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Consultation for total pain in high-risk obstetrics
  1. Warren Mackie-Jenkins1,
  2. Regina M Tosca2 and
  3. Hunter Groninger2,3
  1. 1 Department of Medicine, MedStar Washington Hospital Center Washington, Washington, District of Columbia, USA
  2. 2 Section of Palliative Care, MedStar Washington Hospital Center, Washington, District of Columbia, USA
  3. 3 Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
  1. Correspondence to Dr Hunter Groninger, Section of Palliative Care, MedStar Washington Hospital Center, Washington DC 20010, USA; hunter.groninger{at}


Palliative care (PC) consultation rarely takes place in the clinical setting of high-risk obstetrics, where ‘total pain’ may be undermanaged. Here, we present a case of a young woman carrying twins and hospitalised for acute abdominal pain. Workup for her pain revealed non-viable fetal tissue positioned in the uterine horn; the remaining fetus was viable. Initial attempts to control the patient’s pain with strong parenteral opioids by the obstetrics team and the acute pain service failed. The PC service was consulted to assist. Applying a customary interdisciplinary approach in a novel PC clinical setting, the PC service was able to identify and attend to the patient’s physical, psychosocial and spiritual pain, resulting in an overall decrease in reported pain scores, decreased opioid requirement and a plan for preservation of the viable fetus.

  • pain
  • clinical assessment
  • total pain
  • psychological care
  • obstetrics

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  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement None declared.