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Mirror Syndrome: A Reflection of Fetal Health
CASE STUDY
Corso, K. J. and Robertson, S.
Proceedings of the 2015 AWHONN Convention
due to the high risk of associated mortality. It is recommended that pregnant and postpartum women who present with atypical symptoms be evaluated with consideration of eliminating GAS infection from the differential before seeking other
causes. Nurses are the front-line staff caring for childbearing women and need to be aware of the threat of GAS sepsis. If we improve awareness, early recognition, and rapid treatment, lives can be saved.
Mirror Syndrome: A Reflection of Fetal Health Patricia A. Heale, DNP, RNC-OB, CNS, Children’s Memorial Hermann Hospital, Houston, TX Keywords Mirror syndrome Ballantyne syndrome nonimmune hydrops fetalis preeclampsia
Childbearing Poster Presentation
Kathryn J. Corso, MSN, RNC-OB, C-EFM, Baylor University Medical Center, Dallas, TX Shawna Robertson, BSN, RNC-OB, C-EFM, Baylor University Medical Center, Dallas, TX Keywords placenta accreta placenta previa massive hemorrhage multidisciplinary
Childbearing Poster Presentation
Background irror syndrome was first described as a clinical occurrence in 1892 by John Ballantyne in which nonimmune hydrops fetalis complicates the pregnancy. Maternal edema and other complications including preeclampsia mirror the hydrops noted in the fetus. The purpose of this case presentation is to familiarize the perinatal nurse with this rare complication of pregnancy and to describe the ethical dilemma of immediate delivery versus postponing delivery due to extreme prematurity.
M
Case Three weeks after the diagnosis of nonimmune hydrops fetalis secondary to a large sacrococcygeal tumor, the woman at 24 weeks 5 days gestation presented with severe bilateral lower extremity edema. On admission the woman was noted to have severe range blood pressures, proteinuria, and epigastric pain. Laboratory data also revealed elevated liver enzymes, severe anemia with hemoglobin of 5.0 and hematocrit of 15.3, and thrombocytopenia. Ultrasound and magnetic resonance imaging (MRI) studies revealed worsening nonimmune hydrops fetalis and a significant increase in the size of the sacrococ-
cygeal tumor rivaling the size of the fetus. The woman was immediately started on mjagnesium sulfate, labetalol, betamethasone, and blood replacement products. Several consults were performed with neonatology, pediatric surgery, hematology, and maternal/fetal medicine. The maternal/fetal medicine team assumed care of the woman and encouraged immediate delivery. The woman and her family wanted to continue the pregnancy until 28 weeks to allow for additional maturity of the fetus. Discussions ensued outlining the risks for the mother and to the fetus of continuing the pregnancy. Conclusion At this point the mother continued to refuse delivery. An ethicist was called in to assist and described the four fundamental principles of ethics, beneficence, autonomy, nonmaleficence, and justice, and their relationship to this case. After 2 days of hospitalization the woman relented and a cesarean was performed. The mother needed additional blood products but was discharged to home after 6 days. The newborn underwent emergency surgery to remove the tumor, however, she succumbed to heart failure during the postoperative period.
Multidisciplinary Approach to Reduce the Risk of Morbidity and Mortality Related to Placenta Accreta Background lacenta previa and accreta can be life threatening and have a high risk of morbidity for mother and infant. The incidence of placenta accreta has increased significantly during the last 30 years. Multidisciplinary planning may reduce the risk of maternal and neonatal morbidity and mortality. The American College of Obstetricians and Gynecologists recommended a planned preterm cesarean hysterectomy with the placenta left in situ.
P
Case A 36-year-old, G3P1 woman at 32 weeks gestation was admitted to the antepartum unit with a di-
JOGNN 2015; Vol. 44, Supplement 1
agnosis of complete placenta previa and placenta accreta. A multidisciplinary approach was used to plan for a scheduled cesarean with hysterectomy. Multidisciplinary meetings were used to prepare staff for potential complications. The woman was transferred to labor and delivery (L&D) at 36 3/7 weeks gestation. The woman was taken to the operating room (OR) where she received an epidural and had ureteral stents placed per urology. She was then transferred to interventional radiology where arterial balloons were placed. The woman was transferred back to L&D OR for delivery accompanied by the radiologist who prepared to inflate the balloons as needed. The blood bank prepared for the case with four units of blood in the
S83
Corso, K. J. and Robertson, S.
Proceedings of the 2015 AWHONN Convention
due to the high risk of associated mortality. It is recommended that pregnant and postpartum women who present with atypical symptoms be evaluated with consideration of eliminating GAS infection from the differential before seeking other
causes. Nurses are the front-line staff caring for childbearing women and need to be aware of the threat of GAS sepsis. If we improve awareness, early recognition, and rapid treatment, lives can be saved.
Mirror Syndrome: A Reflection of Fetal Health Patricia A. Heale, DNP, RNC-OB, CNS, Children’s Memorial Hermann Hospital, Houston, TX Keywords Mirror syndrome Ballantyne syndrome nonimmune hydrops fetalis preeclampsia
Childbearing Poster Presentation
Kathryn J. Corso, MSN, RNC-OB, C-EFM, Baylor University Medical Center, Dallas, TX Shawna Robertson, BSN, RNC-OB, C-EFM, Baylor University Medical Center, Dallas, TX Keywords placenta accreta placenta previa massive hemorrhage multidisciplinary
Childbearing Poster Presentation
Background irror syndrome was first described as a clinical occurrence in 1892 by John Ballantyne in which nonimmune hydrops fetalis complicates the pregnancy. Maternal edema and other complications including preeclampsia mirror the hydrops noted in the fetus. The purpose of this case presentation is to familiarize the perinatal nurse with this rare complication of pregnancy and to describe the ethical dilemma of immediate delivery versus postponing delivery due to extreme prematurity.
M
Case Three weeks after the diagnosis of nonimmune hydrops fetalis secondary to a large sacrococcygeal tumor, the woman at 24 weeks 5 days gestation presented with severe bilateral lower extremity edema. On admission the woman was noted to have severe range blood pressures, proteinuria, and epigastric pain. Laboratory data also revealed elevated liver enzymes, severe anemia with hemoglobin of 5.0 and hematocrit of 15.3, and thrombocytopenia. Ultrasound and magnetic resonance imaging (MRI) studies revealed worsening nonimmune hydrops fetalis and a significant increase in the size of the sacrococ-
cygeal tumor rivaling the size of the fetus. The woman was immediately started on mjagnesium sulfate, labetalol, betamethasone, and blood replacement products. Several consults were performed with neonatology, pediatric surgery, hematology, and maternal/fetal medicine. The maternal/fetal medicine team assumed care of the woman and encouraged immediate delivery. The woman and her family wanted to continue the pregnancy until 28 weeks to allow for additional maturity of the fetus. Discussions ensued outlining the risks for the mother and to the fetus of continuing the pregnancy. Conclusion At this point the mother continued to refuse delivery. An ethicist was called in to assist and described the four fundamental principles of ethics, beneficence, autonomy, nonmaleficence, and justice, and their relationship to this case. After 2 days of hospitalization the woman relented and a cesarean was performed. The mother needed additional blood products but was discharged to home after 6 days. The newborn underwent emergency surgery to remove the tumor, however, she succumbed to heart failure during the postoperative period.
Multidisciplinary Approach to Reduce the Risk of Morbidity and Mortality Related to Placenta Accreta Background lacenta previa and accreta can be life threatening and have a high risk of morbidity for mother and infant. The incidence of placenta accreta has increased significantly during the last 30 years. Multidisciplinary planning may reduce the risk of maternal and neonatal morbidity and mortality. The American College of Obstetricians and Gynecologists recommended a planned preterm cesarean hysterectomy with the placenta left in situ.
P
Case A 36-year-old, G3P1 woman at 32 weeks gestation was admitted to the antepartum unit with a di-
JOGNN 2015; Vol. 44, Supplement 1
agnosis of complete placenta previa and placenta accreta. A multidisciplinary approach was used to plan for a scheduled cesarean with hysterectomy. Multidisciplinary meetings were used to prepare staff for potential complications. The woman was transferred to labor and delivery (L&D) at 36 3/7 weeks gestation. The woman was taken to the operating room (OR) where she received an epidural and had ureteral stents placed per urology. She was then transferred to interventional radiology where arterial balloons were placed. The woman was transferred back to L&D OR for delivery accompanied by the radiologist who prepared to inflate the balloons as needed. The blood bank prepared for the case with four units of blood in the
S83