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Re: Two interesting cases From: Anna Meenan, MD (annam@uic.edu) Sat May 7 20:58:55 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Lawyers Tell Doctors: We Come to Teach, Not to Sue -- New Jersey Law Journal" Previous message: RModugno@aol.com: "Re: Two interesting cases" In reply to: Len2976@aol.com: "Re: Two interesting cases" Not sure what would be done differently in the first case. When I was a student, we seldom gave IM Pit after delivery and never gave cytotec (it hadn't been invented yet). I frequently delivered folks without an IV, unless they were a grand multip, had a history of pp hemorrhage, or needed the IV for medications (pitocin, abx, etc). Women routinely leave freestanding birth centers 8 hours after vag delivery. I would say she made the right decision to give up the baby. Will she followup somewhere for a postpartum checkup? In case #2, it sounds like you're nearing 34 weeks as of Monday. I agree with recommending delivery then and hope mom agrees, if she doesn't, you'll just have to document, document, document and keep waiting, or get a court order, I guess, but being an FP, I would be required by hospital policy to consult an OB on this one. -- Anna Meenan, MD At Sat, 7 May 2005, Len2976@aol.com wrote: > >#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 Next message: Joanne Bulley, MD: "Re: Lawyers Tell Doctors: We Come to Teach, Not to Sue -- New Jersey Law Journal" Previous message: RModugno@aol.com: "Re: Two interesting cases" In reply to: Len2976@aol.com: "Re: Two interesting cases"

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