Re: OB: Fun with preeclampsia--very long!
From: Joanne Bulley, MD (jbulley@cheshire.net)
Thu Jul 26 22:23:02 2001
Great job. Lots of sweat.
Joanne
At Thu, 26 Jul 2001, Garry Siegel wrote:
>
>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
>
--
Joanne Bulley, MD
Keene, NH, USA
