10 Things Obstetricians Want Hospitalists to Know

The Hospitalist. 2014 November;2014(11):

November 2, 2014 | The Hospitalist

In most cases, deliveries go well for mother and baby; however, certain conditions not immediately apparent upon observation can cause severe problems. For example, a vaginal exam in a pregnant woman with placenta previa can result in a massive hemorrhage.

“In the third trimester, 500 cc of blood per minute flows to the uterus, so a tremendous amount of blood can be lost very quickly,” Dr. Zelop cautions. “Even in cases of women who appear healthy and normal, your radar must be up because an unknown complication can result in major bleeding.”

Maybelle Cowan-Lincoln is a freelance writer in New Jersey.

Three Keys to Treating Obstetrical Patients

Although the fetus is a consideration, care must be directed toward the mother. The mother must be healthy for the baby to be healthy, so treat a pregnant woman like she is not pregnant, especially before the baby is viable. That means she needs all the tests a nonpregnant patient would get to arrive at a correct diagnosis.^4,5
Almost all medications can be used in an emergency. Although there are some drugs to which you would not want to chronically expose a fetus, in a crisis, remember that you need to give the mother the best care. In a subacute situation, you can consult an OB to see if you need an alternate choice rather than the medication you would usually use.³
Always tilt a woman more than 20 weeks pregnant to her left side. The weight of an expanding uterus constricts the aorta and inferior vena cava, restricting blood flow to the mother’s brain and the baby. This will distort assessment results and make resuscitation nearly impossible.³

References

Ma, Edward. Coatesville VA Medical Center, Coatesville, Pa. Telephone interview. October 31, 2013.
Martin JA, Hamilton BE, Ventura SJ, et al. National Vital Statistics Reports: Volume 62, Number 1. June 28, 2013. Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_01.pdf. Accessed October 6, 2014.
McCue, Brigid. Chief, department of OB/GYN, Jordan Hospital, Plymouth, Mass. Telephone interview. October 28, 2013.
Olson, Robert. Founding president, Society of OB/GYN Hospitalists; OB/GYN hospitalist at PeaceHealth St. Joseph Medical Center, Bellingham, Wash. Telephone interview. October 31, 2013.
Zelop, Carolyn M. Director, perinatal ultrasound and research, Valley Hospital, Ridgewood, N.J. Telephone interview. October 30, 2013.
Callahan, William. Chief, Maternal and Infant Health Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. E-mail interview. November 12, 2013.