Re: Difficult twins
From: Andrew Folley (agfolley@hotmail.com)
Sun Dec 31 05:59:02 2006
favorable cervix, end of year patient request yadda yadda yadda
As far as csection goes, it may take 15-20 minutes to do. anesthesia tied up
etc.
what now?????
>From: Larry Glazerman <l.glazerman@rcn.com>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Difficult twins Date: Sat, 30 Dec 2006 18:39:14 -0600
>
>First of all, why induce? Otherwise, I'd section the second twin.
>
>On Dec 30, 2006, at 7:26 PM, 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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