Re: F/U 15 Week Echo Twin A ,NT4.3 ;Twin B NT 1.6, nl chromo
From: Charlie Chambers (cchamber@gorge.net)
Fri May 30 00:24:31 2003
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>From cchamber@gorge.net Fri May 30 00:24:16 2003
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Thu, 29 May 2003 22:28:14 -0700
Date: Thu, 29 May 2003 22:24:07 -0700
Subject: Re: IUFD @ 35 weeks
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From: Charlie Chambers <cchamber@gorge.net>
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Did anyone check a Kleihauer-Betke when she presented with the bleeding
episode?
On Thursday, May 29, 2003, at 08:12 PM, Efrain Ramirez wrote:
> Prostin gel 2mgs intracervically q 4 hrs - (haven't tried Cytotec PO)
> be
> sure, as Steve pointed out - she has IUP - I don't think she has an
> abruptio - the ones I've seen to produce sudden IUFD - patients seemed
> restless - uncomfortable - large enough to be sonographically
> evident...
>
> She will deliver vaginally - be patient.
>
>>
>
>> , - 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
>
> --
> "Hope is definitely not the same thing as optimism. It is not the
> conviction
> that something will turn out well, but the certainty
> that something makes sense, regardless of how it turns out."
>
> Václav Havel (b. 1936), Czech playwright, president.
>
************************************************************************
**
Charlie Chambers
--
Hood River, OR USA
cchamber@alumni. rice. edu
"I'm a goin fishin.
Yeah, I'm goin fishin
And my baby's goin fishin too!"
Taj Mahal
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