Re: Difficult twins
From: Joe (forcep@intercom.net)
Sat Dec 30 19:52:45 2006
Cervix was fully dilated. Fundal pressure, apply Keillands and deliver.
Joe C
Andrew Folley wrote:
>
> what do you do???
> On call last night. Induced twins for my partner. G2P1 38 weeks.
> Vertex/vertex di/di. Patient with epidural. First baby comes out 6:00
> pm vacuum outlet assist. no problems. Next baby vertex at -2 cx 5-6
> cm. Of course nurse says heart tones are down in 50-60s. Time 6:05.
> US shows heart rate is low. Mom pushes baby not coming out. AROM second
> twins bag clear fluid. Could not apply vacuum due to membranes, placenta
> from first baby in way etc. 6:08 pm heart tones still down. Nurse
> says can not find heart rate. Mom looks at dad, dad looks at me, I look
> to see if my lawyer has showed up yet. What do you do?????????????????andy
>
>> From: "Andrew Folley" <agfolley@hotmail.com>
>> Reply-To: ob-gyn-l@obgyn.net
>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> Subject: Re: Sheehan's syndrome
>> Date: Sat, 30 Dec 2006 10:33:11 -0600
>>
>> Furthermore, it would be unlikely that she would be able to breast
>> feed if there were true pituitary necrosis. agf
>>
>>> From: DoctorJoe@aol.com
>>> Reply-To: ob-gyn-l@obgyn.net
>>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>> Subject: Re: Sheehan's syndrome
>>> Date: Sat, 30 Dec 2006 07:49:01 -0600
>>>
>>> In a message dated 12/29/06 5:59:49 PM, ljmidwife@aim.com writes:
>>>
>>> > I know that Sheehan's is rare (1:10,000) but also know symptoms can
>>> show up
>>> > weeks to years after the occurrence.
>>> > None of my research talked about the extent of blood loss that can
>>> result
>>> > in Sheehan's. Does anyone on the list have experience with this and
>>> can fill
>>> > me in?
>>> >
>>>
>>> Sheehans occurs when there is such dramatic blood loss that the patient
>>> "shocks out" and the pituitary necroses for lack of blood supply. In
>>> your patient's
>>> case, with only 2 units of blood and a Hgb of 6+, I doubt that she's
>>> affected.
>>>
>>> Joe P.
>>>
>>
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