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Re: April foolsFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Mon Apr 2 07:01:37 2007
At Mon, 2 Apr 2007, Danae Steele wrote: > >How about looking at the baby first before cutting? If the baby looks ok on the monitor, and if mom (a multip) has a cervix that has any dilation at all, rupture membranes. Then if its just a marginal abruption from the inferior placenta, the fetal head will likely tamponade the placenta and you can let her deliver vaginally. > > Danae Yes Part of the reasoning for the double setup, the exam showed her to be 1-2 cm dialated 80 % effaced and as expected by abdominal exam the head was unegaged, and indeed the placenta was at the edge of the the cervical os I could not rule out a vasa previa. Waiting for the head to tamponade the bleeding was a game of chicken I was not willing to play, even with out a vasa previa the bleeding could of still been partly from the fetus, 50-100 ml of baby bleeding can compromise baby very fast. I also had the anaesthist remind he he had to go do a perforated viscus at the main o.r. and Nicu standing by; in the end knowing the limits of what your center is capable of is also important, logistics.
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Take care, John
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