Re: Clinical scenario

From: rmodugno@aol.com
Mon Oct 9 17:38:10 2006

Robert Modugno MD MBA FACOG Smoky Mountain OB/Gyn Associates 64 Eastgate Drive, Sylva, NC 28779 828-586-7802

-----Original Message----- From: elishyde@mindspring.com To: ob-gyn-l@dns.obgyn.net Sent: Sun, 8 Oct 2006 6:36 PM Subject: Re: Clinical scenario

On Oct 8, 2006, at 3:50 PM, Efrain Ramirez wrote:    > Suppose she wants to go home.. would you agree with her? 
  I had a very similar client. It was a muslim woman at term who was well-dilated in the office, and refused admission. Next day she was even more dilated. She had a history of rapid labor and a little one at home.    Her husband was quite controlling and domineering, and he refused to allow any intervention (ie AROM). I finally convinced her to go to the hospital when she was 8 or 9 cm. By the time she got there, she was fully dilated.    And there she stayed for more than 24 hours. Multip, term, fully dilated, irregular contractions. The FOB and his sister rarely left the woman alone. In those rare moments when we were alone, she cried and cried...but said she could not go against her husband's will and allow me to rupture her membranes. Husband was also a law student, and told me he knew about those "accidental" membrane ruptures during vag exam, and he would consider that as assault.    Sigh.    After 24 hours of this foolishness, extensive documentation, multiple phone calls with risk management.....I sent her home. Multip, fully dilated, history of rapid labor....and I sent her home.    She spontaneously ruptured a few days later, had an hour or two of labor.    Betsy Hyde CNM  Branford, CT 

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Uterine atony postpartum? Robert Modugno MD MBA FACOG Marietta, GA



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