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Re: Interesting case. From: Charlie Chambers (cchamber@gorge.net) Sun Mar 13 20:02:53 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: Ultrasound as part of the normal exam" Previous message: Charlie Chambers: "Re: Ultrasound as part of the normal exam" In reply to: Garry E. Siegel, M.D.: "Re: Interesting case." I think that Garry's point to offer a termination are quite valid. The prognosis for the pregnancy is quite poor. Having been at the University of Utah, I'm not surprised at their response. Little could be done at their end to improve a terrible situation. Any aggressive intervention in this situation is controversial at best. The biggest concern is observation for chorioamnionitis and not placing the mother at risk. I would be quite frank with the mother that possibilities of a good outcome are rather poor. I can remember a number of transfers by flight from Elko when I was at Utah, and they always seemed to be challenging. ************************************************************************ * Charlie Chambers -- Hood River, OR cchamber@alumni.rice.edu "No matter where you go... there you are." Dr. Buckaroo Banzai ************************************************************************ On Mar 13, 2005, at 6:49 PM, Garry E. Siegel, M.D. wrote: > Dan is so right--the chances of a good outcome here, irrespective of > the > Mom's social problems, is tiny at best. > > How about offerring termination to avoid maternal illness (sepsis)? > > I absolutely would discuss the prognosis with expectant management, and > offer that versus termination. There doesn't seem to be much reason to > transfer anytime soon. > > Sometimes, expectant management for a few days is best to allow time to > pass. A clear answer may come to the patient, or, sometimes the > situation declares itself. > > Garry > > PS--was cleaning up/setting up my office today after water damage, and > saw a quarterly monograph I have gotten for years, called (I think) > Clinical Ob/Gyn. The particular volume was edited by Joseph Pastorek, > who seemed familiar :). > > At Sat, 12 Mar 2005, Brian Fox wrote: >> >> Greetings Listers. >> I am involved in a case I would be interested in your input on. >> 29 y/o, G5P4, history of drug abuse in past; she does not have >> possession of any of her previous children; only one prenatal care >> visit >> prior to this admission; now at 18w3d, known twin gestation, >> dichorionic, diamnionic. She has spontaneous rupture of membranes of >> the >> leading twin. Sonogram shows 2 fetuses, one with severe >> oligohydramnios; >> the other with normal AFI. Fetal growth measurements are concordant. >> Both are still alive. No evidence of infection (yet); no evidence of >> being in labor (yet). Cervix is closed on "sterile" speculum exam. I >> practice in a community of 20K people, 50 bed, nursery level 1 >> hospital; >> referral hospital is 220 miles away. What would you do now? >> >> -- >> Brian W. Fox, MD, FACOG >> 1995 Errecart Blvd., Suite 103 >> Elko, NV 89801 >> > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA > Next message: DoctorJoe@aol.com: "Re: Ultrasound as part of the normal exam" Previous message: Charlie Chambers: "Re: Ultrasound as part of the normal exam" In reply to: Garry E. Siegel, M.D.: "Re: Interesting case."

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