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Re: Placenta previa day.From: Braun, R. Daniel (rbraun@iupui.edu)Wed Dec 17 08:35:13 2003
Await onset of labor. Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. Sent: Wednesday, December 17, 2003 8:09 AM To: Multiple recipients of list OB-GYN-L Subject: Placenta previa day. I usually take care of about 3-4 placenta previas every year, my last case was six months ago it was a previous c-section placenta previa/accerta which I did a repeat c-section on at 38 weeks and every thing went well. So here we are Dec.16 and I was begining to think this year would be a little different when low and behold two placenta previas patients walk in. First case was pretty straight forward, u/s at 19 wks showed low lying placenta, repeat u/s at 32 weeks actually showed complete previa. She had no bleeding and the risks/precautions where discussed with her and she continued her normal work activities until the morning of her scheduled repeat u/s at 35 weeks when she woke up with a small but significant bleed probably about 200 ml. The repeat u/s confirmed complete previa she was admitted and watched for further bleeding which fortunately did not occur but I elected to do a c-section at just under 37 weeks under controlled circumstances with anaesthia and peds present and aware before hand, staffing will be lighter next week and things like stat c-sections may not get done at the drop of a hat. Second case is a little more interesting pleasant 42 y.o. G3 P2 (a real OB only needs 2 letters). First baby was born at 36.5 weeks SVD but induced for possible placental insufficiency baby weighed 4lbs 6oz, Mom was told placenta did not look healthy. I took care of her for her next pregnancy, once again small baby toward the end once again induced at 37 weeks because Mom and doctor where worried once again small healthy baby 4lbs 9 oz and uncomplicated vag delivery. This pregnancy an u/s at 18 wks shows low lying placenta, at 30 weeks because of previous small babies and measuring slightly small do an u/s which shows slightly small baby and posterior placenta previa. I told her if the placenta stays previa until term then she would need a c-section, she was very happy to hear that and reminded me that term for her is 37 wks, I try and temper her enthusiasm for c-section by reminding her of what an easy delivery she had last time. At 35 weeks we repeat the u/s which shows once again small baby the placenta is posterior and 2.5 cm form internal cervical o.s. Well she is now 37 wks(or term as she likes to say) and I know what I am going to do and the most important factor in the decision is that she is a multip. Anyone care to offer suggestions. p.s. here it is Dec.17,2003 and I have delivered two boys both sets of parents Where looking for names and I mentioned Orville and Wilbur, both sets of parents Thought they would pass, I guess they just don't make names like that anymore.
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Take care, John
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