--
Richard Chudacoff, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
Siegel, M.D.
Sent: Sunday, December 11, 2005 8:21 PM
To: Multiple recipients of list OB-GYN-L
Subject: Odd weekend part 1
30 YO P0 at 39 weeks saw my partner Friday late AM with "no" fetal
movement for 2 days. Her pregnancy has been uncomplicated, but she had
undergone a LEEP elsewhere for dysplasia, and apparently have
microinvasive disease such that she had a cold knife conization
subsequently (these were before the pregnancy).
NST reactive, but the patient/husband weren't sufficiently reassured
(per the partner "deer in headlights" look when he told them all was
well)so she went for a BPP. AFI 6, EFW 3900g, to L and D for induction.
My assessment--EFW 3900g, Cx post, 1/2 cm and flush, with a bulging
lower uterine segment and well-applied vertex, and she was contracting
(albeit with no symptoms) regularly. I decided to use a dressing
forceps to gently open the cervix, and it opened a bit (as much as she
would tolerate). However, her contractions picked up such that I
thought that no ripening was needed, and that my intervention may have
tipped her into labor. This was at 7 PM.
The contractions petered out to a degree in the wee hours, and pitocin
was begun at 5 AM. My exam at 8 AM--cervix unchanged, but I could slip
an amniohook in to AROM. She got to 3-4 cm/100% by noon, got an
epidural. When I checked her around 2 PM, maybe 4-5 cm., and I
absolutely couldn't get the cervix to "give"/stretch a bit, yet I felt
that it was under suffcient pressure from the contractions. At 5:30 PM,
no change at all, i.e. 4-5 cm., and I put in an IUPC. One hour
later--gobs of labor, no change.
I sectioned her--9 pound baby, normal lower segment, and I was expecting
a very thin one.
I've really not seen much "cervical dystocia" in my life, but felt that
this was such an animal.
Any thoughts welcome.
G
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Garry E. Siegel, M.D.
Private Practice
Roswell, GA
