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Fetal demise 31 wks aburption.From: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Wed Nov 14 04:41:37 2007
24 y.o. G3P1 prsents 6 hrs after severe onset lower abdominal pain baby not moving for over 12 hrs. Upon admission to D.R. no fetal heart and then fetal demise confirmed by beside U/S. This patient had a c-section at 28 wks for first pregnancy for aburption, that baby is doing well. Had a laproscope for pain last year showed significant scarring with uterus stuck to anterior abdominal wall, no lysis of adhesions as tubes actually looked healthy. Admission blood work Platlets 94,000 , hgb 98, INR 1.1 PTT 37.; Cervix 1 cm 30% effaced, no bleeding intially but definte bleeding after cervical exam. It's obvious she is having a massive aburption and developing a D.I.C., so plan A do a repeat c-section in view of developing DIC and probable difficult c-section which can easily end up in a hyst or massive post op pelvic hemotoma. Plan B attempt vaginal delievery. Anyone have any pearls of wisdom to offer.
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Take care, John
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