I don’t care how many times you repeat the same refrain some patients still don’t get it. A significant number of pregnant women begin prenatal care at the eleventh hour because they’re waiting for insurance approval but others simply procrastinate without rhyme or reason. As a public health physician, I can’t reject difficult patients like my counterparts in private practice. I am obligated to see them for better or for worse. Obstetricians usually steer clear of women who begin prenatal care late and for good reason: they usually present with a host of problems. Quite often I can foresee these problems but on rare occasion, I get duped.
A patient came to see me in her early third trimester and there was nothing unusual about her medical history. She appeared pleasant, cooperative and all of her labs had returned normal, including her fetal ultrasound. Two weeks later, during a routine visit I was unable to hear her baby’s heartbeat. When she stated that the baby had not moved for over a week, my heart sank.
Exhaling a sigh of frustration, I wrote the order for an emergency ultrasound and warned her that things did not look good. Two hours later, a stillbirth was confirmed.
The on-call physician who had delivered the baby gave me an update the next day. The baby had multiple abnormalities and the patient’s lab tests were positive for cocaine. And of course, she initially denied taking it. Her previous ultrasound was allegedly “normal” and although I’m far from being naïve, I would have never suspected the possibility of drugs.
She subsequently refused consent for an autopsy so the official cause of death remains unknown. Earlier prenatal care and a level of honesty might have changed the outcome of this pregnancy. Do I now have to resort to performing drug screens on ALL late prenatal registrants?
What do you think?