Re: Interesting case: Twins, 19 weeks, PPROM,etc.
From: art fougner, md (evsono@pipeline.com)
Thu Mar 17 07:07:13 2005
Brian
fingers crossed - and what are the folks doing about this woman's other
issues?
art
At Thu, 17 Mar 2005, Efrain Ramirez wrote:
>
>We had an almost identical case some months ago - did the same thing -
>but - the second twin was delivered (stillborn??) about 2 weeks later..
>good luck Brian!!
>
>>At Wed, 16 Mar 2005, Brian Fox wrote:
>>
>>Now for the rest of the story. And so many people think nothing much
>>happens out in the boondocks.
>>
>>The patient felt something in the vagina about 36 hours after
>>admission; this proved to be a solitary fetal leg. Still no evidence of
>>infection; she was advised the loss of the leading twin was now inevitable, and
>> loss of the 2nd was likely; she was having a few mild cramps. Over the
>> course of the next 10 hours she reported some additional mild
>>cramping; some additional sensations in the vagina that proved to be due to
>> successive delivery of the other leg, then the torso, and, finally, the
>> head. Fetus was stillborn. Cord was tied off just inside of the cervix
>> with an Endoloop, and cut. The cervix then proceeded to close down.
>> Remaining twin was active and viable. She was watched in the hospital
>> overnight. Next morning, no cramps, no unusual discharge, Cervix
>> visualized and seen to be closed.
>>
>> Seen in office Monday; no fever, no cramps, no unusual vaginal
>>discharge. Cervix closed. Fetus B is active, strong and regular fetal heart tones. Advised to rest often; to place nothing in the vagina; take temperature twice/day; call if any feelings of ill health, etc. To be seen twice/week and PRN. She continues to smoke and indulge in her other
>> usual habits. I told her that today she is a walking miracle, but could not provide any promise about the future.
>>
>> PS. Cowboy poetry festival is every year, last week of January; quite a gathering.
>>
>>--
>> Brian W. Fox, MD, FACOG, Ruby Mountain OB-GYN
>> 1995 Errecart Blvd., Suite 103
>> Elko, NV 89801
>>
>--
> I think I will do nothing for a long time but listen,
> And accrue what I hear into myself...and let sounds
> contribute toward me.
>
> ~walt whitman~
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
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