Re: 4th degree laceration
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Mon Sep 26 16:59:51 2005
I wish I had thought that quickly on me feet!
Garry :)
At Mon, 26 Sep 2005, Efrain Ramirez wrote:
>
>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~
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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