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Re: new case From: Joanne Bulley, MD (jbulley@cheshire.net) Mon May 29 20:03:47 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Rupak Ranjan Roy: "Re: new case" Previous message: Joanne Bulley, MD: "Re: Cephalocentesis-question" In reply to: Betsy Hyde: "Re: new case" Next in thread: croure@ibm.net: "Re: new case" Reply: croure@ibm.net: "Re: new case" Reply: sanbonav@tin.it: "Re: new case;labor is also a uterine muscolar work" Betsy - Thanks for re-posting the original reason for your post. Having read all of the responses and nasty stuff - then your newest post drawing us back to the original question - The one case of rupture I have been involved involved a G4 or 5 or 6(?) with IUFD. Underwent pitocin induction - with MINIMAL apparent uterine response, increased doses, episode of severe pain followed by no further evidence of contractions accompanied by tachycardia and SOB. She also had abdominal pain that was fairly nonspecific. What I now take out from this is that the usual HEALTHY woman we have in pregnancy, can tolerate rupture of the uterus quite well - tachycardia and SOB with pain that is fairly non-descript. Only with the 20/20 hindsight of your case does our case seem so obvious. What I learn from this is that if I ever go back to OB, I will keep this association of symptoms in my head - Ruptured Uterus as the diagnosis when tachycardia, SOB, lack of apparent progress in labor despite normal doses of oxytocic agents. With IUFD we do not have the sudden change in FHR that would alert us. Joanne At Mon, 29 May 2000, Betsy Hyde wrote: > >At 10:17 AM 5/29/00, Luis Sanchez-Ramos, MD wrote: > >>It is hard for me to believe that a patient with an unscarred uterus >>would suffer a catastrophic uterine rupture with two separate 25 mcg >>doses of misoprostol (adminestered to apatient who is not having regular >>uterine activity). > >these are the facts. The woman received 2 25 mcg doses of misoprostil, 4-6 >hours apart. Our institutional protocols state that doses will not be >repeated if contractions are more frequent q 3-4 minutes. The second dose >was given only because she was *not* contracting. After the second dose she >had a brief period of very painful contractions, and developed tachycardia. >The contractions then stopped. Not detectable on the monitor and not >reported by the woman. > >The purpose of my post was to elicit the opinions of list >members in nailing down a reason for tachycardia, SOB and abdominal pain in >a woman who had delivered a stillborn fetus. At the time of my post, >neither I nor my OB attending, cardiologist, MFM consult, or general >surgeon knew she'd sustained a uterine rupture. The diagnosis was made at >surgery, well after I posted this case. Although uterine rupture was >include in my list of differentials (along w/ PE and AFE), there was no way >to confirm the diagnosis. > >I posted this case because it was a puzzle. I don't think I deserved the >comments that we shouldn't ever use miso because we don't know how to use >it, that we are "eager to make public these occurrences", and that I am, in >some way attempting to hide other examples of uterine rupture in my >practice. I am not. > >It is certainly disappointing that a straight-forward posting of an >interesting (to me) clinical case is met by such hostile replies by someone >with such a wealth of experience in the area of misoprostil use. > >-- >Betsy Hyde CNM >Assistant Clinical Professor, Yale University >Director, Midwifery Services >Obstetrics-Gynecology-Infertility Group, PC >New Haven, CT > -- Joanne Bulley, MD Keene, NH, USA Next message: Rupak Ranjan Roy: "Re: new case" Previous message: Joanne Bulley, MD: "Re: Cephalocentesis-question" In reply to: Betsy Hyde: "Re: new case" Next in thread: croure@ibm.net: "Re: new case" Reply: croure@ibm.net: "Re: new case" Reply: sanbonav@tin.it: "Re: new case;labor is also a uterine muscolar work"

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