-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: 4th degree laceration From: R. Daniel Braun (rd.braun@gmail.com) Sun Sep 25 21:11:51 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "Re: 4th degree laceration" Previous message: R. Berg: "Re: Salary question" In reply to: Marie Harkins: "4th degree laceration" Next in thread: Garry E. Siegel, M.D.: "Re: 4th degree laceration" Reply: Garry E. Siegel, M.D.: "Re: 4th degree laceration" The only one I ever saw that way presented with the hand coming out the rectum and the head out the vagina with an intact perineum. Scared me half to death. Couldn't get the hand to go back so that I could deliver the baby.. Had to cut the perineum to get the baby out. Repaired it and she did well at least in the immediate period. I don't have any longer than a 3 year follow up on her. Dan On 9/25/05, Marie Harkins <mharkins@twcny.rr.com> wrote: > > 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 > -- R. Daniel Braun Kinky for Governor Next message: Garry E. Siegel, M.D.: "Re: 4th degree laceration" Previous message: R. Berg: "Re: Salary question" In reply to: Marie Harkins: "4th degree laceration" Next in thread: Garry E. Siegel, M.D.: "Re: 4th degree laceration" Reply: Garry E. Siegel, M.D.: "Re: 4th degree laceration"

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.