September 30, 2008

Complete previa

Every once in awhile in L&D, you have a patient come in that makes you nervous. This weekend, we had someone come in with a complete previa, and had had some bleeding a couple times at home over that last 12 hours or so. She never bled while she was at the hospital, but the on call doc ordered a sonogram to see what was going on. She was 37 weeks and some change, and they had done an amniocentesis to check lung maturity at her last doctors visit, and the lungs were immature. So they cancelled the c/s they had planned and were planning on checking maturity again in a week. Anyway, she's hanging out, and now I come on at change of shift. Both me and the prior shift nurse get to talking about the tentative plan to let her go home if the sono was fine. We were both a bit nervous and wanted to at least observe her overnight. Things can get ugly very quickly with a complete previa (placenta completely covering the cervix), and she had bled a couple times at home and was now having contractions every 3-5 minutes. Since I was the one coming on shift, I wanted to at least have IV access if she was staying because the last thing I wanted to do was have her bleed majorly, have the baby take a dive and not have IV access. Quite honestly, I was hoping they'd call for a c/s because if something did happen at 2:00 a.m., there wouldn't be an OB or anesthesiologist in house, which could make an ugly situation uglier. But, at the same time, things could be just fine. The prior nurse and I decided to give the patients doc a call, just to let her know she was here. And, much to our relief, she decided delivery would be the best bet, instead of waiting until something happened. With a previa, you never know how much blood loss you'll have. If the placenta is on the backside of the uterus, you are usually okay, but if it's in the front, where they make the incision, you can have a hemorrhage on your hands. I've seen where they've actually had to cut through the placenta to deliver the baby. Boy was that messy and scary. We started two IV sites, with 16 gauge hoses, just so if she did start to hemorrhage, we'd have to huge lines to run blood and fluids in quickly. We had 2 units on the unit and ready for use. Thankfully, the c/s went off without a hitch, the placenta was posterior and the blood loss was typical for a c/s. The baby did fine. She was breathing a little fast and was grunty working to breath, but never did need oxygen and by morning was going out to mom. I'm not usually a huge hurry-up-and-intervene-when-things-are-stable, but in this case, me and the prior nurse just had a "feeling" something would happen in the middle of the night. Now I've not been a nurse long enough to go by my instincts alone, but I think you get those feelings of foreboding for a reason. Ahh, just another day in the life of a labor nurse.

No comments: