|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
4th degree lacerationFrom: Marie Harkins (mharkins@twcny.rr.com)Sun Sep 25 11:08:47 2005
I would love some thoughts on this case. 30 yo, G1P0 at 40 weeks gestation. Hx of Graves disease and thyroidectomy (2000), on Levoxyl and followed by an endocrinologist. She is not a smoker, no hx of STDs, monogomous relationship x 9 years. She is a runner and ran 2 half-marathons during her pregnancy. Total weight gain during pregnancy was 25 lbs with an initial BMI of 23. She had an uncomplicated prenatal course. She went into spontaneous labor and arrived in L&D 4cm/90%/0station. Her labor progressed well, she had nothing for pain and no augmentation. She was fully dilated and pushing 5 hours later. She pushed well spontaneously and within 20 minutes some head was visible. As she was at that point where a small portion of the baby's head became visible with her pushes there was a gush of amniotic fluid and blood that came from her rectum. The baby delivered 15 minutes later, 3250 gm with a compound presentation of the posterior hand. She had a 1st degree perineal tear, rectal sphincter intact. Behind the hymanal ring, there was a 3cm tear through the rectal mucosa. The repair was done in the OR under spinal anesthesia. The MDs and other CNMs I work with thought it was unusual for a 4th degree to happen that far before crowning and birth of the baby. Have any of you seen this type of laceration? Any thoughts for counseling with her next pregnancy? Thanks.
-- Marie Harkins, CNM Ithaca, NY
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Jul 2 04:40:56 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.