OB-GYN-L Messages for June, 2006: Re: 2nd trimester fetal demise

Re: 2nd trimester fetal demise

From: Barbara Nicol MD

blnicol@ix.netcom.com

Wed Jun 28 17:43:10 2006

- Barb Nicol

The effect of placenta previa on blood loss in second-trimester pregnancy termination. AU Thomas AG; Alvarez M; Friedman F Jr; Brodman ML; Kim J; Lockwood C SO Obstet Gynecol 1994 Jul;84(1):58-60.

OBJECTIVE: To determine whether placenta previa increases bleeding during second-trimester pregnancy termination. METHODS: The records of 131 consecutive women undergoing elective pregnancy termination at 13-24 weeks' gestation were reviewed and divided into those with and without placenta previa based on an ultrasound examination before the procedure. These two groups were then compared for differences in maternal characteristics, estimated blood loss, operative time, infection, and hospital admission. RESULTS: Twenty-three of 131 women (17.6%) had placenta previa. Sixty-seven percent of the previa patients smoked, versus 37% in the control group, a statistically significant difference. A statistical difference was noted with respect to placenta previa in intraoperative blood loss (P < .05), but not operative time, time to discharge, infection, hemorrhage, or other complications. CONCLUSION: Second-trimester pregnancy terminations in the presence of placenta previa are associated with a higher estimated blood loss, but no apparent increase in abortion-related infection, postoperative transfusion requirements, hysterectomy, or other complications.

At Wed, 28 Jun 2006, Barbara Nicol wrote: >
>In residency, did a similar case at 23 weeks by D&E but she was a multipara with a 3 cm dilated cervix (and active bleeding). It was a pleasure to be able to avoid hysterotomy - the patient was stable for discharge within a few hours! (The cervical dilation was visible on ultrasound, before you ask). The patient had Crohn's disease as well so we REALLY wanted to avoid abdominal surgery. I think it would be rather difficult to dilate to a size adequate for D&E without prep, and both lams and cytotec seem contraindicated to me, though there may be information about previa in the abortion research literature that would help. You may be stuck with hysterotomy.
>
>- Barb Nicol, M.D.
>San Francisco
>
>-----Original Message-----
>>From: Dr Eberhard Lisse <el@lisse.NA>
>>Sent: Jun 28, 2006 12:52 PM
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: Re: 2nd trimester fetal demise
>>
>>Induce a Placenta Previa?
>>
>>Please load the Golf bag into the Porsche and let me have the keys and
>>the registration, you will not be needing them any longer.
>>
>>on 6/28/06 8:42 PM Dr. Ainsworth said the following:
>>> I have a patient who is a surrogate mom - donor egg and sperm from the
>>> biological parents, now at 20wks with a fetal demise that probably
>>> occurred one week ago. She has a complete previa. If she wants to
>>> terminate the pregnancy, would you do a D&E with laminaria or try
>>> cytotec? At this point, she is showing no signs of labor and does not
>>> want to continue the pregnancy. If you used cytotec, what dose -
>>> 200mcg, 400mcg, 800mcg q6h? Would you try a low dose and work up? Would
>>> you do it as an inpatient with blood available, or as an outpatient
>>> until you begin getting some response?
>>
>>el
>>
>>--
>>Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
>>el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
>>PO Box 8421 \ / Please send DNS/NA-NiC related e-mail
>>Bachbrecht, Namibia ;____/ to dns-admin@na-nic.com.na

-- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA

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