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Re: Prior cesarean, SGA, need your help....From: R.Daniel Braun, MD FACOG (rbraun@netdirect.net)Wed Jul 30 21:35:35 1997
At Wed, 30 Jul 1997, Geffrey H. Klein, MD wrote: > >Hi all.. > >New case > >27 y/o G4P1A2 started prenatal care with this office at 31 wks gestation. >Prior doctor did ultrasound at 15 wks supporting due date of 8/16/97. >Patient has prior cesarean section with an LUT incision. Patient refusing >TOL. Ultrasound was ordered 7/14/97 due to size less than dates. EFW at >35 3/7wks by U/S was 1900g (~10%). Repeat U/S by me on 7/15/97 (I did not >have the report until later that day) was 2200g (greater than 10%) but head >was 35 wks and body was 33 wks. AFI was 20. At that point I decided to get >weekly NST's which have been reassuring. > >I had her at the hospital today at 37 4/7 wks. > >Strip was reactive. No contractions. > >My plan was to tap and deliver if mature... >L/S was 1.2 and PG was 0.0. > >Questions: >1) Should I have just sectioned her? >2) Now that I documented immature lungs, what should I do? > >-- >---------------------------------- >Geffrey H. Klein, MD >---------------------------------- >gklein@bcm.tmc.edu >---------------------------------- >http://members.aol.com/gklein01/geff.html >List-owner OB-GYN-L >co-moderator sci.med.obgyn >Advisory Board Chairman OBGYN.net >http://www.obgyn.net/medical.htm >Office: >2200 Nasa Rd #1 >Houston, Texas 77058 >Tel 713 741 2273 x2628 >page 713 415 4395 > Geff; Do you have documentation on that 15 week US ? Do you have a diabetes screen on her? If she were 38 weeks and had a normal diabetes screen, I would have sectioned her without even considering an amniocentesis. You have not really documented immaturity of the fetal lungs, you have not documented maturity. They are slightly diferent. Many babies without PG will have lung maturity. Also many will not. That is the problem, you don't know. If you do not have a diabetes screen on her, I would at least get a fasting or 1 hour postprandial to see what her glucose status is. Also your last US was 2 weeks ago. Has the baby grown any? You may have a poor first US and just a small baby or you could have IUGR (borderline). If she's not diabetic, I would section her next week or in 4 days if her AFI drops to less than 10 or her NST becomes non reactive. Or even sooner if she sneezes. Let us hear the outcome. Dan
-- R.Daniel Braun, MD
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