Re: 4th degree laceration
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Sep 26 08:08:48 2005
Did you shake hands? :)
>At Mon, 26 Sep 2005, R. Daniel Braun wrote:
>
>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 we l
>> 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
>
--
"Character may be manifested in the great moments, but it is made in the
small ones."
- Phillip Brooks
~walt whitman~
