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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Cat:OpenClinicalForum:083a12c9-861a-4a42-a5af-ddc3263b34bc
Cat:OpenClinicalForum:083a12c9-861a-4a42-a5af-ddc3263b34bcDiscussion:195d9bc4-d697-4b13-b99e-57b47ab7e97e
Forums » Open clinical » Cardiology » Keeping the baby?
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Re: Keeping the baby?
posted at 29/1/2012 7:22 AM GMT
on bmj.com
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Posts: 446
First: 17/6/2011 Last: 15/5/2012 |
Hi Dr Nourah and John D Thanks for your advice. John D - if she goes ahead with the pregnancy her care will be transferred to the high risk maternityh unit at our local teaching hospital - we all agree she can not stay with us. I agree with you entirely even if I can get ther through the first 20 weeks I'm certain that labour will be a whole other story. I think I've been very clear in my advice to her. If she does continue the pregnancy my problem is that invariably if there is an acute issue she will come to us. I'm not sure how I feel about saying to her that I refuse to look after her if she won't follow my advice - I would be grateful for everyone's thoughts on this. thanks sadian |
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Re: Keeping the baby?
posted at 29/1/2012 12:41 PM GMT
on bmj.com
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Posts: 838
First: 12/3/2010 Last: 15/5/2012 |
Sadian, Again, I hope I'm not telling you how to suck eggs, and you have involved an obsteric anaesthetist in this case, but have you involved the ICU consultants? If she does present in your Maternity unit (and she will!), I'm sure your management will be to transfer her, and she will need invasive monitoring and the care of a critical care specialist in transfer. They will appreciate the opportunity to plan that, even though it would have to be ad hoc at the time. John |
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Re: Keeping the baby?
posted at 30/1/2012 11:43 PM GMT
on bmj.com
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Posts: 189
First: 8/6/2011 Last: 12/5/2012 |
I think it is good to ask for a psyhiatric consultation ( and the psyhiatrist to be informed about the problem). In any case i would announce and the regional district attorney about that problem . That is a medico-legal matter and not just medical. |
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Re: Keeping the baby?
posted at 31/1/2012 6:32 AM GMT
on bmj.com
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Posts: 446
First: 17/6/2011 Last: 15/5/2012 |
dear both, thank you for your advice. I agree that if she carries on with her pregnancy she will undoubtedly present back to us whether her care is transferred or not! My obstetric anaesthetic colleague has sessions in ICU (we do run a medium risk maternity service but to be honest I think this case is too high risk for anyone!). She was at the regional centre yesterday and I'm seeing her tomorrow to see what she has decided. Asking for some psychological input seems like a good idea. thanks again sadian |
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Re: Keeping the baby?
posted at 24/2/2012 10:01 AM GMT
on bmj.com
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Posts: 682
First: 19/4/2010 Last: 16/5/2012 |
I had a patient a few months ago who presented with breathlessness 18 weeks into her second pregnancy. She had a large effusion, secondary to a massive lymphoma mass in her anterior mediastinum. I counselled her on keeping the baby or not, advising that her best chance of survival was to have a termination, and then get chemo. My thoughts were very much that it is better to be alive for the son she already has than to die trying to give birth to another child. She agreed, had the termination, and started chemo the next day. She has done very well. Difficult cases. |
Forums » Open clinical » Cardiology » Keeping the baby?
