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Re: Difficult case From: Andrew Folley (agfolley@hotmail.com) Tue May 15 19:22:02 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: D. Ashley Hill: "Re: Pat myself on the back-lets discuss OBG vs just G" Previous message: Raymond Stephen: "Re: Difficult case" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Difficult case" Next in thread: art fougner, md: "Re: Difficult case" Thanks good recommendations and advice. >From: johnprov@sympatico.ca (Dr. John Provatopoulos B.Sc. M.D.C.M. >F.R.S.C.) >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: Re: Difficult case >Date: Tue, 15 May 2007 07:06:06 -0500 > >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 _________________________________________________________________ Make every IM count. Download Messenger and join the i’m Initiative now. -- _________________________________________________________________ It’s free. http://im.live.com/messenger/im/home/?source=TAGHM_MAY07 Next message: D. Ashley Hill: "Re: Pat myself on the back-lets discuss OBG vs just G" Previous message: Raymond Stephen: "Re: Difficult case" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Difficult case" Next in thread: art fougner, md: "Re: Difficult case"

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