In distress

[seattle_patient]

I shouldn't have driven myself to the ER. It made the bleeding worse. I probably have blood all over my butt now, but I guess I don't care. I'm probably losing my baby, and that's what I should care about. I really should care about that

Comments

[dr_a_sloane]

I stand in the hallway reading my newest patient's chart. Bleeding at 7 months. If I'm forced to deliver this baby now, I know the chances of survival grim. If we can stop the bleeding, I might be able to buy more time. Maybe even a full term birth.

My patient, Gillian Mathews, is unconscious and unreactive as I rub the cool gel on her stomach and press the transducer probe to the womb.

[isobel_izzie_s]

Bailey's paged me to grab the results for Dr. Shepherd's newest case and assist her all day. I wonder what's wrong with Cristina? I walk into the room to see an unconsious patient, and Dr Shepherd performing an ultrasound. I peek around to get a good look at the screen while handing her the results

"Dr. Montgomery Shepherd... Ms. Matthew's lab results are in."

[dr_a_sloane]

"Thank you, Dr. Stevens," I say, still engrossed in the images on the screen. "Tell me, what are common causes for late pregnancy bleeding?"

I stop when I find what I've been looking for and turn to look at my intern. I can only hope this one has a heart.

[isobel_izzie_s]

"The most common causes are placenta previa or abruption, in this case least likely to be previa due to the pain... Her HCG or progesterone levels could be falling, both contributing to an inability to keep the pregnancy viable. Or she could be going into preterm labor" I look over at the patient and try not the wince. Hopefully Dr. Shepherd can help.

"Did I miss anything?"

[dr_a_sloane]

She exceded my expectation. "Very good, Stevens," I said with a nod. "Now take a look at the screen, and tell me what you see."

[isobel_izzie_s]

I peer at the screen.

"Her placenta is implanted practically on top of her cervix... Placenta previa...But why the pain?" I look at Dr. Shepherd, confused and unsure. "I thought the bleeding was painless?"

[dr_a_sloane]

"The bleeding is painless," I reply as I turn off the ultrasound equipment and reach for the lab results. "Which is why we will keep looking. I'm not ready to rule out other complications at this point. How do we treat Placenta Previa?"

[isobel_izzie_s]

I search my brain quickly, overwhelmed at the bleak outlook on this woman's pregnancy.

"If the baby is past 37 weeks, and the patient is having contractions or hemorrhaging, it's safest to deliver. If there is no sign of hemorrhage and she is not contracting, bed rest and constant monitoring is usually the safest route, with steroids to help the development of the baby's lungs. If the mother or baby is in distress," I glance at the patient, "it's usually best to deliver, to save the life of the mother."

[dr_a_sloane]

"Again, very good Dr. Stevens. Have you had experience with Placenta Previa before?" I question. "And how would you suggest we treat Ms...."

My voice trails off when I notice something odd in her lab work. "Her progesterone levels are dangerously low." I slide the results into her chart and flip it closed. "Treatment first. How would you suggest we treat her low progesterone levels and her Placenta Previa?"

[isobel_izzie_s]

"Treat the low progesterone with hormone supplements, definite bed rest. Moniter the fetus for signs of distress, and hydrate the mother." I shrug slightly and look at Ms. Matthews. "It's just a waiting game..."

[dr_a_sloane]

I hand her the chart. "You should also check for progesterone allergy."

I trail off when I notice Ms. Matthews stir. I can only hope she will be able to fill in some of the gaps.

I smile slightly at her when I see her eyes open, hoping it will help to keep her calm. "Gillian, I'm Dr. Shepherd and this is Dr. Stevens. Do you remember why you're here?"

[seattle_patient]

I groan slightly as I see all the bright lights and hear voices. "Hospital?" I close my eyes again. The way the lights dance and flash make my migraine even worse. "I'm bleeding. I thought the baby might be in danger, so here I am."

I cover my eyes with my hand and try to block out the throbbing noise. "I've been getting migraines a lot lately. I knew one was coming on, but I guess I blacked out."

I hate this. I hate being here. It would be better if I just miscarried.

[dr_a_sloane]

I glance at Dr. Stevens at the mention of migraines and turn back to Gillian. "Your placenta is low in your uterus, covering the cervix. That is what caused the bleeding. We've gotten your bleeding under control, but if it continues, we may have to deliver. However," I smile are I deliver the good news. "If we can keep the bleeding under control, you should be able to carry the baby to term."

[seattle_patient]

The doctor is talking about the placenta and a full term pregnancy. I turn my head away from her and look at the wall until I can't bear to keep my eyes open any longer. And I start to cry, but it hurts my head.

This isn't me. What has happened to me?

[isobel_izzie_s]

"Ms. Matthews" I begin gently. "I'm going to order a test to make sure you aren't allergic to any of the treatment options, ok? They'll just need to take a little blood." I take the chart and look at Dr. Shepherd for confirmation.

[dr_a_sloane]

I nod to Stevens and take a step closer to our patient. The headaches, the extreme reaction and the low progesterone may be related.

"And I think to be on the safe side, order a C.T. and page Dr. Shepherd." I turn back to Gillian and smile again. "Maybe we can find out why these migraines have become so frequent. I know that you're scared, Gillian, but right now you have nothing to be concerned about. The bleeding has stopped and your baby is no longer in distress."