Re: placenta previa pearls please!

From: S Osterling M.D. (sdoesterling-obgyndotnet@yahoo.com)
Tue Mar 7 20:56:06 2006

In reality, I tried going around it - but the placenta didn't cooperate. I am not sure of the grading system for placenta previa. I'm sure its in Gabbe, but I don't keep it in my head as working knowledge. How would it be different based on previa grade?

On Mar 7, 2006, at 3:19 PM, Raymond Stephen wrote:

> 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
>

S. Osterling M.D. California



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