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Re: StillbirthFrom: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au)Wed Jan 25 02:57:22 2006
Your proposed management is essentially what was done in the previous pregnancy and didn't work then, so I doubt if it is going to change anything this time. Nothing that you can do will prevent chorioamnionitis. I think you should see the CTG in the few hours leading up to the intra-uterine death, and try to find out why that baby died. A Caesar at 37 weeks isn't going to prevent a death in labour at 35. Steve -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. Ainsworth Sent: Wednesday, 25 January 2006 4:20 PM To: Multiple recipients of list OB-GYN-L Subject: Stillbirth I had a high risk patient transfer to me from the midwives I backup. She is currently at 24 weeks, G2 P1100. She had one stillbirth in 1997 at 40 weeks secondary to a "cord accident," which I have not received a copy of. Her next pregnancy in 1999 was followed at a tertiary care center, I'm not sure if the Ob was a perinatologist, but she had weekly AFIs, NSTs 2x weekly from 34 weeks. At 35 weeks she had decreased AFI and was brought in for induction. FHTs were lost in labor, when the OB arrived, AROM showed thick meconium and no cardiac activity, the infant was 5# 2oz, AGA for 35 weeks. Pathology showed acute chorioamnionitis, as far as I can tell she was afebrile in labor and postpartum and GBS negative. My plan is to do weekly NSTs from about 32 weeks, 2x weekly from 34 weeks, serial sonos with weekly AFIs from 34 weeks. I've offered her the option of elective C/S at 37 weeks. What would others do??
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