a baby is 2 weeks younger than it actually is. Many moms think that you start counting from the day of conception, but you really count from about 2 weeks before that at the beginning of the cycle. So even though the mother may have only been pregnant for 21 weeks, the baby would be officially a 23 weeker. I know it's really weird and I have issues myself with counting that way, but that's just how it is. And 23 weekers have less than a 50% chance of survival, so that sound more realistic for that particular baby. If they expected him to die, but he didn't and kept himself going long enough for them to decide to try and save him...then I really don't see any way how he could have truly been 21 weeks. Between the undeveloped lungs, decreased respiratory drive, and lack of body fat...I don't see how he could have survived more than a few minutes on his own.

[BSNtobe2009]

For the baby to have survived 3 months, I suspect that it was probably NOT a 21 weeker. The baby was probably an older, SGA baby that "looked like" a 21 weeker.

At 21 weeks, there is essentially no alveolar development in the lungs. Without these air sacs where 02 and CO2 exchange take place, there is no way to oxygenate the body. No amount of ventilation or oxygen therapy will be effective.

By 24 weeks, many babies have sufficient alveoli to oxygenate their bodies with the assistance of available technology. The trick is to support their bodies' needs without damaging these alveoli. (Both oxygen and the pressure needed to deliver it into the baby's lungs are damaging to the delicate alveolar tissue.) Babies can "outgrow" lung disease because they continue to develop new (healthy) alveoli until about the age of 12.

It's impossible to know what this baby's outcome will be, but bless you for caring so much about that child.

Thanks. My daughter was in there about 3 weeks when the mother was going to hold him for the first time...she was crying, I gave her a big hug (my eyes are welling up just thinking about this), I just told her that God didn't hold his tiny hand this long for nothing...she had an amazing spirit. I would give anything if I could contact her and see how it went, I can't so I just keep her in my thoughts.

Now, the only reason I thought the baby was a 21-weeker was the mother told me she was 21 weeks when she gave birth, but it could have been a miscalculated due date.

I do remember her saying the baby was very much like a burn victim when he was born b/c the lack of sufficient skin layers (thickness?). The doctor that delivered him was so sure the baby was going to die, he didn't have a heated isolette just in case or anything, he didn't call in the neonatologist, nothing...he set the baby in a regular isolette (not sure what they did after the baby was born, b/c surely he couldn't breathe on his own?), and that is when they made the transport.

[LizzyL&DRN]

The doctor that delivered him was so sure the baby was going to die, he didn't have a heated isolette just in case or anything, he didn't call in the neonatologist, nothing...he set the baby in a regular isolette (not sure what they did after the baby was born, b/c surely he couldn't breathe on his own?), and that is when they made the transport.

We had this happen once in our OR. I don't remember the gestation, but it was very early (22-23weeks???). After the c section the doc put the baby and the placenta in the basin and set it all aside. They thought the baby was already dead, during the closure someone in the OR happenend to walk by the basin and saw the baby move. NICU was called, baby lived and went home with mom. Thank God that baby moved when she did. :yelclap:

[babynurselsa, RN]

Got code pinked to a delivery one night. Shoulder dystocia, stunned baby. As we blew in the door we saw the ob resident doing mouth to mouth on the baby......