Re: bad babies and BAD day
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Nov 28 19:40:44 2005
Transfer her ASAP.. this smells bad, really bad, and it can get
extremely bad by the hour...
Ef
At Mon, 28 Nov 2005, Babycatchers@aol.com wrote:
>
>Dear list:
>I need to vent a minute and I have a legitimate question at the end. We have
>had 17 babies in 12 days, so my brain is not working on all cylinders. ( We
>usually do 30 births a month)
>Last Monday we shipped out 4 babies and 2 moms. One for cardiomegaly, one for
>RDS (term), one that wouldn't keep his blood sugar over 40-even with feedings
>q 2 hours and an IV (mom was not a diabetic-no family history) and one for a
>spontaneous pneumothorax.So I am a little paranoid.
>
>Today I had a 17 yo show up in the office. She had been to the ER on Sat and
>Sun for urinary retention and pain. The ER doc put her on Bactrum and pyridium
>on Sat, then when she came back on Sunday-having not voided in over 24 hours,
>he changed the antibiotic to amp and put in a foley with a leg bag and did a
>BHCG. He told her she was 16 weeks pregnant (no US done) and told her to show
>up at our office this morning. On Monday mornings it is just me (CNM) in the
>office. The OB does afternoon hours on Monday. She shows up and we work her in.
>She presented with the leg bag full. She denied that she could be pregnant at
>all. (I forgot to mention she was 5'4" and weighed over 300 pounds.)
>Something looked weird about her and the physical exam made me very nervous. Palpation
>of abd felt like a big baby to me. Speculum for pap and GC/CH revealed no
>cervix and a head full of hair. Her pelvis was heart shaped and narrow. I had the
>OB come in and do an US. He thought she was 37 weeks with a 2700 gms baby. So
>she is sent to OB for prenatal workup and delivery.
>We have no idea when her water broke or any idea what we were really dealing
>with. She labored for several hours and pretended to push. She was 17 and in
>denial and still did not believe she was actually pregnant-so why push. I
>ordered 2 gms Amp and she got 2 doses. She became febrile at 101 degrees, so the OB
>decided to section her.
>The 2900 gram male was born with pus pouring out of his nose and mouth. The
>ped was there and is doing the workup for the baby. Mom's uterus shredded when
>we were going in and I lost count of the number of laps we had to use to get
>the uterus clean. It has been a long time since I have seen one tear this
>badly. (I first assist at all surgeries.) It took us a lot of time and patience to
>put the puzzle back together again after cleaning out the uterus and doing
>antibiotic fluid irrigation of the belly. She is going to be on
>amp/gent/clindamycin IV.
>Now my question: The OB is going out of town and the covering OB is about 30
>minutes away and does not like our practice. I am trying to make sure that I
>cover all the bases, because I am on my own until I can beg this OB to visit.
>After tomorrow it is just me in this town. (One of the back up doc's patients
>coded in our OB department and the ER doc and I ran the code. She did not visit
>the patient until 24 hours after the problem).
>What else should I do besides a culture of the placenta (done), send it to
>pathology (done), cover her with the antibiotics that will stop a truck (done).
>I didn't get blood cultures before I gave the first dose of Amp, I didn't
>realize how bad it really was. Her WBC on admission was 16, but the doc figured it
>was from the UTI.
>She is bleeding a little more than I am comfortable with, but not time for
>methergine yet. Fundus firm. BP beginning to climb. 120s/80s on admit- now
>160s/80s. 1-2 + bilat pedal edema. 2+ reflexes. Temp still 101.
>I am telling everyone I can find that this is OUT OF MY SCOPE-but the
>administration and the OB think I can handle it. I will climb the food chain when it
>gets bad. But I need to have my ducks in a row when I do it. Other than a CBC
>in am, lytes, liver function tests, uric acid and chem panel - what else
>should I do? What should I be looking for so that I can catch this before she
>crashes?
>Any help would be appreciated.
>Vicki, CNM
>
>Vicki Smith, CNM
>Midwives-changing the world one baby at a time.
--
Have the courage to be ignorant of a great number of things, in order
to avoid the calamity of being ignorant of everything.
Sydney Smith (1771 - 1845)
~walt whitman~
