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Postdates,Neonatal DeathFrom: Ingrid Gold (igold@cox.net)Mon Aug 1 20:54:12 2005
As I'm sure most of you remember, I'm in a group practice. 2 CNM's, 2 OB's, almost all patients are shared, most are monolingual spanish. Last week, on Monday I think I sent a woman over from the office to be induced, indication postdates. She was 41 1/7, with good dates, G4 P3 (all NSVD), no previous problems (spanish only). She was being induced without incident (I was not on call) when the strip got bad and the midwife called the OB. They waited about 1 1/2 hours before deciding that she ought to have a cesarean. As is standard at our hospital, a neonatologist was present for the ceserean. Apgars were 8 & 9. Thick meconium was present at delivery, it had not been noted earlier, even though membranes were ruptured, and internal leads placed. The baby and placenta were heavily stained. At 1 hour the baby had a pulmonary hemmorhage and was transported from our level I facility to a level III, 3 miles away (by helicopter of course). About 4 hours later resuscitative attempts were stopped and the baby was pronounced dead. The next day, Tuesday, after office hours I went to L & D, planning to see the parents and express my sorrow. I was warned by both the OB nurse and the OB there not to go into the patient room, that she was in a blaming mode, and I'd be a perfect scapegoat. I followed their advice. One of the questions she'd asked was why I had waited to have her induced, and not sent her in a week earlier. I had seen her for her last 4 prenatal visits. Until now our practice has done NST's at 41 weeks, and induction at 42 weeks. I had a hard time deciding to send her in "so early", but without insurance she'd have to pay for the NST (but not the delivery, FES). I actually gave her the option and she chose induction.She was 2-3 cm, 80%, -2 when I sent her in. Complicating my timing were that they had just brought the baby over from the other hospital, a priest was there, and so were the organ donation people (who she refused to see). I went home without seeing her that day. The next day I was on call, and had 6 deliveries. (a record for me in one day, and with only 2 OB nurses). I did not stop in and see them. Then I had four days off, and went out of town (it was great to escape the 115 degrees in Phoenix, and go to the top of Sandia mountain in Albuquerque where it was 66). She came to the office today. I didn't realize she was there until she was gone. The MA said she was accepting, not blaming, and doing well given the circumstances. Your comments please.
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