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We’ve all had the experience of showing up for our first day of work, eager, prepared but not quite sure what to expect. The following is a brief synopsis of Dr. Debbie Bredestege’s first day at one of Ob Hospitalist Group’s (OBHG) newest hospitalist programs at Cox South in Missouri.
Early in Dr. Bredestege’s first shift, a young female patient arrived by EMS after being discovered unconscious by a family member. She was evaluated by the Emergency Department physician who called Dr. Bredestege upon discerning a positive pregnancy test in addition to hypotension and tachycardia. Even before Dr. Bredestege saw the patient, she suspected an ectopic pregnancy.
The patient did not know she was pregnant. Dr. Bredestege ordered an ultrasound immediately which revealed a large quantity of fluid in the abdomen indicating bleeding within the peritoneal cavity. Dr. Bredestege diagnosed a ruptured ectopic pregnancy and the patient was rushed to the Operating Room (OR) for a Laparoscopic partial salpingectomy and evacuation of hemoperitoneum. Two liters of blood were evacuated from her abdomen. The time from initial diagnosis to surgery was less than 30 minutes.
Ectopic pregnancies occur in about 20 out of 1000 pregnancies. Ruptured ectopic pregnancies account for 4-10% of all pregnancy related deaths and are the leading cause of maternal death in the first trimester. If the patient’s family hadn't been home to find her passed out, she most likely would not have survived. Dr. Bredestege’s experience, diagnostic skill and compassion in dealing with this young patient made the difference between life and death.
Later in that same shift, a young female presented by ambulance after an unrestrained motor vehicle crash. She was in her second trimester of pregnancy, but was not conscious enough to provide any details. Dr. Bredestege, a Labor & Delivery nurse, and the trauma team were all present when she arrived as they had been paged when the ambulance called ahead.
The patient was reportedly around 28 weeks pregnant and upon admission and had several other severe injuries sustained in the accident.
Initial fetal heart tones were heard in the normal range. So she was taken to CT scan to assess for internal bleeding and head trauma. Dr. Bredestege had the forethought and commitment to serving this patient to don a lead apron and stay with the patient during the CT.
While the rest of the team was evaluating the severity of the patient’s other injuries, she hand-held the fetal monitor continuously assessing the fetus as a placental abruption was a very dangerous and likely complication of such an accident. Initially the fetal heart tones were normal, but then the fetus began having decelerations and Dr. Bredestege called for an emergent C-section.
The trauma surgeon and a private OB/GYN who was already on-site joined Dr. Bredestege in the OR where she immediately performed the surgery. Blood was noted upon entering the abdomen and the trauma surgeon began packing the upper abdomen to allow Dr. Bredestege time to deliver the infant. A classical C-section successfully delivered a one-pound infant.
Trauma in pregnancy is the leading cause of maternal and neonatal death in the United States. Maternal trauma can compromise the fetus as a result of maternal hypotension or hypoxemia, placental abruption, uterine rupture, or fetal trauma.
Upon reflection on her first day as an OBHG hospitalist, Dr. Bredestege notes that “having an OB/GYN in the hospital at the time that both patients arrived was very necessary to expedite the diagnosis and treatment of these life-threatening emergencies. A delay of even 30 minutes for a private physician to arrive from their office or home could have resulted in death for moms and babies. I am excited to be a part of a program that makes such huge strides toward improving patient safety.” And we at OBHG are proud of Dr. Bredestege and welcome her and Cox Health to a nationwide team of service-oriented hospitalists elevating the standard and safety of women’s healthcare every day.
We invite you to discover more about OBHG and the advantages that our customized programs deliver to our partner hospitals, physicians and patients. Contact an OBHG representative today at Programs@obhg.com or 800.967.2289
Written and published by OBHG Media. Copyright © 2013.