Re: OB: 31 week IUFD
From: Charlie Chambers (cchamber@gorge.net)
Thu Mar 18 22:01:12 2004
Ideally, you'd like to await spontaneous labor, but I always found it
difficult to suggest to a patient to carry a demise indefinitely. Seems
at best, you can strike some sort of compromise.
BTW, did you happen to get a tox screen on this patient?
Tough situation. Best of luck to you and your patient.
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**
Charlie Chambers
--
Hood River, OR USA
cchamber@alumni. rice. edu
"I'm a goin fishin.
Yeah, I'm goin fishin
And my baby's goin fishin too!"
Taj Mahal
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On Mar 18, 2004, at 7:06 PM, Garry E. Siegel, M.D. wrote:
> I only have partial information here, but would appreciate any input.
>
> approx 30 YO P2002, 2 prior unknown sections, now 31 weeks presents for
> a routine visit and found to have an IUFD, vertex, closed/thick cervix.
> My partner has said she is not the best and the brightest, and her
> understanding level (to him) was substandard.
>
> She has been a bit haphazard in her prenatal care, missing
> appointments,
> social trouble, etc. At around 11 to 14 weeks, she was in the hospital
> for many days with GI trouble/?gallstones (I can't remember the
> details). She mainly has been seen by one of my partners, who is less
> experienced than me by over 15 years. This was around noon today.
>
> He asked me about the patient, as I'm on call starting Friday for the
> weekend, and I suggested that, if her cervix was poor (at the time we
> talked, it hadn't been checked), that it might be best to sit tight a
> few days rather than immediately deliver. I also pointed out that this
> was no emergency medically, and perhaps the smartest thing that we
> could
> do would be nothing. We discussed ripening and induction, and I vetoed
> cytotec (2 prior unknown sections) and suggested cervidil and pitocin
> if
> induction were chosen.
>
> My partner called me around 7 PM from L and D, where she had gotten her
> cervidil, wondering what we should do if she doesn't respond.
>
> I suggested that we reassess her in the AM, and if her cervix is still
> rock hard, to again consider NO action as the best course.
>
> Any thoughts?
>
> Garry
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
