Re: fetal demise
From: Andrew Folley (agfolley@hotmail.com)
Fri Jan 6 10:41:03 2006
Interesting thought Dan. i have never considered intusseception in uteru
but it makes sense particularly with the blood etc. andy
>From: "R. Daniel Braun" <rd.braun@gmail.com>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: fetal demise
>Date: Fri, 6 Jan 2006 10:04:06 -0600
>
>Sounds to me like a GI hemorrhage. I wonder if you will find a volvulus or
>intusussception at the post. Draw the Pathologists attention to this so
>that
>he will open and run the entire intestine.
>
>Dan
>
>On 1/6/06, doctorjoe@aol.com <doctorjoe@aol.com> wrote:
> >
> > These babies are fairly large. Do we have any glucose tolerance data on
> > the mom?
> >
> > The THEORY behind sudden IUFD in diabetics is that there MAY be fetal
> > arrythmias (which are obviously not detectable anatomically) due to
> > increased glucose --> increased CO2 --> acidosis --> arrythmia.
> >
> > So I'd be interested in the mother's glucose status (and how much did
>she
> > weigh, etc.).
> >
> > I think the Proteus is a red herring, however pathologic exam of the
>cord
> > and fetus might show something if it were, indeed, an invasive
>infection.
> > Funisitis, pneumonia, etc.
> >
> > Joe P.
> >
> > -----Original Message-----
> > From: Babycatchers@aol.com
> > To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> > Sent: Thu, 5 Jan 2006 21:56:46 -0600
> > Subject: fetal demise
> >
> > I have been with one of our patients for the past 30 some hours and I
> > need to know if you might have any ideas about this situation.
> > 33 yo G2 P1 1st del NSVD of 8'11" baby. no problems. Almost 2 years to
> > the day (yesterday). I did the delivery and she had requested me again
> > (CNM).
> > This EDC was 1/05/06. She was seen on Monday am by OB. + FM,
>measurements
> > = dates, no c/o. Cervix 1/thick/soft/post. This started out as a twin
> > pregnancy. She lost the twin, it was reabsorbed and the rest of the
> > pregnancy was uneventful. VERY compliant patient and supportive family.
> > OB was going to see her in office today for US and possible induction.
> > She presented to the office yesterday (Wed) afternoon with no movements
> > since that morning, no definite time. Sent straight to OB, no heart
>tones,
> > US stat and OB there within a few minutes. No fhr on us, no abruption
>seen
> > and no visible problem with cord.
> > admitted, epidural, induced (3cm/50%/-1). At AROM there was dark
>cranberry
> > colored amniotic fluid with clots. We suspected cord
> > tear/abruption-something. She became febrile about 1 hour before del.
> > Started on PCN IV.
> > She delivered about 12 hrs after admission. Boy weighing 9'14" with a
> > small 1st degree. Could not get any cord blood for chromosomal
> > studies-already clotted and cord was complete burgundy color. 3 vessel
>cord.
> > placenta delivered intact with no signs of abruption (and the OB and I
> > looked). No torn umbilical vessel to account for the bleeding in the
> > amniotic fluid. No vasa previa. The baby looked like he had been dead
>for
> > more than 12 hours. The skin was macerated and peeling to the touch. No
> > deformities. (We were reaching-so got ap/lat x-rays of skull- read said
> > normal. AP and lat of chest-organs looked normal per radiologist.)
> > The only thing we found was a dilated rectal sphincter and it was oozing
> > clots for quite a while after delivery. Oral cavity was clear. This was
>not
> > mecc, but bloody fluid.
> > The only thing I could find after digging thru the chart was the GBS
> > culture at 36 weeks at grown out Probeus gram neg. OB had noted it.
> > The placenta was sent off for path, I got culture that just came back as
> > probeus ( ?-could that be vaginal contamination from delivery?)
> > Mom's temp continued to climb, so OB ordered Amp and Gent today.
> > Another OB just joined the practice and he came in this am for call and
> > walked into the whole staff crying, the OB hitting walls and me crying
>with
> > the family) and family everywhere crying. Poor guy. Neither of them had
>ever
> > seen anything like this before. Did we miss something?
> > For my future reference-is there something else we should have looked
>for
> > or done?
> > Family has decided for an autopsy, so that may help with a few
>questions.
> > This is disjointed-but we have been racking our brains and doing the
>case
> > over and over all night while she labored and after the baby delivered
>and
> > just could not come up with ideas. Is it plain to anyone else and we are
>too
> > close to see it?
> > Thanks for any help.
> > (I am a CNM in WV, USA)
> >
> > Vicki Smith, CNM- West Virginia
> > Midwives-changing the world one baby at a time.
> >
>
>--
>R. Daniel Braun
> Kinky for Governor
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