Re: Twins case part I
From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com)
Sun Apr 28 17:37:18 2002
Strange. I have this case tomorrow. Neo and anesthesia are aware, as
my associate, and we are inducing at 7 AM. Vertex/transverse. 36
weeks, 80%, 4 CM, with some increasing dopplers in baby B.
Joe Cutchin <forcep@intercom.net> said:
> 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
>
--
Richard Chudacoff, MD, FACOG
Chudacoff Obstetrics & Gynecology, PLLC
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