Controversial preterm case

[Mercedes86]

---

Members do not see this ad.

A patient came in today (not mine) that became the topic of a small debate. Wondering how you would handle it, I'll tell you what the doctor did later.

History:
The patient came into the ER once before at 28 weeks complaining of contractions every 5 mins, but was sent home on Nifedipine with a closed cervix, no thinning (still contracting). No other complications.

Today:
Patient now is 30 weeks, returning as instructed as contractions have become more frequent and very painful (patient indicates a 7). Patient was monitored for 8 hours, contractions were steady and did not respond to hydration, Nifedipine, Indocin, Terbutaline, or Magnesium. Corticosteroids given.

Contractions: every 1-2 minutes
Fetal heart rate: 145 bpm (temporary drop to 90 once in 8 hours)
Cervix: 1.5 cm dilated, 80% effaced
BP: 130/75
Fetal Fibronectin: negative

4 Questions:
After 8 hours and no further cervical change, are these braxton hicks?
Would you send her home?
If you do, what advice would you give her about when to return?
If you don't, what treatment options would you pursue next?

 

[GeneralVeers]

Didn't that hospital have Labor and Delivery? I don't even deal with pregnancy-related issues past 20 weeks unless the baby is already coming out. Every female over 20 weeks pregnant with any abdominal complaint goes up to L&D and I (hopefully) don't have to see them again.


If I was in a hospital without L&D I would immediately transfer the 20+ week patient by ambulance to a hospital that did have it.

 

[Arcan57]

Didn't that hospital have Labor and Delivery? I don't even deal with pregnancy-related issues past 20 weeks unless the baby is already coming out. Every female over 20 weeks pregnant with any abdominal complaint goes up to L&D and I (hopefully) don't have to see them again.


If I was in a hospital without L&D I would immediately transfer the 20+ week patient by ambulance to a hospital that did have it.

Agree. Perhaps better addressed in the OB/GYN forum.

 

[EctopicFetus]

Agree. Perhaps better addressed in the OB/GYN forum.

Same here. Those issues arent for me to decide.

 

[DrMom]

If I was in a hospital without L&D I would immediately transfer the 20+ week patient by ambulance to a hospital that did have it.

I am almost always working at a hospital without L & D and where I'm the only doc in the place. When I get these types of patients (and I do somewhat regularly) I stick an US on them for a quick look and then call for immediate transfer.

And I agree that this is not an EM topic, but the pt already posted in OB/GYN so I'll just close this one.