Re: 4th degree laceration
From: R. Daniel Braun (rd.braun@gmail.com)
Mon Sep 26 03:30:39 2005
That didn't work in my casethe entire arm was extended from the shoulder on
out.
On 9/25/05, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote:
>
> My wife's Ob simply put his hand in the posterior vagina and that
> reduced/probably extended my son's arm, and thus the hand back from the
> rectum into the vagina.
>
> Garry
>
> At Sun, 25 Sep 2005, R. Daniel Braun wrote:
> >
> >The only one I ever saw that way presented with the hand coming out the
> >rectum and the head out the vagina with an intact perineum. Scared me
> half
> >to death. Couldn't get the hand to go back so that I could deliver the
> bab .
> >Had to cut the perineum to get the baby out. Repaired it and she did well
> t
> >least in the immediate period. I don't have any longer than a 3 year
> follow
> >up on her.
> > Dan
> >
> > On 9/25/05, Marie Harkins <mharkins@twcny.rr.com> wrote:
> >>
> >> I would love some thoughts on this case.
> >>
> >> 30 yo, G1P0 at 40 weeks gestation. Hx of Graves disease and
> >> thyroidectomy (2000), on Levoxyl and followed by an endocrinologist.
> >> She is not a smoker, no hx of STDs, monogomous relationship x 9 years.
> >> She is a runner and ran 2 half-marathons during her pregnancy. Total
> >> weight gain during pregnancy was 25 lbs with an initial BMI of 23. She
> >> had an uncomplicated prenatal course.
> >>
> >> She went into spontaneous labor and arrived in L&D 4cm/90%/0station.
> >> Her labor progressed well, she had nothing for pain and no
> >> augmentation. She was fully dilated and pushing 5 hours later. She
> >> pushed well spontaneously and within 20 minutes some head was visible.
> >> As she was at that point where a small portion of the baby's head
> >> became visible with her pushes there was a gush of amniotic fluid and
> >> blood that came from her rectum. The baby delivered 15 minutes later,
> >> 3250 gm with a compound presentation of the posterior hand. She had a
> >> 1st degree perineal tear, rectal sphincter intact. Behind the
> >> hymanal ring, there was a 3cm tear through the rectal mucosa. The
> >> repair was done in the OR under spinal anesthesia.
> >>
> >> The MDs and other CNMs I work with thought it was unusual for a 4th
> >> degree to happen that far before crowning and birth of the baby. Have
> >> any of you seen this type of laceration? Any thoughts for counseling
> >> with her next pregnancy?
> >>
> >> Thanks.
> >>
> >> Marie Harkins, CNM
> >> Ithaca, NY
> >>
> >--
> >R. Daniel Braun
> >Kinky for Governor
> >
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
--
R. Daniel Braun
Kinky for Governor
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