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Re: IUFD @ 35 weeksFrom: Griffiths Malcolm (Malcolm.Griffiths@ldh-tr.anglox.nhs.uk)Fri May 30 02:01:16 2003
Re induction - try mefipristone followed by gemeprost/misoprostol. Alternatively try Dilapan. Malcolm Griffiths Clinical Director & Consultant O&G -----Original Message----- From: Len2976@aol.com [mailto:Len2976@aol.com] Sent: 29 May 2003 17:52 To: Multiple recipients of list OB-GYN-L Subject: Re: IUFD @ 35 weeks 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
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