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Re: placenta previa pearls please!From: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au)Tue Mar 7 16:17:27 2006
First principle - don't go through the placenta - go around it. Babies' blood volume is less than a litre. Second principle - if you are going to need an upper segment incision, go transversely rather than in the midline - the resulting scar is stronger. I presume you had a Grade IV PP? Steve PS I wait to 38+ if no bleeding earlier. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of S Osterling M.D. Sent: Tuesday, 7 March 2006 2:22 PM To: Multiple recipients of list OB-GYN-L Subject: placenta previa pearls please! I did a section for an anterior previa today. Everything went well, but I didn't have a real firm pre-op plan - other than open uterus, take out baby, keep blood in mom where it belongs. Seriously, I scanned her pre-op and found more placenta on her left. It was about 1/3 the way up the anterior abdominal wall. Intra-op I palpated the uterus to find the thinest part of the lower segment, where i though head was for sure (it was on the right) I opened the uterus in this spot and saw placenta. I had to bluntly dissect through the placenta, rupture membranes, and use fundal pressure to bring the head down. At this point the placenta was in the way. I put on the forceps and easily brought the kid out. Overall, minimal bleeding - like 600 ml in the suction, 200 more on the laps. Apgars 7/8. Does anyone have any pearls? Should I have made a high classical incision and stayed well above the placenta? Should I have made the incision where I usually do and delivered across the center of the placenta? Outcome in this case was good, but I'd rather have more ideas and options for next time. PS- Do you deliver at a set gestational age or do you tap at 36? S. Osterling M.D. California
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