Keeping the baby?
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Cardiology
Keeping the baby?
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I have a patient with peripartum cardiomyopathy with severe left heart failure (EF 27% on MRI) who despite my best advice is now pregnant again. Her risk of a bad outcome must be very high. I had cle
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Forums » Open clinical » Cardiology » Keeping the baby?
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Keeping the baby?
posted at 22/1/2012 6:56 AM GMT
on bmj.com
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Posts: 328
First: 17/6/2011 Last: 21/2/2012 |
I have a patient with peripartum cardiomyopathy with severe left heart failure (EF 27% on MRI) who despite my best advice is now pregnant again. Her risk of a bad outcome must be very high. I had clearly told her and her husband the risks of a future pregnancy in terms of her heart but should I have done more in terms of their family planning? This is troubling me because at the moment she wants to keep the baby! Advice please. |
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Re: Keeping the baby?
posted at 22/1/2012 10:11 AM GMT
on bmj.com
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*Moderator*
Posts: 541
First: 17/11/2008 Last: 22/2/2012 |
I would imagine you did give her family planning advice. It is difficult to know how much advice to gve and in what way. Yoiu're a cardiologist and it would probably be better coming from her GP anyway. Women will get pregnant sometimes whatver the risk. It is also difficult to understand risk as it applies to you as well. But I can understand that feeling of should I have done more. You explained the risks. |
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Re: Keeping the baby?
posted at 22/1/2012 12:01 PM GMT
on bmj.com
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Posts: 241
First: 15/7/2011 Last: 22/2/2012 |
It sounds to me that you have tried to advise her about her specific risk of severe problems if she has a future pregnancy. The pregnancy may be deliberate or unplanned and whatever the case she now will be likely to have serious problems ahead if she wishes to keep her unborn child/foetus. Is she religious and cannot accept not having the baby?. Does she know categorically the grave risks ahead?. It must be worrying and frustrating for you but provided the patient is of sound mind and has all the facts laid out before her then she must make her own decision however illogical or foolish it may seem to the Doctor. I honestly don't think that family planning is logically your area of emphasis. Your principle concern is your patient. Would it help to have another Cardiologist speak to her and her husband (a kind of second opinion) - it might make them realise that there are serious issues to think about. Just as another thought crossed my mind - what about a Consultant Obstetrician being informed to also advise her about the risk of prgnancy, childbirth (or elective C section) etc. All the best sadian. |
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Re: Keeping the baby?
posted at 23/1/2012 6:38 AM GMT
on bmj.com
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Posts: 328
First: 17/6/2011 Last: 21/2/2012 |
Thank you all for the reassuarance. She has seen a consultant obstetrician and a consultant obstetric anaesthetist and we have all told her and her husband the same things. I have also spoken to her and a supporter/ advocate. The patient is religious but the other issue is her mother who has told her to accept what is to come! I'm seeing my patient again on Tuesday. |
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Re: Keeping the baby?
posted at 25/1/2012 5:55 PM GMT
on bmj.com
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Posts: 328
First: 17/6/2011 Last: 21/2/2012 |
I saw her again yesterday - she has asked for a second opinion to which she is of couse entitled. She will be seeing an obstetric medicine consultant next Tuesday. Thankfully she is only 8 weeks pregnant so can afford to delay her decision a week or so. I'm still hoping she will agree to a termination. sadian |
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Re: Keeping the baby?
posted at 25/1/2012 9:30 PM GMT
on bmj.com
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Posts: 294
First: 13/4/2011 Last: 22/2/2012 |
Hello Sadian: I am having difficult times now, that´s the only reason I did not answer your post before. I had a similar patient to yours a few months ago. The mother did not listen to one single word from me and told-me she was having a blessed pregnancy. The patient was seeing-me like a kind of enemy of her baby. I was really impressed how all my advices were not taken into consideration. You need to be very careful, because if anything goes wrong, the mother would think that you were guilty of that. I reported this case to my superiors and the patient started to see another doctor. I would recommend that you do the same. All Best, Joey
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Re: Keeping the baby?
posted at 26/1/2012 11:04 AM GMT
on bmj.com
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Posts: 294
First: 13/4/2011 Last: 22/2/2012 |
Hello Sadian: In my humble opinion there must be a minimal amount of empathy between physicians and patients. If this is not happening you may end-up in court if the mother does not take full responsibility of her health and the baby´s health. All Best, Joey
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Re: Keeping the baby?
posted at 26/1/2012 4:59 PM GMT
on bmj.com
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Posts: 328
First: 17/6/2011 Last: 21/2/2012 |
Thanks for the sound advice JoeyR. She is seeing someone at the regional obstetric medicine unit next week. I'm planning to see her after that - if we can't reach agreement her care will need to be transferred to a larger unit in any case but I appreciate what you say about getting someone else to see her. best sadian |
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Re: Keeping the baby?
posted at 26/1/2012 5:14 PM GMT
on bmj.com
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Posts: 611
First: 12/3/2010 Last: 21/2/2012 |
Sadian, "if we can't reach agreement her care will need to be transferred to a larger unit in any case" Do you mean that she will be going to the 'larger unit' (teaching hospital?) ? IMHO it is previous experience with such difficult, hazardous cases that can make all the difference, and that experience should be concentrated. If she wants to go ahead, and in a local DGH unit that doesn't see this sort of thing, then I think that this is something you can insist on. Apart from her optimal care, it is unreasonable for the midwives and obstetricians to have this responsibility put on them, however much they might relish it! John |
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Re: Keeping the baby?
posted at 27/1/2012 7:05 PM GMT
on bmj.com
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Posts: 1
First: 27/1/2012 Last: 27/1/2012 |
In Response to Keeping the baby?: I have a patient with peripartum cardiomyopathy with severe left heart failure (EF 27% on MRI) who despite my best advice is now pregnant again. Her risk of a bad outcome must be very high. I had clearly told her and her husband the risks of a future pregnancy in terms of her heart but should I have done more in terms of their family planning? This is troubling me because at the moment she wants to keep the baby! Advice please. Posted by sadian I am a consultant obstetrician and from my experience I can say that it is not wise at all to continue the pregnancy if the EF is 27%. No matter how religous she is you should not be part of this, if she wants to die she can do this somewhere else. Sorry for being so tough, but I just had an unbooked pregnant mother at 34 weeks with very similar history. she died during her immediate post cesarean period. I am sure that you know that she may seem ok now but during labour it is somthing else. |
Forums » Open clinical » Cardiology » Keeping the baby?
