Caring for a Patient with a History of Recurrent Pregnancy Losses and Bipolar Disorder

Background: Bedside nurses provide firsthand ongoing evaluations of the patient’s responses to their plan of care. The dynamics of labor and delivery often require changes in the plan of care. The nurse must prepare the patient for any changes. Caring for a complex obstetrical patient in labor requires competency in understanding the patient’s medical history to be proactive. This demands effective communication techniques. The nurse must also communicate well to integrate and collaborate with other healthcare providers

Case:  

S.G is a 35 year old G7P0, with a history of recurrent pregnancy loss, occurring in the second trimester. None of her previous pregnancies have reached viability. Her surgical history includes: Loop Electrosurgical Excision Procedure (LEEP) eight years ago, a hysteroscopy, and surgical removal of a uterine septum (Metroplasty) one year ago. A McDonalds Cerclage placed during her 12^th week gestation. This was removed at her 36^th week gestation. Her medical history includes bipolar disorder which has been well controlled with medication. Prior to her pregnancy she was taken off of her medication. She has continued under the care of her psychiatrist. Fetal well-being was monitored with biophysical ultrasound studies, non-stress tests and fetal kick counts. After her 24th week of pregnancy she received steroid injection protocol prophylacticaly for her risk for preterm delivery Serial cervical sonograms were done to measure changes in her cervical length. She is married. Her husband is supportive. She is a high school graduate. She does not smoke or use recreational drugs. Her medication is prenatal vitamin.s Her occupation is a dog walker. She intends on becoming a full time stay at home mother after the delivery of her baby. She presents in labor at 41 weeks gestation. When dilated to 4 cm she recieved an epidural for pain control. Her labor progressed until she was dilated to 7cm. Fetal heart tones became tachycardic. Her cervical dilation stopped. A cesarean section was done. Her baby was transferred to the NICU for respiratory difficulties.

Conclusion:

 This case exemplifies effective communication and the ability and power of healthcare providers have working together to produce a positive outcome. Proactive, planning, and establishing follow-up care was done It also focuses on the communication techniques used in the nurse-patient relationship. This gave her confidence as the plan changed. This made her birth experience a positive one.

Keywords:

Recurrent pregnancy loss

Bipolar Disorder

McDonald Cerclage

Loop Electrosurgical Excision Procedure

Hysteroscpic Metroplasty

Uterine Septum