Re: 4th degree laceration
From: R. Daniel Braun (rd.braun@gmail.com)
Mon Sep 26 12:06:38 2005
Yep!
On 9/26/05, Efrain Ramirez <eramirezt@coqui.net> wrote:
>
> Did you shake hands? :)
>
> >At Mon, 26 Sep 2005, R. Daniel Braun wrote:
> >
> >That didn't work in my casethe entire arm was extended from the shoulder
> on
> >out.
> >
> >On 9/25/05, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote:
> >>
> >> 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
> we l
> >> 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
> >>
> >--
> >R. Daniel Braun
> >Kinky for Governor
> >
>
> --
> "Character may be manifested in the great moments, but it is made in the
> small ones."
>
> - Phillip Brooks
>
> ~walt whitman~
>
--
R. Daniel Braun
Kinky for Governor
