Ms. P is 19 weeks pregnant. Her VS are 105/67, 89, 99.1. She has a history of gonorrhea in February of this year when she went for her PAP. She was treated with “a shot and some pills.” On May 8 at 14 weeks, she began to bleed heavily, saturating through four large pads during the day and passing a clot the size of a golf ball. She also had some cramping. She went to the Emergency Room where she was diagnosed via ultrasound with complete placenta previa and was told to follow up with her OB. She went to her OB but by that time, the bleeding and cramping had stopped. She continued on full duty, doing PT and road marches because she was not given a temporary profile.
Today, Ms. P presents with severe cramping that feel like spasms; pain level 8/10; no spotting or bleeding. She has not eaten for 36 hours (taking a little water only) and feels lightheaded. A vaginal ultrasound indicates that the placenta is no longer sitting on the cervix. My preceptor explained that as the uterus grew, the placenta moved up and away from the cervix. The cervix was intact with no dilation or thinning. FHR was 150 and there was a lot of fetal movement. The patient was told that the baby was developing normally, the placenta previa had “resolved,” and she had no restrictions.
I would like to have seen Ms. P given an explanation for the pain and spasms. I asked my preceptor if it could be round ligament pain; he stated it probably was, but this was not explained to the patient. She was also not treated for her nausea and lightheadedness. It was very hot in North Carolina during this period of time; dehydration was an issue. I also thought that because Ms. P had a problem with placenta previa earlier in the pregnancy and she is now having nausea, she should have been given a temporary profile not to run or do road marches for the remainder of her pregnancy.
My preceptor surprised me with this case. He is a fertility doctor and is very compassionate with his patients. He is very generous with con leave and profiles. I expected more aggressive treatment.
Subscribe to:
Post Comments (Atom)
Hi CPT Masse! I would agree with you in your concern for the profile, etc. From seeing a patient here in Virginia that had Placenta previa, I guess I would have been a little more aggressive on the treatment, as well. The two patients we have seen with Placenta Previa were both given bed rest, they were told to avoid pelvic exams which would also mean no Intercourse and to also limit traveling. Profiles would and should include NO ROAD MARCHES as well as lifting, etc.. I am curious to to how old your patient was. I was told that Advanced Maternal Age as well as the increased number of pregnancies increases a patients risk for having placenta previa. I think Placenta Previa makes the provider as well as the parent nervous. Th risks for mom are tremendous to include a possible C/S and increased risk for PP Hemorrhage. Those risk factors alone are scary enough for me that I would have my patient on bed rest.
ReplyDeleteAs far as the nausea and lightheadedness is concerned. I would ensure to emphasize the importance of her increasing her fluid intake and by now she would have definitely gotten a profile. I also would have given her something for her nausea. There are a alot of safe drugs out there for nausea in pregnancy that are given every day to OB patients.
Zofran (class B), 4-8 mg is very commonly used here at Fort Hood with OB patients and all the ones I have seen have praised its efffect on dec/stopping nausea related to pregnancy (1st trimester).
ReplyDelete