Re: 4th degree laceration
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sun Sep 25 22:14:48 2005
My wife's Ob simply put his hand in the posterior vagina and that
reduced/probably extended my son's arm, and thus the hand back from the
rectum into the vagina.
Garry
At Sun, 25 Sep 2005, R. Daniel Braun wrote:
>
>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 bab .
>Had to cut the perineum to get the baby out. Repaired it and she did well t
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
