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low hgb-updateFrom: Babycatchers@aol.comSat Aug 11 17:42:36 2007
I just wanted to thank everyone for their great information. The patient was induced last Wednesday and she delivered without difficulty. Her hgb on admit was 9.1 after all the IV Fe. She was on pit for about 5 hours and delivered. Her uterus was extremely boggy after delivery, not responding to pit and I ended up giving methergine X3 doses, 8 hours apart. We had the whole house on stand by for her. The OB (not my normal back up OB) went home to mow his grass (another story entirely), but I had a CCU nurse in the room with me, crash cart outside the door, methergine/hemabate and 2 units on the floor ready to go. The ER doc and on call surgeon were ready to help and in house. The OR crew had everything pulled for a hyst if we needed it and used the call time to restock the OR. My philosophy is to 'ward off evil things' by being ready for the worst. Anything less than that is a good thing. EBL was about 500cc. We ran several H&H and PT/PTTs after delivery- MDs were worried about DIC. Next morning H&H was 7.6 and 26. She got a couple of more doses of FE before she went home. Thank God everything went well. Up here, the high risk center is not real helpful with patients. Someone said to call them and get something done. Well, about a year ago ALL of the attending OB/GYN staff left the hospital to protest the malpractice and the practice situation in this state, so there are very few new recruits at the referral center and they are swamped. I can't blame them, but it makes our job harder. Still no real answer about the reason for the low H&H or the neuro symptoms. We did a CT with and without contrast the next day- but it didn't show anything. This is the biggest zebra I have seen in a long time. I hope it is a long time before another one comes along. Thanks again for all the great info. Vicki Smith, CNM, MSN West Virginia Midwives- changing the world one baby at a time.
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