• Tammy Euliano

My pregnant patient needs an emergency

I am writing this scene in which my heroine has preeclampsia and faints from a traumatic situation while in labor. She is rushed to the hospital where the doctor tells the father the umbilical cord prolapsed and they need to take the babies because it’s risky and he could lose both babies and mom. Since she is passed out, would they need to give her something anesthetic? I need both mommy and babies to survive in the end. Can you give me some advice as to what happens?


Interesting!

from Preeclampsia Foundation

First, a little about preeclampsia, formerly known as toxemia, and still known as one of the leading causes of maternal mortality. It’s a hypertensive disorder of pregnancy, coupled with some other signs or symptoms (protein in the urine, swelling all over, headache that won’t go away, visual changes, etc).


We don’t really know the cause, but there are some risk factors, and multiple gestation (like twins) is one. As is first baby so your scenario is great. If you want to make your heroine a morbidly obese diabetic you’ll really be golden (just kidding). Depending on how severe the high blood pressure and other symptoms, and how far along she is in her pregnancy, she might be kept in the hospital until delivery. If her blood pressure is difficult to control, or other symptoms progress, that alone is reason to take the babies early (you don’t need to add cord prolapse – see below). We try to get babies to 37 weeks, if not, 34 weeks is another safe endpoint. Earlier than that we try to keep moms safely pregnant for 48 hours to give steroids, which help the babies’ lungs mature.


Umbilical cord prolapse is much less common. It can’t happen until the water breaks and the cervix is dilated at least as wide as the cord (couple centimeters), and in twins would only risk the one whose cord is hanging out. Recognized immediately, the presenting part (head or butt of the baby, hopefully) can usually be pushed up to avoid squishing the cord. We roll mom straight to the OR with someone riding on the stretcher keeping the baby from strangling itself. That person remains under the surgical drapes while we induce general anesthesia and deliver the baby by C-section.  If cord prolapse were to happen when your character is at home, the baby is really unlikely to survive.


So you don’t need the prolapse, or the fainting for that matter. Preeclampsia is so named becomes it is the symptoms that occur before (“pre”) eclampsia – which is seizures. If a mom is brought in by ambulance having seized, and we’re pretty sure it’s from eclampsia, and the baby is far enough along, we’ll do an emergency c-section right then.


Either way she would still need anesthesia. If she just passed out from being surprised or bad news or whatever, it would only last seconds to a minute or so. Longer than that would have to be from something else (or faked).


So, if you want drama, here’s my suggestion…she has a seizure at home and doesn’t really wake up (your EMT can call it a post-ictal state when he calls it in, just to sound cool). Her blood pressure is high, and maybe she’d been having a headache all day. When they arrive in the ER they go straight to Labor and Delivery. The doctors check her BP and find protein in her urine so they go straight to the OR. She’s still quite groggy and Dad is freaking out. She is anesthetized for the emergency surgery, and they can’t be sure she’s going to wake up b/c she might have had a stroke (most common cause of death in preeclampsia).  You could even have her wake slowly from the anesthesia to draw out the anxiety…or maybe they do a CT scan of her brain which ends up normal and then they just have to wait (up to several hours).


In case a pregnant woman happens upon this article…preeclampsia occurs in only about 3-5% of pregnancies in America – three times more in the developing world – and most cases are mild. So have no fear. Go on and reproduce. Just get your blood pressure checked occasionally, and go to the hospital if it’s sky high or you have a headache that won't go away with normal treatment.

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