The Critical Care Obstetrics Podcast

# Navigating Abdominal Pain in Pregnancy: A Case Discussion

> Exploring critical insights from a unique case in obstetrics

Welcome to this week’s discussion on a challenging case involving a 20-year-old pregnant patient presenting with severe abdominal pain. We dive into the complexities that arise in the emergency department when treating pregnant patients and the importance of thorough evaluations.

## Case Overview
Our patient, a Gravida 2 Para 1 at about 20 weeks gestation, arrives at the emergency department complaining of abdominal pain rated at 10 out of 10, accompanied by nausea, vomiting, and constipation. Her initial vital signs show a blood pressure of 117/51 and a heart rate of 78, indicating she is stable upon presentation.

## Common Misdiagnoses
Stephanie raises a critical point about how easily severe abdominal pain during pregnancy can be dismissed as mere constipation. As Suzanne points out, such symptoms are often normalized during pregnancy, potentially leading to dangerous oversights.

> "I find it fascinating how willing we are to just chalk up an emergency department visit to constipation before evaluating anything else." — Stephanie Martin

This highlights the necessity for healthcare professionals to maintain a high index of suspicion when it comes to abdominal pain in pregnant patients.

## Diagnostic Challenges
As the case progresses, lab results reveal a potassium level of 3.2, which correlates with the patient's symptoms of nausea and vomiting. However, the white blood cell count at 13.5 and the discovery of 1% bands raise flags that shouldn’t be ignored. Despite the lab slip labeling these results as normal, these anomalies prompt deeper investigation.

## The Role of OB Consults
An essential aspect discussed is the timing and necessity of involving obstetricians in such cases. Julie emphasizes that even if the patient is stable, early notification of an OB consultant can help ensure that the pregnant patient receives appropriate care throughout their stay in the ED.

> "I do think there needs to be some OB involvement at some point." — Stephanie Martin

This conversation sheds light on the systemic issues in emergency settings regarding the handling of pregnant patients and the importance of timely communication between departments.

## Conclusion
This case serves as a reminder of the critical thinking and collaborative efforts required in obstetric emergencies. As we continue to unravel this case in upcoming discussions, let’s reflect on how we can improve our practices and ensure that we do not overlook serious conditions masquerading as common complaints.

For more in-depth discussions and case studies like this, join us at our [Patreon](https://www.patreon.com/CCOB).

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

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Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

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# Navigating Patient Care: Where to Send Your OB Cases?

> Exploring the challenges of patient placement in critical care obstetrics.

In this episode of the Critical Care Obstetrics Podcast, Stephanie Martin, Suzanne Baird, and Julie Arafe discuss a pivotal question that many healthcare professionals encounter: **Where does your patient belong - in the ED or OB triage?**  

Using fictional yet realistic case studies, they delve into the complexities of patient placement and the critical decisions that must be made in emergency situations involving obstetric patients.  

## Key Case Studies  
**Case 1: Early Pregnancy Complications**  
The first scenario presents a 26-year-old woman in her first trimester with right lower quadrant pain and light vaginal spotting. Stephanie emphasizes the importance of confirming the pregnancy status and evaluating possible complications, including ectopic pregnancy and miscarriage.  

> “Just because she's saying her period was seven weeks ago does not mean she's pregnant.” — Stephanie Martin  

The discussion highlights the need for timely intervention, including labs and imaging, to determine the right course of action. Suzanne points out that emergency departments often face challenges in managing these patients due to the fear of misdiagnosing a potentially serious condition.  

**Case 2: Complications at 18 Weeks**  
As the conversation shifts to an 18-week pregnant patient presenting with severe abdominal pain, the stakes get higher. Stephanie stresses the need for a thorough evaluation to determine whether the issue is obstetric or non-obstetric.  

> “Lower abdominal pain can be very, very challenging.” — Stephanie Martin  

Here, the team discusses the emotional and logistical challenges of patient placement. Julie raises a poignant point about the best environment for a patient experiencing a potential miscarriage, advocating for an OB unit where specialized care can be provided.  

## The Key Takeaway  
In navigating these complex cases, the team reinforces the importance of having clear protocols in place for patient evaluation and placement. Understanding the nuances of each situation not only improves patient outcomes but also alleviates the stress on healthcare providers facing these critical decisions.  

Reflecting on the episode, it's clear that every case is unique, and having an open dialogue about where to send patients can greatly enhance the quality of care provided in critical obstetric situations. For more insights and to hear the full discussion, tune in to the episode!

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

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# Confronting the Willful Blind Spot in Maternal Care

> A deep dive into the disconnect in hospital leadership and patient care.

In this episode of the Critical Care Obstetrics Podcast, Stephanie Martin and Suzanne Baird tackle a crucial yet often overlooked issue in maternal care: the disconnect between hospital leadership and bedside realities. As they discuss the phenomenon they term the "willful blind spot," they highlight the frustrations felt by those at the front lines of care and explore the reasons behind the lack of action from administration.

## The Willful Blind Spot

Stephanie opens the conversation by addressing a pressing concern: why does it seem that hospital leadership often turns a blind eye to the critical issues faced by clinicians? She notes that while those working directly with patients are acutely aware of the problems, solutions often remain elusive. 

> "Everybody's afraid of the lawsuit," says Suzanne. This fear creates a culture where leadership hesitates to make necessary changes, fearing that doing so might be seen as an admission of guilt. Instead, they wait until lawsuits are resolved, leaving vulnerable patients at risk in the meantime.

The podcast reflects on a significant 2018 **USA Today** article by Alison Young, titled "Hospitals Know How to Protect Mothers. They Just Aren't Doing It." This piece resonated with both hosts, highlighting that despite knowing how to improve care, systemic inertia continues to hinder progress.

## The Role of Silos

A recurring theme in their discussion is the damaging effects of silos within healthcare systems. Clinicians often operate in isolation, unaware of ongoing lawsuits or changes being discussed at higher levels. This disconnection not only affects care but also contributes to a culture where learning from past mistakes is stymied.

Stephanie emphasizes that "being present physically and doing a lot of things doesn't necessarily mean that you provided standard of care or even good care."  This highlights the need for an integrated approach where feedback from frontline workers is actively sought and acted upon.

## Financial Constraints as a Barrier

Financial considerations also play a pivotal role in the decisions made by hospital administrations. As Stephanie points out, obstetric services are not typically profit centers for hospitals. This leads to a reluctance to invest in necessary training or changes that could enhance safety, as budget constraints take precedence. 

> "The OB service line doesn't have a budget for that. Yet you've got the hospital as a whole is highly profitable," she remarks, pointing to the disparity in resource allocation.

## Moving Forward

The episode concludes with a call to action for both clinicians and hospital administrators to acknowledge these challenges and work collaboratively towards solutions. As Suzanne notes, "we have opportunities to improve"—and recognizing the issues is the first step in creating a safer environment for mothers and their babies.

This conversation is a crucial reminder that change is possible when we confront the willful blind spots in our systems. 

For more insights and discussions, tune into the full episode and join the conversation about improving maternal health care.

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

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 Recognizing the Unseen: When Vitals Don't Tell the Full Story

> Explore the nuances of assessing patient conditions in critical care.

In the latest episode of the Critical Care Obstetrics Podcast, Dr. Suzanne McMurtry Baird and Dr. Stephanie Martin delve into a crucial topic that every healthcare professional encounters: the discrepancy between a patient's vital signs and their clinical presentation. 

 The Importance of Context

Healthcare providers often find themselves in situations where the numbers on the chart suggest one thing, while the patient in front of them tells a different story. Suzanne begins with a critical reminder: **"We treat the numbers and we don't really treat the patient."** This highlights the necessity of integrating clinical judgment with the data at hand.

 Case Analysis: Is It Normal or Not?

The episode kicks off with a case study that exemplifies this disconnect. A postpartum patient exhibits a heart rate of 132 despite appearing relatively well. As Stephanie points out, **"Just because the patient looks fine doesn't mean the numbers are too."** This leads to a discussion on how easy it is to rationalize away abnormal signs, especially when the patient appears comfortable.

 Key Takeaways:
- **Essential Signs:** A heart rate that’s rising in a postpartum patient is a red flag, regardless of how they appear. It’s crucial to question any assumptions that lead to complacency. 
- **Quantified Blood Loss:** The importance of measuring blood loss accurately was emphasized, with the doctors urging that all deliveries should have quantified blood loss recorded, not just select cases. 
- **Compensation is Key:** Stephanie warns against the trap of assuming that normal blood pressure means everything is okay. **"It means she's compensating,"** she says, highlighting the need for proactive monitoring and intervention.

 Continuing Education

To further explore these scenarios and improve clinical skills, Suzanne and Stephanie invite listeners to join their Patreon community, where they extend these discussions and provide additional insights into critical care practices.

In closing, always remember: the numbers might not tell the full story, but with careful attention to both the data and the patient, we can provide the best care possible. Tune in to the full episode to immerse yourself in these valuable discussions and enhance your clinical acumen.

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

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🚨 Are you putting patients at risk by normalizing bad practices? 🚨  
  
Tag a friend who needs to hear this!  
  
In our latest podcast episode, we dive deep into the challenges of continuous ECG monitoring in obstetric settings. 🚑✨  
  
Nurses and healthcare teams often lack clarity on monitoring protocols. This can lead to dangerous assumptions and inadequate responses to emergencies.  
  
We highlight:  
- The importance of understanding what monitoring truly means  
- How normalization of deviance can compromise patient safety  
- Real-life examples of high-risk situations and how to prepare for them  
  
Don’t let complacency be the enemy of safety.  
  
What’s your experience with ECG monitoring in labor? Share below!  
  
Full episode - link in bio!  
  
#CriticalCare #PatientSafety #HealthcareEducation #Obstetrics #NursingCommunity

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

CCOB Facebook: ...

🌟 Ever wondered how a simple oversight could lead to major complications in childbirth? 🤔  

Tag someone who needs to hear this!  

Today, we dive deep into the crucial role of nursing teams in managing high-risk pregnancies, particularly with Placenta Accreta Spectrum (PAS).  

In the world of maternal-fetal medicine, it’s not just about the doctors or the surgery; it’s about the entire system working together.  
Nurses are often the first line of defense, identifying risks and advocating for patients.  
Without their keen observations and timely interventions, outcomes could be drastically different.

So next time you hear about PAS, remember: it’s a team effort. Our nurses are the unsung heroes! 💪❤️  

What’s your experience with teamwork in healthcare?  

More insights in our latest podcast episode - link in bio!  

#MaternalHealth #NurseAdvocacy #PlacentaAccreta #TeamworkInMedicine #MFM

http://www.passquared.org

http://www.is-pas.org 

https://www.utmbhealth.com/services/ob-gyn/services/mfm

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

CCOB Facebook: ...

I wish someone had told me this sooner: the respect we give new nurses and physicians shapes our future colleagues. 🤔

Tag someone who needs to hear this! 

As we dive into healthcare, it’s easy to forget that every nurse and physician in training is on a journey, just like we were. They need our support, not just instruction.

Remember, the world of medicine is small. The students you teach today could be your colleagues tomorrow. Let’s invest in their growth instead of dismissing them. It’s our responsibility to uplift each other. 

We all have stories about our training. What’s one moment that shaped you? 

🔗 Check out our link in bio for more insights!

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

CCOB Facebook: ...

In the fast-paced world of healthcare, effective communication can be the difference between life and death. Yet, many healthcare professionals find themselves in environments where speaking up feels risky. In this post, we will explore the findings from the article "Silence Kills 2.0" and why it’s crucial for healthcare professionals to engage in open dialogue. We’ll also discuss actionable insights that can improve communication in your workplace.

Article referenced: Joseph Grenny, Vicki Good, Ramón Lavandero, Elizabeth Scruth; Silence Kills 2.0: How Communication Failures Stifle Innovation and Harm Patients. Am J Crit Care 1 May 2026; 35 (3): 182–190. doi: https://doi.org/10.4037/ajcc2026203

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

CCOB Facebook: ...

In this episode, Dr. Stephanie Martin, Julie Arafeh, and Suzanne McMurtry Baird share their recent healthcare experiences, insights into emergency department chaos, and the importance of system improvements. They also introduce their fun segment of two truths and a lie, and discuss the challenges faced by healthcare professionals and patients alike. This episode features a detailed discussion on crisis management, leadership, and healthcare communication, illustrated through real-life scenarios and expert insights. It emphasizes the importance of calm, strategic thinking, and compassionate care in high-pressure situations.

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

CCOB Facebook: ...

*** Learn how the TALK tool enhances team communication in critical care settings. Discover its benefits, implementation strategies, and key takeaways for healthcare professionals.

Article referenced: Iago Enjo-Perez, Cristina Diaz-Navarro, Esther Leon-Castelao, Miquel Sanz-Moncusí, Inma Carmona-Delgado, Javier Pérez-Dueñas, Rocío Ponce-Muñoz, Sara Fernandez-Mendez, Jose-Ramón Alonso-Viladot, Jose María Nicolàs-Arfelis, Pedro Castro; Use of the TALK Tool for Interprofessional Team Self-Debrief During Everyday Opportunities for Learning in Critical Care. Am J Crit Care 1 May 2026; 35 (3): 171–181. doi: https://doi.org/10.4037/ajcc2026814

The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women.

Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics.

Suzanne McMurtry Baird, DNP, RN is the Nursing Director for  Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women.

Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.

Critical Care Obstetrics Academy: https://www.clinicalconceptsinob.com/

Follow us:

Patreon: patreon.com/CCOB

YouTube: @CriticalCareOBPodcast

Instagram: https://www.instagram.com/criticalcareob/

Dr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112a

CCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/

Twitter/X: https://twitter.com/OBCriticalCare

CCOB Facebook: ...