Re: Postdates,Neonatal Death
From: Atkinson, Samuel M (ATKINSONS@mail.ecu.edu)
Tue Aug 2 15:57:00 2005
You should read the review article by Lakshmanan, Morgan et al from the
Jan 2005 issue of Obgyn Survey. This article is required reading for
recertification in OB/GYN. Meconium increases up to 30-40% from a max of
22% at term. In general Meconium Aspiration Syndrome is an intrauterine
event prior to delivery. On earlier delivery can assure one of no fetal
distress. While suction is still recommended, auropsy and laryngeal
studies show that the meconium is usually beyond where sucton can make a
difference.
Our motto-after 38 weeks the baby is your enemy. Only one good thing
can happen and too many evil outcomes.
________________________________
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Ingrid
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________________________________
Gold
Sent: Monday, August 01, 2005 9:56 PM
To: Multiple recipients of list OB-GYN-L
Subject: Postdates,Neonatal Death
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.
