RE: High Risk OB dilemma

[Robin/Joan MacNeil <macneil@accesswave.ca>]

Hi Everyone. 

This is my first post here, but this question speaks directly to me. I
am Obs Air Transport Nurse in Halifax, NS, Canada. (We have both an Obs
specialty team and a Neo/Peds specialty team here. Our specialty teams
have the exact same safety and flight training as the Adult team. Our
Obs flight nurses are required to have 3+ years of Tertiary care
Obstetrical nursing and to have taken additional Obs courses such as the
ALSO [Advanced Life Support for Obstetrics] course. The average tertiary
care Obs experience for a nurse on our team is currently 10+ years) Our
Obs team is comprised of the Obs RN, a Neo/Peds RN and an RT.

It is always easier to say what you would do in a hypothetical situation
than in a real situation, but I would not transport this patient. A 26
week preemie has enough risk factors that a delivery in the air would be
a complete disaster. This mom is a primip, but 26 weekers can just slip
out of a 5-6 cm cervix, so the likelihood of this mom delivering soon is
very high. 

None of the Obs Air Transport Nurses on our team would transport this
mom. Instead we would recommend strongly the delivery occur at current
facility and the neo-peds team would transport the baby if need be.

Joan MacNeil
**********
RN, BScN, PNC(C), IBCLC
Halifax NS Canada mailto:macneil@accesswave.ca

-----Original Message-----
From: flightmed-admin@flightweb.com
[mailto:flightmed-admin@flightweb.com] On Behalf Of Dave Sharpe
Sent: August 3, 2003 15:20
To: flightmed@flightweb.com
Subject: High Risk OB dilemna


Ok folks, here's a scenario for you.  Your service flies a BO-105 
aircraft, and has an agreement with a local OB receiving facility to 
provide transport for high-risk OB patients.  On these flights, you 
send the aircraft with one Flight Nurse to the receiving facility to 
pick up a Labor and Delivery Transport Nurse as part of your team, then 
respond to the sending facility 20 minutes away (90 minutes by ground). 
  Upon arrival, you find  a 26 week pregnant, G1P0 patient whose cervix 
is dilated to 10 cm with intact but bulging membranes.  She came in the 
day prior with contractions which were controlled with a MagSo4 drip at 
3gm/hr.  She is no longer having contractions.  The sending physician 
wants her transferred to the receiving specialty center to manage her 
pre-term labor, but does have the capability to resuscitate a preemie 
newborn if necessary.
1.)	Would you transport this patient?
2.)	For the sake of discussison, lets stipulate that you're not 
comfortable with transporting the patient, but the L&D specialty nurse 
and the receiving Perinatologist feel the patient is stable enough to 
transport by air, and is not in danger of delivering precipitously 
enroute.  Given this information, would you then transport the patient?




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