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Re: Normal delivery and uterine rupture after c-sectionFrom: ainsron (ainsron@sbcglobal.net)Thu Feb 24 15:08:41 2005
That's true, but those patients were asymptomatic, this one is not and may need a trip to the OR to correct the defect, as Art suggests, or worse case scenario, a hysterectomy - which will solve the problem of worrying about what to do the "next" pregnancy. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn D. Montgomery, M.D. Sent: Thursday, February 24, 2005 1:49 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Normal delivery and uterine rupture after c-section Let me play the devil's advocate here. Why not labor her the next time? Back when Baylor's TOL/VBAC study was ongoing, the practice was to feel the lower uterine segment following successful vaginal delivery and it was not uncommon to palpate a defect. There were no particular precautions or warnings provided these patients and that was back in the 80's. In fact, we stopped palpating the lower segment because it didn't change management... Lynn Lynn D. Montgomery, M.D. Maternal-Fetal Medicine, OB/GYN Rocky Mountain Women's Health 2835 Fort Missoula Rd., Suite 304 Missoula, Montana, 59804 406-549-0978 fax 406-549-0987 e-mail: apgar10@montanadsl.net -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron Sent: Thursday, February 24, 2005 2:35 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Normal delivery and uterine rupture after c-section Why is that such a big question? I don't think that anyone would recommend a trial of labor with a history of previous scar separation. The bigger question is should she even consider another pregnancy? What if she ruptures catastrophically next time? Ronald E. Ainsworth The big question will be what to do with the next pregnancy??? Lynn Lynn D. Montgomery, M.D. Maternal-Fetal Medicine, OB/GYN Rocky Mountain Women's Health 2835 Fort Missoula Rd., Suite 304 Missoula, Montana, 59804 406-549-0978 fax 406-549-0987 e-mail: apgar10@montanadsl.net -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Ricardo Savaris Sent: Thursday, February 24, 2005 1:48 PM To: Multiple recipients of list OB-GYN-L Subject: Normal delivery and uterine rupture after c-section Dear all, I has been a long time since my last e.mail, but I have seen the msg. This is the following case. A 27yold, had a normal delivery 10 days ago. She has a previous c-section 2 years ago. She arrives at the ER complaining of vaginal bleeding, and pain. On PE: abdomen: low intensity pain over suprapubic region. Epiotomy painfull, moderate bleeding. US: show a 5cm uterine gap, suggestive of uterine rupture. Free fluid in the abdominal cavity. I just order CBC, no signs of local or systemic infection. Suggestions?
-- Ricardo Savaris, MD Porto Alegre - Brasil
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