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Re: Difficult caseFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Tue May 15 07:04:59 2007
At Tue, 15 May 2007, Andrew Folley wrote: > >You are all on the right track. Oligo most likely a sign of serious >placental dysfunction leading to hypoperfusion of kidneys with oligo. >Maternal Hb 9.3. No evidence of vasa previa or PPROM. Doppler studies of >the baby show Middle Cerebral Artery S/D of 2.65 and the Umbilical Artery >S/D of 2.93 >When would you deliver her? > It's not always clear cut, c-section now is the easy out and gauranties a live baby at birth. I have followed a baby with s.d. of middle cerebral of 2.4-2.5 from 24 to 28 wks also had intermittant oligo. Baby did well after c-section at 28 wks. Here's how I would present it to Mom; c-section now would ensure live baby at birth but there is a 20-30 % chance of losing baby after that, c-section in 3 weeks would put the chances of the baby surving at greater than 90% but there is at least a 30% of the losing the baby by waiting. There is nothing wrong with fluid resusitating mom +/- transfusion and repeating everthing in 1-2 days.This is a case where a significant vaginal bleed to force the issue makes your life easier.
--
Take care, John
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