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Drugs to induce VAGINAL BIRTH in COMA patient.

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If a woman is in a coma on a vent(head injury) I know she can give birth. I have read most doctors op for a vaginal birth due to C-section during coma and after healing. is this true? also what drugs would be used to induce labor during a comma/vent?
Can you also tell me what medications may be used on a female age 37, having a severe head injury, 5 months pregnant. Coma & on a vent? She gives birth at 7 months due to some problem(would be good to know what that may be) I have it written as fetal distress? I am attempting to be as accurate as I can. She has been in a coma for 9 weeks. Any added detail you can offer will greatly enhance the accuracy of my story line. Thank you Author Cory Cyr

Category: OBGYN

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Category: Infertility Specialist
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Hello,
Thank you for your query at DoctorSpring.com
I am one of the InHouse Physician and can you kindly elaborate on ' I have read most doctors opt for a vaginal birth due to C-section during coma and after healing. is this true? '. What exactly do you mean by that?
Also, is it possible for, you to post a slightly detailed query. We understand this is fiction based. So the specialist needs to understand what exactly you want.
Once you reply she will get back to you,
Regards.


Patient replied :

Thank you for responding. When I GOOGLED it. Most of what came up by other physicians was that a vaginal birth is safer for a coma patient because the recovery process is easier. This doesn't have to be exact. I would just like to add some authenticity to my book.
Patient is 37 in good health, had previous child
Been in a coma 8.5 weeks due to severe head injury(car accident)
Gives birth during coma at 29 weeks.
I need to know: the actual process of delivery when the patient is in a coma,
the medications for inducing labor,
Also possible scenarios for the baby who is born at 29 weeks. I currently have him in the NICU on a C-pap due to undeveloped lungs?(will this work??)
and what MIGHT happen about 7-10 days after giving birth that might put patient in cardiac arrest or other possible scenario.
Thank you Author Cory Cyr


Hello
Glad to hear from you again.
And it is an honour to correspond with a celebrated author !
Here are my inputs for you -
1. There are very few studies, obviously, on women in coma and on a ventilator who have had ongoing pregnancies, so there are very few resources to go by. Most are anecdotal, hence I will not quote studies, but will give you information based on scientific facts.
2. It is rare, well nigh impossible, for a woman to continue the pregnancy for 2 months while in a comatose condition. The vital functions are compromised to an extent that the baby cannot survive in utero for 2 months while the mother is in coma.
3. More than 80 % of women go into spontaneous labour due to the shock and trauma that leads to a coma. So in your story, that would be a more plausible scenario, If you wish the baby to be live born, then it has to be born soon after the mother goes into a coma. Also, a baby born at 5 months rarely survives, so the lady going into coma around 7 months of gestation and then delivering soon after coma is a likely scenario medically speaking.
4. Yes, vaginal birth is preferred in a comatose woman, due to various complications that could occur while undergoing a C section. Also rarely is the woman's stability compromised for the baby's sake by undertaking a C section. The exception is if the mother is brain dead, with no hopes for survival, and the baby is near term and its safety is guaranteed by going in for an emergency C section.
5. To summarize - either the woman goes into spontaneous labour due to the accident and head injury ( no details needed regarding the birth as she spontaneously expels the baby due to the shock) .
Now, the other option is to have the woman in coma with contractions and irritable uterus due to the shock and trauma. Then the labour is expedited ( induced ) using drugs such as vaginal prostaglandin gels or prostaglandin creams used vaginally. Once the cervix ripens and opens up, oxytocin infusion is given to speed up uterine contractions.
If you need exact dosages and more detailed regimes for labour induction ( am not sure if it is required, I can provide that too ).
6. Regarding the baby, at 29 weeks, it would be preterm, and the lung development would not be optimal. Surfactant injections are given to enhance lung development. The baby would be on a ventilator too for breathing difficulties post birth. It would be ventilated immediately after birth, for upto 2 - 3 days, then it would be weaned off the ventilator gradually, and put on a C pap, and then , as the condition stabilizes, it would be on oxygen supplementation ( Timeline - approx 2 -3 days vent, 2- 3 days C pap and then 2 - 3 days oxygen ) before being on spontaneous respiration ( approx 7 - 10 days after birth ) .
7. For the mother, 7 - 10 days after birth, the most striking complication of childbirth ( and the most fatal ) would be - pulmonary embolism.
Please look that up. Google ' pulmonary embolism after birth ' .
I hope this information helps you.
Please feel free to ask me for more inputs based on your requirements.
Take care.


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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