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A Routine Delivery Becomes Life-threatening in an Instant
Perhaps no other department in the hospital is as prone to rapid, unforeseen changes as the Labor and Delivery Department. OBHG hospitalists make life and death decisions every day. One such incident occurred recently when an expectant mother arrived at one of OBHG’s partner hospitals. She was a private patient sent in for induction with her second child. Mother, father and older sibling were anxiously awaiting the arrival of their new family member, but no one could have contemplated how quickly a routine delivery would escalate into a life-threatening emergency.
The expectant mother was induced as planned and not long after a healthy male infant was delivered without incident.
Just a few short moments after the delivery, the new mother began to hemorrhage. The OBHG hospitalist on duty was quick to respond and took immediate steps to address the bleeding. She was taken to the Operating Room (OR) to determine the cause. Unfortunately she was continuing to bleed and her situation was becoming more precarious with each passing minute. A second hospitalist joined the team in the OR and together they agreed to proceed with an emergency hysterectomy.
The hysterectomy was successfully completed but the hemorrhage was more profuse than ever. OBHG hospitalists worked diligently to stop the hemorrhage, but it continued to bleed from multiple areas. By this time the patient had gone into Disseminated Intravascular Coagulation due to the excessive blood loss. The mother, whose baby was safely waiting in the well-baby nursery, was dying. A general surgeon rushed into the OR to support to our hospitalist team and after more than 6 hours of surgery, the bleeding was stopped.
Thanks to the agility, expertise and experience of our on-site hospitalists, both mother and son were able to leave the hospital happy and healthy. It was an extraordinary emergency requiring exceptional teamwork, and the team delivered!
The outcome of such a serious situation may not have been so positive had Ob Hospitalist Group not been on the scene to provide immediate emergent care. This situation and the many like it that occur in hospitals across the country every day echo the importance of OBHG’s commitment to elevating the standard of women’s healthcare by providing on-site OB/GYN coverage 24 hours a day, 365 days a year.
An Extraordinary Maneuver Delivers an Exceptional Outcome
Recently, Dr. Alan Johnson of Ob Hospitalist Group was called to a delivery room to assist with a birth complicated by shoulder dystocia, one of the most frightening emergencies in the delivery room. Although many factors have been associated with shoulder dystocia, most cases occur with no warning. Calm and effective management of this emergency is of critical importance; the private physician and Dr. Johnson intuitively understood this and immediately formed a seamless collaboration, focused solely on their patients.
After quickly considering the primary maneuvers to relieve the impacted shoulder, then secondary and tertiary maneuvers it was determined none of them would work. Dr. Johnson then performed the only remaining option: The Zavanelli maneuver, this procedure is performed by gently pushing the baby’s head back into the birth canal, followed by an immediate emergency cesarean section.
Nurses present said the Zavanelli maneuver was performed effortlessly. The 10 lb. 2 1/2 oz. baby was born with Apgar scores of 6 at 1 min. and 8 at 5 min. Greater than 6 at 5 min. is strongly correlated with normal outcome. The cord blood chemistries were predictive of a normal outcome, too.
According to UpToDate, Shoulder dystocia only occurs in 0.2 to 3 percent of all births and represents an obstetric emergency. Few shoulder dystocias can be anticipated and prevented, as most occur in the absence of risk factors. Therefore, the obstetrician must be prepared to recognize a shoulder dystocia immediately and proceed through an orderly sequence of steps to affect delivery in a timely manner. The goal is to prevent fetal asphyxia and permanent Erb's palsy, while avoiding physical injury. Fortunately, thanks to the collaboration between a community physician and an OBHG hospitalist, this newborn was delivered safely and without injury.
Four out of 100 births begin with a breech presentation. One such case occurred in an OBHG partner hospital recently. A first-time expectant mother in labor was observed by a nurse to be in breech presentation after spontaneous rupture of membrane.
At this time, the patient was completely dilated and plus one station. The on-site OBHG hospitalist was urgently summoned to confirm presentation. The position was confirmed and the patient was noted to be experiencing increased pelvic pressure and urge to push. The patient’s private physician was not in-house at the time and requested our hospitalist manage the patient until her arrival. The patient was rushed to the OR for a cesarean section, which the OBHG hospitalist performed without incident.
The private physician arrived at the hospital approximately 30 minutes after first notification. By that time, the baby had already been delivered and closure was under way.
The newborn scored Apgars of 2 and 8 and mother and child were quickly reunited following surgery. Had the procedure been delayed until the arrival of the patient’s physician, the labor would have proceeded and a vaginal delivery of breech presentation would likely have been required, at great risk to the infant. Fortunately, due to the presence of an OBHG hospitalist, the patient and her newborn didn’t have to be exposed to that increased risk and were able to deliver in a timely, safe manner.
Due to the fact that our hospitalists practice entirely in a hospital environment, they are experts in emergent care. Our service-oriented physicians are committed to providing the very best medical care to every patient regardless of time, complication or circumstance.
Prolapsed Umbilical Cord
A patient was laboring and 6 cm dilated. Her private OB/GYN was at the hospital but not in the Labor and Delivery Department. An attending nurse discovered an umbilical cord prolapse at 1906. The baby’s fetal heart was only 30-40 beats per minute. The OBHG hospitalist on-site was notified as the patient was urgently transferred to the Operating Room (OR). Her private physician was notified at the same time and was en route to the OR. The patient arrived at the OR at 1910. The baby’s fetal heart rate was noted as bradycardic at 50 beats per minute. The surgical team rapidly prepped for emergency surgery and the incision time was recorded at 1912. The very fortunate baby was delivered at 1913; just seven short minutes from the discovery of the prolapse.
The rapid response and life-saving surgery aided the baby in scoring Apgars of 5 at 1 minutes and 9 at 5 minutes. What could have been a catastrophic outcome ended with the healthy newborn transferred to well-baby nursery.
The patient’s primary OB/GYN arrived in the OR approximately 5 minutes after delivery and participated in the surgical closure.
Had the delivery been delayed until the arrival of the primary OB/GYN, the arterial cord gases would likely have been below 7.0 with the associated increased risk for neonatal injury secondary to birth asphyxia.
Pre-term Complications Require a Team Effort
At 3:00 a.m., Dr. Santiago, the on-site OBHG hospitalist was alerted to an emergency situation in the Labor and Delivery Department. The staff had already transported the patient to the Operating Room (OR) and Dr. Santiago headed straight there from the on-call room. She was advised the patient was a woman in her 27th week of pregnancy who had been admitted two days earlier by a private OB/GYN for a membrane rupture and a breech presentation of the baby.
The patient got up during the night to use the restroom and inadvertently caused a prolapse of the umbilical cord, an obstetric emergency that instantly threatens the baby’s life. The OR was filled with a frantic team working on the patient with one of the nurses trying to relieve pressure on the umbilical cord. They were already starting to lose the baby’s pulse. The teamwork was incredibly efficient; the patient was prepped, sedated and ready for surgery.
Within minutes an emergency C-section was performed, and the baby was delivered with an amazing 5 minute Apgar of 7-8, very rare for a baby at that gestational age. Dr. Santiago credits the entire team and their extraordinary efforts but states unequivocally that had she not been on-site, there’s no doubt that the baby would not have survived the unfortunate turn of events.
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.