Immediate Care is the Best Care
You don’t have to be a high-risk patient for immediate OB/GYN care to be a high priority. Perhaps no medical environment has more potential for situations to turn from routine to life-threatening than the Labor and Delivery department. Nobody knows this more than an Ob Hospitalist Group (OBHG) hospitalist. In fact, since our inception, our team of highly-skilled, Board Certified OB/GYNs have performed over 74,000 deliveries, many of which began as routine and ended up anything but. For each one of these deliveries, the presence of an OBHG hospitalist may have meant the difference between life and death. Below are three such deliveries: Pre-term Complications Require a Team Effort At 3:00 a.m., the on-site OBHG hospitalist was alerted to an emergency situation in the Labor and Delivery department. The staff had already transported the patient to the Operating Room (OR) and our hospitalist headed straight there from the on-call room. She was advised the patient was a woman in her 27th week of pregnancy who had been admitted two days earlier by a private OB/GYN for a membrane rupture and a breech presentation of the baby. The patient got up during the night to use the restroom and inadvertently caused a prolapse of the umbilical cord, an obstetric emergency that instantly threatens the baby’s life. The OR was filled with a frantic team working on the patient, with one of the nurses trying to relieve pressure on the cord. They were starting to lose the baby’s pulse. The teamwork was incredibly efficient; the patient was prepped, sedated and ready for surgery. Within minutes an emergency C-section was performed, and the baby was delivered with an amazing 5 minute Apgar of 7-8, very rare for a baby at that gestational age. The OBHG hospitalist credits the entire team and their extraordinary efforts but states unequivocally that had she not been on-site, there’s no doubt that the baby would not have survived the random and tragic turn of events. Prolapsed Umbilical Cord A patient was laboring and 6 cm dilated. Her private OB/GYN was at the hospital but not in the Labor and Delivery Department. An attending nurse discovered an umbilical cord prolapse at 1906. The baby’s fetal heart was only 30-40 beats per minute. The OBHG hospitalist on-site was notified as the patient was urgently transferred to the Operating Room (OR). The patient arrived at the OR at 1910. The baby’s fetal heart rate was noted as bradycardic at 50 beats per minute. The surgical team rapidly prepped for emergency surgery and the incision time was recorded at 1912. The very fortunate baby was delivered at 1913; just seven short minutes from the discovery of the prolapse.
Ob Hospitalist Group
10 Centimeters Drive • Mauldin, SC 29662 • P: 864.908.3530 • F: 864.627.9920 • www.OBHG.com
The rapid response and life-saving surgery aided the baby in scoring Apgars of 5 at 1 minutes and 9 at 5 minutes. What could have been a catastrophic outcome ended with the healthy newborn transferred to well-baby nursery. The patient’s primary OB/GYN arrived in the OR approximately 5 minutes after delivery and participated in the surgical closure. Had the delivery been delayed until the location and arrival of the primary OB/GYN, the arterial cord gases would likely have been below 7.0 with the associated increased risk for neonatal injury secondary to birth asphyxia. Breech Presentation Four out of 100 births begin with a breech presentation. One such case recently occurred in an OBHG partner hospital. A first-time expectant mother in labor was observed by a nurse to be in breech presentation after spontaneous rupture of membrane. At this time, the patient was completely dilated and plus one station. The on-site OBHG hospitalist was urgently summoned to confirm presentation. The position was confirmed and the patient was noted to be experiencing increased pelvic pressure and urge to push. The patient’s local provider was not on-site at the time and requested our hospitalist manage the patient until her arrival. The patient was rushed to the OR for a cesarean section, which the OBHG hospitalist performed without incident. The local provider arrived at the hospital approximately 30 minutes after first notification. By that time, the baby had already been delivered and closure was under way. The newborn scored Apgars of 2 and 8 and mother and child were quickly reunited following surgery. Had the procedure been delayed for arrival of the local provider, the labor would have proceeded and a vaginal delivery of breech presentation would likely have been required, at great risk to the infant. Fortunately, due to the presence of an OBHG hospitalist, the patient and her newborn didn’t have to be exposed to that increased risk and were able to deliver in a timely, safe manner. As our hospitalists practice entirely in a hospital environment, they are experts in emergent care. Our service-oriented physicians are committed to providing the very best medical care to every patient regardless of time, complication or circumstance. And the best care is immediate care. We invite you to discover more about OBHG and the advantages that our customized programs deliver to our partner hospitals, physicians and patients by visiting www.OBHG.com or contact an OBHG representative today via Programs@OBHG.com or 800.967.2289.
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Ob Hospitalist Group
10 Centimeters Drive • Mauldin, SC 29662 • P: 864.908.3530 • F: 864.627.9920 • www.OBHG.com