Re: Twins case part I
From: Joe Cutchin (forcep@intercom.net)
Sun Apr 28 08:54:52 2002
If anesthesia and pedi are not 100% devoted to being present,sched CS.
"Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C." wrote:
> This is a bread and butter twins case, I guess some of you will find
> this
> boring, but just think its only a matter of time before a multicenter
> randomised
> clincal trial is done comparing elective c-section at term for twins Vs.
> a trial of labour(I tought I heard one was in the works somewhere). I
> think any such trial will almost certainly mirror the results of the
> Canadian multicenter
> term breach trial, that being that overall c-section will be found
> safer(for the babies). Anyway here goes...
>
> I am on call for the hospital and have just finished an easy
> straightfoward delievery when I get a call from a family Doctor who
> works in a local hamlet
> about 80 mi from our center. He would like to transfer a 34 y.o. G3 P2
> mom with
> twins at just under 35 wks , he is afraid mom is going into labour and
> the local
> hospital's nursury doesn't feel comfortable taking care of 35 wk twins.
> Family
> Doctor says Mom is 4cm dialated,80 % eff. stx -1 and contractiong every
> 4 minutes. Mom
> had an ultrasound on that day which shows twins are vertex/vertex, there
> are
> two sacs(thank God!), twins are apropriate for 34-35 wks but twin B is
> about
> 20 % smaller than Twin A. Mom's last labour had a first stage of 3 hrs
> and a
> second stage of less than 20 min for an 7 lbs baby. It's just before
> midnight
> and he's going to send mom over by air ambulance, it sounds like he is
> not
> convinced mom is in active labour, he doesn't ask about tocolysis and I
> do not
> tell him he must start tocolysis . Mom and Dad get to our hospital just
> after
> 1 am , I say hello to them very pleasant and reasnable couple. Almost
> by instinct the D.R. staff have straped on the EFM. EFM shows very
> nice tracing
> for both twins and contractions every 3-4 min. I examine patient the
> results are
> about the same as family doctors last exam, I palpate a couple of
> contractions
> and they are not to impressive, mom says she can feel them but not
> painfull. D.R. staff ask about calling in the anaesthist for epidural,
> I tell staff I
> don't think mom is in active labour yet. I ponder giving Mom some
> betamethasone
> (celestone),but instead tell Mom to try and get some sleep because
> that's what I
> plan to do!
> So here is the Question for part II, its 2.5 wks latter and sitting on
> my hands
> seems to have caused Mom and twins no ill effects. So should I book an
> elective
> c-section at 38 wks, book an elective induction on quiet day where I
> plan to have anaesthist and pediatrician present, or should I throw all
> caution to the wind and just hope anaesthist and peds are readily
> available when Mom goes into labour ?
> Take care, John
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