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Re: IUFD @ 35 weeks From: Marco A. Pelosi, III, MD (marcop@agoron.com) Thu May 29 16:54:14 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff, MD: "name of test" Previous message: Steve Raymond: "Re: IUFD @ 35 weeks" In reply to: Len2976@aol.com: "Re: IUFD @ 35 weeks" Next in thread: Efrain Ramirez: "Re: IUFD @ 35 weeks" Textbook abruption until proven otherwise. Ultrasounds rule out previas, but not abruptions. Elevated MSAFP? Smoker? Abuser? Leiden mutation? Diagnosis is clinical. Treatment of choice is delivery at maturity or onset of trouble - whichever comes first. Close surveillance is always mandatory because stillbirth rate is high. The management plan for delivery version 2003 should include a time frame for response to induction agents & prompt cesarean if that time frame is exceeded. I assume you have toxicology & coagulation studies in progress & plan to autopsy the fetus. At Thu, 29 May 2003, Len2976@aol.com wrote: > >This patient is a 29 y/o G2, P0. Her pregnancy was uneventful until 4/23/03 >(31 weeks gestation) when she experienced some vaginal bleeding. She was >evaluated in L & D. FHTs were reassuring, cervix was long and closed, and she was >not contracting. U/S showed no evidence of abruption or previa, AFI was >normal, growth was at the 50%, and BPP was 10/10. No further bleeding was >observed and she was sent home. > >Patient was seen in the office 1 week later by another CNM and she had no >further bleeding. The patient reported good fetal movements and FH measured 34 >cms. A f/u U/S 1 week later again was normal with AGA of 32 weeks, normal AF, >and normal placenta. > >At a subsequent prenatal visit 2 weeks ago the patient again reported no >bleeding, good fetal movements, and FH measured 35 cms. > >I saw the patient yesterday. She was vague about fetal activity. FH >measured 30 cms, no FHTs were heard, and an office U/S revealed no FCA. U/S at >radiology Dept in hospital confirmed above, no AF was seen, and fetal measurements >were c/w 30 weeks. Of course she is devastated. > >After counseling patient was admitted by the CNM on call (consulted with OB) >for IOL. Cx was unfavorable. Patient now has had cytotec 100 mcg p.o. q 3 >hours (7 doses) with no effects yet--started to ask about C/S, which we >discouraged. > >Questions for group: > >1. Should management after bleeding incident 1 month ago have been managed >differently? weeking BPPs, NSTs, etc??? > >2. Suggestions for IP management now. I have found in the past with 2nd >trimester IUFDs that vaginal cytotec seems for effective than p.o. Comments? >Dosage? > >Thanks for the advice.. > >Lenora McCall, CNM -- M.A. Pelosi, III, MD Next message: Richard Chudacoff, MD: "name of test" Previous message: Steve Raymond: "Re: IUFD @ 35 weeks" In reply to: Len2976@aol.com: "Re: IUFD @ 35 weeks" Next in thread: Efrain Ramirez: "Re: IUFD @ 35 weeks"

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