Re: Normal delivery and uterine rupture after c-section
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Feb 24 15:16:04 2005
The differences here -IMHO - are symptoms and signs -
I didn't stop palpating - it seems reasonable to me that a 2cms defect
is better than a hole you can put in your whole hand - and the site of
the defect - I would be more concern if it's lateral - you add to that a
moderate bleeding -
>At Thu, 24 Feb 2005, Lynn D. Montgomery, M.D. wrote:
>
>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
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
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