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Interesting case: Twins, 19 weeks, PPROM,etc.From: Brian Fox (snofox@citlink.net)Wed Mar 16 19:57:48 2005
Now for the rest of the story. And so many people think nothing much happens out in the boondocks. The patient felt something in the vagina about 36 hours after admission; this proved to be a solitary fetal leg. Still no evidence of infection; she was advised the loss of the leading twin was now inevitable, and loss of the 2nd was likely; she was having a few mild cramps. Over the course of the next 10 hours she reported some additional mild cramping; some additional sensations in the vagina that proved to be due to successive delivery of the other leg, then the torso, and, finally, the head. Fetus was stillborn. Cord was tied off just inside of the cervix with an Endoloop, and cut. The cervix then proceeded to close down. Remaining twin was active and viable. She was watched in the hospital overnight. Next morning, no cramps, no unusual discharge, Cervix visualized and seen to be closed. Seen in office Monday; no fever, no cramps, no unusual vaginal discharge. Cervix closed. Fetus B is active, strong and regular fetal heart tones. Advised to rest often; to place nothing in the vagina; take temperature twice/day; call if any feelings of ill health, etc. To be seen twice/week and PRN. She continues to smoke and indulge in her other usual habits. I told her that today she is a walking miracle, but could not provide any promise about the future. PS. Cowboy poetry festival is every year, last week of January; quite a gathering.
-- Brian W. Fox, MD, FACOG, Ruby Mountain OB-GYN 1995 Errecart Blvd., Suite 103 Elko, NV 89801
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