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Re: Merry ChristmasFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Sun Dec 26 09:16:51 2004
I can't top Dan's Christmas. 6 AM off to hospital #1 for 34.5 week ROM/labor multip. midwife patient who doesn't like IV's, monitors, etc. Thank goodness she's GBS negative, and kudos to the CNM who did the test early since her first one was at 34 weeks. She dilates oh-so slowly, and pushes for 1.5 hour for a 6.5 pound baby! The intermittent heart tones are slow to recover after many contractions, but I sit there torn between recommending a vacuum and having to argue/discuss it. That is one facet of having a midwife practice that I really don't like--fearing/being hesitant to recommend intervention that I think appropriate due to the aggravation and hard feeings it will cause during the tense time of an unmedicated labor. Babe out OK, to ICU and ventilator, Mom says she can't believe an Obstetrician was so patient with her! Cord arterial pH 7.23 :). Meanwhile, at hospital 1 also, term P0000 with PROM comes in. Pit begun around 6 AM. Also, at hosptial 2, 35.5 week twins with IUGR are awaiting a section (breech/transverse) delayed from 12/24 due to PTT being out. She is on heparin due to a Prothrombin gene mutation, having had bilateral LE DVTs and a vena cava filter this pregancy AFTER her laparotomy at 6 weeks for a huge dermoid. The C/S was for 7:30 AM, but off for the delivery at hospital 1. I really don't want to bother my partner to come in today. . . C/S done finally around 3 PM, return to hospital 1 for primigravida delivery, who pushes it out easily. Home at 5 PM, exercise, shower, and what's for dinner? Leftovers in a hurry. . . 7 PM--16 YO P0000 with Von Willebrand's presents in term labor. Gets DDAVP per Hematologist, goes quickly and delivers around 11 PM. 10 PM another 16 YO ER hit comes in. 20.2 weeks, PROM from a few days ago, sent home to bedrest from other good group at hospital 2. Presents with 2 feet about 2 cm out, purple and wiggling. Large rural family is upset and initally hostile, and "do anything to save the baby" and "why can't anything be done--it has a heartbeat" and "why did the other doctors tell us everything would be allright?" Large rural family comes and goes out of LDR, arguing amongst themselves, and I called the excellent nursing supervisor to control traffic! Oh, by the way, patient so upset/scared/tense/immature that examing her is pretty fruitless, so I ask for an epidural once IV in, CBC done, etc. While awaiting that, she delivers to the umbilicus slowly so the fetus easily comes out, and thankfully is stillborn. Then, I run to deliver DDAVP girl awaiting the placenta. . . D and C for the placenta in the OR at 12:45 AM, then home by 1:30 for 8 uninterrupted hours. Off to make AM rounds. . . Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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