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Re: Interesting case.From: ainsron (ainsron@sbcglobal.net)Mon Mar 14 09:46:13 2005
Bedrest, serial ultrasound, monitor for chorio, cover with PCN for GBS until cultures available. Counsel her very strongly that this pregnancy has minimal to no chance to survive to viability and if they do, the chance of serious morbidity - cerebral palsy, mental retardation, etc is probably greater than 90%. Transfer to Level III nursery at whatever time they will take her, but probably not before 23 weeks. You have to remember, this is an invevitable abortion at <20 weeks, not a threatened preterm delivery. I would also tell her that any attempt to resuscitate these infants below 24 weeks would no be warranted, to be prepared to see some attempts at spontaneous respirations and cardiac activity, but intervention is not recommended. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Brian Fox Sent: Saturday, March 12, 2005 9:45 PM To: Multiple recipients of list OB-GYN-L Subject: Interesting case. 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
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