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Re: Two interesting casesFrom: Len2976@aol.comSat May 7 16:41:19 2005
#1. 35 y/o G2,P1 presented in labor at 10:00 a.m. She has had no prenatal care and her family (parents who she lives with) does not know she is pregnant. She does not know who the FOC is. She tells the nurses that she had one other child that was taken away because "they said I abused it." She refuses an IV. NSVD at 10:45. She refuses IM Pitocin or po cytotec--luckily she does not have excessive blood loss.. Drug screen + only for TCA. States she plans to leave (walking) at 2:00. Her behavior is odd, but she seems aware of what she is saying and doing. At 1:00 patient signs papers to relinquish all rights to the baby to DCF caseworkers--her only obvious concern about this is if it get her into trouble. She is reassured that she did the right thing to give birth in a safe place. At 6:00 despite counselling she signs out "AMA"--a neighbor picks her up. #2 26 y/o G3, P2002 who presented last weekend at 32 3/7 weeks with leaking of AF. Afebrile, WBC 15.2, AFI 14., BPP 10/10. Patient counseled about POC--observation, steroids, monitoring, daily AFI and BPP, probable delivery at 34 weeks unless anything changes. After 24 hrs. and 2 doses of steroids, patient "can't stand" being in the hospital and insists on going home. She was seen by both one of my CNM partners and the obstetrician who were unable to change her mind. She agrees to return for BPPs and AFIs and monitor her temp at home. Yesterday she was able to bring in some leaking AF in a urine cup which was sent for L/S and PG. PG was absent and L/S was .8, BPP 10/10, AFI 12.0, WBC 16.5, afebrile. POC discussed with obstetrician who is trying to decide whether to still deliver at 34 weeks as planned, or to continue present management and try to repeat PG and L/S. Of course if there is any change in WBC, BPP, or AFI he said he would deliver. We do have a Level 2 NICU. He asked me to present this to the group and ask for comments. Lenora McCall, CNM SPring Hill, FL
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