Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
Author Affiliation: Dr Sachs is Chief, Obstetrics
and Gynecology, Beth Israel Deaconess Medical Center; Harold H. Rosenfield
Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical
School; and Professor in the Department of Society, Human Development and
Health in the Faculty of Public Health, Harvard School of Public Health, Boston,
DR DELBANCO: Mrs
W is a married, self-employed, healthy woman living in a community several
hours from Boston. She has private health insurance. At age 38, she was admitted
to the hospital for elective delivery of her first child, but the admission
ended tragically with fetal loss, hysterectomy, and a prolonged hospitalization.
The pregnancy, her first, was wanted and uneventful. When seen initially
by her obstetrician, Mrs W’s blood pressure was 112/80 mm Hg. She showed
no sign of labor at term. At 40 weeks of pregnancy, her blood pressure was
126/78 mm Hg, rising shortly thereafter to 144/85 mm Hg. She had trace proteinuria.
Her creatinine level was 0.8 mg/dL (70.7 μmol/L), and her uric acid level
was 6.3 mg/dL. At 41 weeks of gestation, her obstetrician, Dr F, decided to
admit her for misoprostol induction. Dr F was not on call that night.
Sachs BP. A 38-Year-Old Woman With Fetal Loss and Hysterectomy. JAMA. 2005;294(7):833-840. doi:10.1001/jama.294.7.833