Tuesday, January 19, 2010

How do you

tell a woman her baby has a lethal anomaly?

And yes, I'm sure. My sonographer is excellent. The pictures are crystal clear, textbook perfect. The sonographer came out of the room in tears and called me.

Got her squeezed in yesterday to see me after her scan. She and her husband are in shock.

This is the 6th one since July for my practice. We've had about 170 deliveries in that time frame. And most of them have been related to one particular organ system.

I think I'm going to be talking to our local health department...it just feels like too many. I'm not sure the HD will do anything, it's relatively impotent (hence the reason my little clinic does the STD testing).

OB is happy until it's not.

10 comments:

Marissa said...

how terribly sad.

Grumpy, M.D. said...

Sorry.

Bad news is the hardest part of this job.

Sometimes the best we can do is give it with compassion.

rlbates said...

Terribly sorry for you and the family.

rural_obgyn said...

Am I understanding? You have picked up 6 lethal anomalies on ultrasound (most in one organ system) since July?

ER's Mom said...

Yes. Couple of Potters syndrome and a couple of early (15-18 wk) bilateral multicystic kidneys. The Potters syndromes were found on routine scans around 20 weeks. The others were late care and were dating scans that turned into a craptastic mess.

We found another multicystic kidney this week, after I wrote this post. Unilateral this time and has amniotic fluid. Better prognosis...but still.

2 anencephalies. We also diagnosed a Trisomy 18, which I did not count.

I think next week, I'm going to go through those charts and grab some pertinent info and then contact the HD to go from there. I'm hoping for a funky statistical anomaly, but all of these lethal GU anomalies feel to me to be too many for my small town.

student dr. blaze said...

whoa. that sounds like an exceptionally high incidence. anybody using large amounts of pesticides nearby? i once worked on a grant to create a cme for pcps re: pesticide poisoning and the data was scary. (government-published data, i might add....) the worst was learning how women and children often get poisoned via clothing. just the simple act of separating the worker's wash from the rest of the family's could make a huge difference in some areas. sadly, few providers are educated about this, even in agricultural areas....

it must be especially difficult to deal with anencephaly. i'll never get the images from the embryology text out of my head...and those were just photos. :-(

sorry you got stuck having to deliver bad news so much this year, in addition to everything else you've had to deal with. i hope this was all just an anomaly and that you get batches of healthy babies soon.

ER's Mom said...

Yes, we are a farming town. Corn and soy are big here...the local paper publishes corn futures.

I drive past a dairy farm and corn fields on my way to the hospital. I buy eggs from an L&D nurse every few weeks.

dr. whoo? said...

Wow, that is quite a high percentage for what would be considered a relatively low population at large. So scary, and sad for those families. You are right, when OB is bad, it is terrible.

student dr. blaze said...

Any way to tell if the women are living with anyone who works on the farms and might have high exposure to pesticides? Because it sure sounds like the kind of anomalies that would be prevalent if the women were being exposed. Just a thought....

ER's Mom said...

@Studentdoc

That's why I've got to sit down with the charts (in my free time)...to see if they are "city" (I use that term loosely to describe this town), county or different county. Plus see any job similarities...etc.