Shortness of Breath
A 22-year-old lady with no medical history presented with lower abdominal pain and shortness of breath. She had been seen the day before by one of our physician assistants who diagnosed her with bronchitis and prescribed erythromycin. She came back because she was getting worse.
When I went in the room, I saw a trim young woman who was hyperventilating and clearly in distress. As I talked with her, she relaxed and became quite comfortable. Her physical examination was normal except for an obviously distended abdomen. Just as I went to examine her abdomen more closely, it tightened up and she started to hyperventilate again. Getting the big picture, it became clear to me she was in labor. Her contractions were causing her pain and distress leading to hyperventilation. She had no breathing problem at all. She was about to have a baby.
When I shared my impression with her, she became very upset. She said there was no way she was pregnant. She had normal periods every month and could not possibly be pregnant.
As she told me this, her abdomen softened and she relaxed. I realized I could be wrong so I excused myself to go and get a Doppler, which is an electronic listening device that can detect blood flowing and turn it into sound. When I placed it over her abdomen, the rapid swoosh, swoosh, swoosh of a baby’s heartbeat was clearly audible. I told her she was, indeed, going to having a baby.
“No!” she screamed, and started to sob. I tried to comfort her, which was not helpful. I told her we were sending her up to labor and delivery. She made no response but continued to cry.
As she was leaving, I asked if there were anyone with her. Between sobs, she told me her mother was in the waiting room, but cried, “Don’t tell my mother!”
“You think she’s not going to find out?” I asked. She collapsed back on the gurney and sobbed uncontrollably. Off she went to labor and delivery.
When I told the mother the news, she was subdued but didn’t seem really surprised. When I asked her if she had not noticed her daughter getting big, she said, “We just thought she was gaining weight.”
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Comments (7)
Becca
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Didn’t the PA notice the big belly? I am a bit surprised bronchitis was diagnosed, but nothing else.
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tad
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When I asked him how he missed the pregnancy, he asked me why he would examine the abdomen of someone who was complaining of shortness of breath. He just missed it, that’s all. She had no cough and was not a smoker. There was no reason to think she had bronchitis. And antibiotics don’t help you if you have bronchitis. Just a lame diagnosis and missed opportunity to find out what was really wrong with her. A risk we alway face.
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Carolyn
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I can’t imagine the shock it would be to be told you’re going into labor if you truly had no clue that you were pregnant! You’d have barely any time to process the concept, it would be crazy! But, of course, I can scarcely imagine not knowing I was pregnant either!
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Bethany
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How does someone mis-diagnose pregnancy for bronchitis??
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Carmen
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Whoa! So then she had probably already been in labor since the day before when she had come in to be seen. That’s so crazy! Good thing she came back for a return visit, an unexpected home birth would be pretty traumatizing and probably dangerous.
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Teresa velez
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Was it ignorance on the part of the young lady and her mom or just
Plain denial?
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Flavia McKnight
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That is crazy!! I can’t believe that he missed it. Usually mothers can notice, maybe this mother didn’t want to accept that her daughter was pregnant! Good thing that you are awesome:)
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