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Clinical Crossroads
Clinician's Corner
August 17, 2005

A 38-Year-Old Woman With Fetal Loss and Hysterectomy

Author Affiliations
 

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, Mass.

JAMA. 2005;294(7):833-840. doi:10.1001/jama.294.7.833

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.

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