Re: 2nd trimester fetal demise
From: R. Daniel Braun (rd.braun@gmail.com)
Wed Jun 28 20:13:23 2006
Perfect management.
Dan
On 6/28/06, Dr. Ainsworth <ainsron@sbcglobal.net> wrote:
>
> Thanks for the information. I am sending her to a Doc in Sacramento who
> does 2nd trimester D&E's for Planned Parenthood.
>
> At Wed, 28 Jun 2006, Barbara Nicol MD wrote:
> >
> >Well, should have looked it up before typing. Check out this paper on
> >previa and D&E.
> >You can use laminaria - best wishes!!!
> >
> >- 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
> >
>
--
R. Daniel Braun
"The way to health is an aromatic bath and scented massage everyday".
Hippocrates
