Maternal Mortality and Infection – OB/GYNs are On the Frontlines of Care

When I was in OB/GYN residency training, we saw all types of complex medical cases.  Part of the reason for residency is to prepare to handle all these situations solo.  There have been many moments at 2:00 AM, when I have been grateful for the words of attending physicians who shared their knowledge and skills.  

One of the phrases I tell myself came directly from a Maternal Fetal Medicine (MFM) attending, and anyone who trained at MSU has heard this.  “It’s better to have a living patient without a uterus than to bury them with it.”  I remember my intern year and the first time I heard this phrase.  It seemed so obvious to me.  Of course, I would do a hysterectomy to save someone’s life.  

I was chief rotating on the MFM service during my third year of residency.  We arrived early to conduct medical rounds, check patient vitals, ensure fetal status was stable, and plan for the day ahead.  We had been watching a patient for premature rupture of membranes (PPROM).  She had a very desired pregnancy and was seven weeks away from the fetus being able to survive outside of the uterus.  I was rounding with an amazing attending, and she was precise, detail-oriented, and focused on doing the right thing.  She spoke about all the pregnancy options with the family daily.  

She was keenly aware of the risks of continuing a pregnancy with PPROM.  One of the risks of this pregnancy is infection.  If the bag of water, the amniotic sac, is broken, then there is an open area where bacteria can take hold.  Unfortunately, this infection can become significant and risk the mother’s life.  

One day, this very thing happened to our patient.  Once an infection starts, patients often have more pain, uterine tenderness, and vaginal discharge.  Sometimes people will begin bleeding and can hemorrhage.  The uterus is a muscle; if infected, you can imagine, it will respond with contractions.  

At the same time, the infection could spread through the patient’s body.  This is something called sepsis.  A patient’s heart rate goes up, blood pressure can go down, and chills, dizziness, and a loss of consciousness can occur.  People can develop shortness of breath, nausea and vomiting, diarrhea, and other dangerous symptoms.  As sepsis progresses, organs can start shutting down.  When septic shock appears, mortality is between 30-50 percent.  

Physicians need to be trained to notice when someone is becoming sick and developing an infection.  The concern is the progression of the infection to shock and death.  In some states, the legislation is so vague that physicians wait for patient instability to act.  In Missouri, an ectopic pregnancy was being observed, and physicians felt like they couldn’t legally act until someone showed changes in their vital signs and hgb dropping, which means bleeding internally.

Now, imagine the physician unable to act to save a life – confused – confused by the ambiguity of state law – not medical best practice.  Imagine years of training and oversight; the patient must be shunted aside for procedures and policies. Will the residents of the future be trained to turn an eye to a primary medical credo written millennia ago and guiding skill and mission? “Do no harm.” 

These pregnancies aren’t viable, meaning the fetus will not survive outside the patient’s body.  If the patient dies, the fetus dies.  We are handicapping physicians from practicing evidence-based medicine.  We are putting people at risk, even in our hospital systems.  Who is going to be held accountable for this? Who will take responsibility for the impossible position healthcare workers are in?  

We should be acting in the best interest of our patients, always. 

Physicians specializing in women’s health should be part of critical policy conversations.  We are endangering the lives of the American people.  Laws created in 1849, like in Wisconsin, have no business regulating what a physician can and can’t do in modern-day healthcare.  Let healthcare be provided by the people who trained their whole lives to provide it.  Hospitals, administrators, nursing staff, and physicians need to meet and develop ongoing policies to handle things in a timely fashion instead of waiting for life-threatening events to happen.