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Re: new caseFrom: Betsy Hyde (elishyde@connix.com)Mon May 29 22:47:40 2000
a number of list members have written about uterine ruptures, and fetal demise. There has been some suggestion that perhaps an unknown uterine defect (physiologic, related to infection, perhaps due to to uterine anatomy, perhaps due to prior uterine surgery) has resulted in a fetal demise, first, and then a rupture secondary. I sure as hell don't have the answer to this....but I know that observation of phenomenon, and questioning of the occurence, often times leads to an explanation...or at least proposes an hypothesis for future testing. I did research for almost 10 years prior to midwifery. Have a long CV and list of peer-reviewed publications. I am not uninformed as to the scientific method. I do know that observation is often what drives the research......and I offer no apologies for posting my observation. This woman had minimal contractions. She was given misoprostil, and then pitocin in a manner which is well within the standard of care. There was no apparent reason for rupture. She had an IUFD prior to the rupture, but it seems to me that we need to at least think about this case, and ponder whether there were any predisposing factors. Was a prior existing condition the cause of demise, and then the rupture....or was the rupture due to intrapartum management? I don't know the answer, nor do any of you....but this is a topic worthy of discussion, IMO. At 9:23 PM 5/29/00, croure@ibm.net wrote:
>Is it a problem with the uterus itself or is it something else?? Any there is no reason why my posts should have engendered the multiple nasty posts ( many of them in private as well as public) which I have received. In my personal experience, this has happened once in 10,000 births. I am hardly an inexperienced birth attendant. The woman had a dead baby, and had misoprostil induction for IUFD. It was administered in a manner which, IMO, most of you would agree is prudent. We do the same miso inductions with women with live babies. Our method of induction is prudent....indeed, is cautious per many published articles. My original post was not to brag/prematurely publish/post about a miso rupture.....it was to ask for help in a puzzling clinical case. On this list, there is a wealth of experience with IOL....miso, PG, pit.....I was perhaps mistakenly under the impression that this was a forum for discussion of puzzling cases of this nature....if not, I truly apologize.
-- Betsy Hyde CNM Assistant Clinical Professor, Yale University Director, Midwifery Services Obstetrics-Gynecology-Infertility Group, PC New Haven, CT
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