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Re: Difficult caseFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Mon May 14 19:04:01 2007
At Mon, 14 May 2007, Andrew Folley wrote: > >26 yo WF G3P2 at 26 weeks presents to triage last friday evening with >bleeding. No prenatal care. This is her third pregnancy with 8 pound baby >delivered vaginally 6 years ago and 5 pound baby delivered at 36 weeks >c-section for breech 15 months ago. Ultrasound on admission shows low lying >placenta possible marginal previa and some possibility of abruption. US also >reveals oligohydramnios with AFI 3 cm. Ultrasound plots the infant at 27 >weeks 5 days. Weight is 2 poiunds, vertex and 47% for growth; no anomalies >seen. She receives steroids Friday and Saturday. FHTs are 140s and >"normal non reactive for 26 weeker" no variables seen. Patient remains >stable Sunday and today bleeding about one pad per day and no pain or >contractions. Continuous EFM show no changes in tracing. MFM consultant >recommends she be delivered soon ie next 24 hours by C-section. Why???? >
If she was 29 wks I would agree with delievery by c-section if placenta 2.0 cm or less from internal o.s.; at 26 wks its not clear cut IMHO your looking at 70-80% survival under the best circumstances. C-section now; is the easy way out avoids scrambling at 2 am looking for support people. There was an excellent poster in the white journal that showed 36 weeks was the best time to deliever singleton previas when risk analysis is done.
--
Take care, John
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