Friday, June 11, 2010
I am so excited I am finally Pregnant!!!!
I had a 25yo G4P1 11wk gestation New OB Visit patient who responded to my question, "How are you feeling today?" with "I am so excited I am finally pregnant!" In short, she had her first child when she was 19, she had a missed abortion in 2009 at 9 weeks gestation, a missed abortion in February this year only to learn approximately two weeks after her D&C she was pregnant again. She didn't know she was pregnant with the the previous two so finding out "while" she was pregnant that she was pregnant was exciting! Unfortunately, when we went to check for fetal heart tones, none were to be found. We did a transabdominal US only to find no fetal movement or fetal cardiac movement...so we tried the transvaginal US, measured the fetus to be at approx. 8 weeks gestation, no movement, no heart movement....she was again...with a demise. Although my preceptor could have asked the doctor sharing her office with her to verify the US, she decided she did not want to trouble him for "this because it is routine and doesn't warrant me bothering him about it." He was standing right there in the hallway...completely available (well, in my opinion he was). The Acute MD was not available so my preceptor opted to have the client go to radiology to have a confirmation US performed and she would "get back with" the patient when the results were "available." She did have the patient return later that evening to review the results but, again, no MD was available to discuss her tx options. The patient had to wait two days before a doctor finally saw her to discuss her treatment options. I just found this to be unacceptable. I can't imagine making a woman sit there for two days knowing she had a three week demised fetus in her womb and no present control on how to deal with it. I think I would have asked the doctor sharing my office if he wouldn't mind spending some time with my client to review the findings and discuss tx options while I took on one or two of his clients. A long paragraph but I thought the details were important.
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CPT Kwolek,
ReplyDeleteHad the provider cared for the patient during her previous miscarriages? Did they know each other? Was there interpersonal conflict between your preceptor and the other providers in that clinic? Or was that provider recently graduated or new to the military system and intimidated by coworkers? Did they have a resolve through sharing grief program there or was the provider hesitant to refer until definitive results received from radiology? Did they also consider quant hcgs? Was the patient hesitant to ask questions or in shock as "oh no this is happening all over again?" I agree that this case could have been handled much differently.
VR,
Maj Betancourt
CPT Kwolek... I can imagine how that can feel as I lived that before quite a few times. It is very traumatic and devastating to the patient. Their is a wide range of emotions that one experiences when they lose a child. I knew a 19 year old girl that was 6 months pregnant with twins which she did not know until she was 6 months pregnant (1st OB visit). The hospital only had 1 OB doctor at that time as all the doctors had PCS. So unless it was an Emergency or you were in your 2nd trimester you were not seen. Well she was ecstatic as she had felt the baby move every day. When she went in for her appointment the following day, the doctor listened for fetal heart tones and of course did not find any. Prior to doing an ultrasound, he looked at her and said, (28 year old male) and said, "Your baby is dead" and went to get another doctor to confirm the findings. The patient was devastated as one should be. The patient was referred off base to a civilian facility to confirm the findings and then back to the military (after 1 week) to deliver the babies as the policy was the patient could not have a D & C that late in the pregnancy. It is very traumatic and providers need to be empathetic to the patients.
ReplyDeleteCPT Kwolek,
ReplyDeleteI find it disconcerning how callously and disrespectful some providers are toward unborn babies and how badly they treat patients who have had a miscarriage. I was working with an infertility doctor who was very sympathetic with patients who had lost a baby, even if they weren't infertility patients. He gives them encouragement and sympathy, telling them he is sorry for their loss. He gives them con leave and a profile to help them not only heal physically but emotionally as well.
We had one young patient come in who had a miscarriage a few days earlier. Even though it was an unplanned pregnancy, she was in tears when talking to me about her loss. The day after the miscarriage, she went to talk to her NCO who told her that "a miscarriage is no big deal. My wife had two. You can have another baby." This poor girl just wanted someone to understand that this was a very emotional time for her, not just something "to get over."
We gave her 2 weeks con leave and a 21-day profile. She left knowing that someone cared about her and the baby she lost, and she knew that we cared about the pain she was experiencing.