OB: Fun with preeclampsia--very long!
From: Garry Siegel (garrys@mindspring.com)
Thu Jul 26 21:47:58 2001
33 YO P0, infertility patient, now at 38 weeks sees my partner for a
routine visit.
Day One
11 AM: BP 120/90, no increased weight or proteinuria, normal edema for a
38 weeker, but BP up a bit over baseline from early pregnancy. Cervix
0/25%/firm/high/posterior/rotten. EFW clinically 2500g, vertex.
Sent to L and D for blood, NST, a few BP checks.
1 PM: SGOT normal, creatinine 1.1 (elevated for pregnancy), platelets
95K. Diagnosis of severe preeclampsia by virtue of thrombocytopenia.
2 PM: DTR 3+, no symptoms, cytotec 50 mcg. placed in vagina. Magnesium
sulfate begun, and all explained in depth to patient despite full office
getting fuller.
"Can I take a shower? Do I have to have an IV?"
Contracts mildly overnight, sleeps a bit. Contracts too much to re-dose
cytotec.
Day 2
8 AM: cervix 0/50% maybe, and a bit more anterior. "I've had good
labor, haven't I?" Pit begun, all lab stable.
1 PM: external os open a bit, hurts too much to get to internal os, Pit
24 or 36 mu (can't remember). "I'm progressing nicely, aren't I?"
6 PM: Has a meltdown, IV somehow comes out, crying. Neuro exam normal,
discs sharp, calms down. Cervix the same.
Doc: you have severe preeclampsia requring delivery. You can have a
section now, or at any time, or we can start Pitocin now and not stop
until you deliver. Nurses are drawing straws to see who gets this
patient for the next shift.
Why don't you take a *QUICK* shower, and when you are out, we'll
re-start your IV, get an epidural, and either have a section or start
Pitocin?
Patient: Great; we're thinking about options.
7:30 PM: Quick shower over 1.5 hours later, hair has been blown dried.
IV re-started, mag and pit begun. Epidural on the way.
9:30 PM: Epidural in, Pit at gazillion, AROM at 1 cm/25%.
11 PM to 6 AM: Droperidol for nausea, epidural re-dosed by
anesthesiologist 3 times. Nice anesthesiologist isn't as happy as he
was as the hours progress.
Day 3
6:15 AM: 3 to 4 cm./80%, and off to the OR. Hand over to partner.
Patient: "You mean that you may not deliver my baby?"
11 AM: Deliveries healthy baby vaginally by partner. Asks partner why
she has to stay on mag for 24 hours!
Garry
--
Garry E. Siegel, M.D., F.A.C.O.G.
Roswell, GA
Private Practice
