Re: Normal delivery and uterine rupture after c-section
From: Lynn D. Montgomery, M.D. (apgar10@montanadsl.net)
Thu Feb 24 15:20:16 2005
I actually agree with y'all - I would first discourage pregnancy and second,
do an c/s early. Just fun to consider things...
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 Efrain
Ramirez
Sent: Thursday, February 24, 2005 3:17 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Normal delivery and uterine rupture after c-section
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)
