A Hard Lesson on Prenatal Care for One High Risk Pregnancy

The author of the following article learned after becoming pregnant that she would have a high risk pregnancy. Fortunately, the author was then working at a hospital. She therefore encountered little difficulty in finding a suitable doctor. She had not, however, expected her case to present her chosen obstetrician with such a great challenge. Read the story in the article below.
In late 1982, the obstetricians at UCLA Hospital did not have available to them detailed information on prenatal care for a patient with a ventricular-peritoneal shunt. In fact, at that time, only four other physician teams in California had ever had to search for information about prenatal care for a pregnant woman with such a shunt.

Because not one of those teams had reported any special problems, the doctors at UCLA did not expect their pregnant patient to encounter any great difficulties. In November, however, those doctors discovered that they had had incorrect expectations. Their mistake, once realized, taught them a good bit about the prenatal care for a patient with a ventricular peritoneal shunt.

Now since the patient with the shunt was known to be in a high risk pregnancy, she had consulted with more than one health care provider. Two doctors were overseeing her care. One was her pediatrician, and the other was a neurologist.
The patient with the shunt had an obstruction that prevented the normal absorption and flow of the cerebrospinal fluid. The shunt carried that fluid out of the cranial cavity and into the woman’s peritoneal cavity. The neurologist needed to watch for any significant changes in the performance of the shunt.
Evidence that there could indeed be such a change appeared about two weeks before Thanksgiving. The pregnant woman with the shunt began to have a severe headache. Eventually she chose to contact one health care provider—her obstetrician. He instructed her to go to the emergency room.

The doctors at UCLA then started to restudy the available information on prenatal care for a woman with a shunt. The woman’s obstetrician also contacted her neurologist. That evening the patient with the headache had a CT scan. She had to wear a heavy lead apron during that scan, in order to protect her growing baby from any radiation.

The information from the CT scan indicated that the developing baby had slowed the rate at which cerebrospinal fluid could flow through the shunt. The slower-functioning shunt had apparently caused the severe headaches. The obstetrician then made a decision that added to the available information on prenatal care for a woman with a shunt.

The obstetrician made two suggestions. He told his patient to try to sleep with her head in a raised position, as if she were sitting. In that way the fluid in the shunt would feel the pull of gravity at all times. The obstetrician also asked the woman’s husband to push on the shunt pump everyday. That increased pressure at a fixed point on the wife’s scalp would help to keep the fluid from “backing-up” in the peritoneal cavity.

That combined approach to the problem did the trick. That combined approach brought an end to the headaches that the pregnant woman had been having. That combined approach offered new information to any obstetrician intent on learning about prenatal care for a little-studied, high risk pregnancy. The selected approach showed that any such care can benefit from the husband’s involvement.
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