Re: Term IUFD and suspected gestational hypertension
From: art fougner, md (evsono@pipeline.com)
Sat Apr 22 15:28:16 2006
Why not section? You've stabilized ... if plan A doesn't work, why not
plan B? Just a thought ... I could be wrong.
Art
At Sat, 22 Apr 2006, Garry E. Siegel, M.D. wrote:
>
>Hank, you are too nice.
>
>I forgot to reply to Richard--P1001, 8 YO delivered vaginally.
>
>Off this weekend? Hardly. I did her section at 10 PM last night, then a
>vaginal delivery around 1, while awaiting a term patient with SROM who
>had a prior shoulder dystocia and had a planned section for next week.
>Thus, I did her section around 2, home at 3:30. Slept late until 9, now
>rounding and on the second day of:
>
>34 YO P0 at 32w3d presented Tuesday in transfer for CNM care with 150/95
>and 4+ protein. Vertex, long, closed. Long story short, on Thursday AM
>her 24 hour protein was 7 grams, other labs OK (OK, a bit
>hemoconcentrated but SGOT normal, creat only 0.5), so she got cervidil
>Thursday night (S/P steroids, I should add), Pit all day yesterday,
>rested overnight.
>
>This AM a tight 1.5/50 and I was able to AROM; the pit is on 36 mu and
>it will be a long day.
>
>Garry
>
>At Sat, 22 Apr 2006, Henry Gregor wrote:
>>
>>Everything you did was thoroughly professional Gary. Can lead a horse to water, right?
>> Hope you're off this weekend and go pat yourself on the back for doing good work and do something enjoyable with family or friends.
>>
>> Hank
>>
>>"Garry E. Siegel, M.D." <garrys@mindspring.com> wrote:
>> Well, I told this woman and husband (too controlling, in my opinion)
>>about everything that I could think of, and I pretty much think we've
>>got it covered here--scar, death, you name it. It was a surreal and
>>pleasant conversation in which we agreed to disagree--newspeak for sure.
>>I wanted to tell them how wrong there were, and did so explicitly.
>>
>>Initially, I spoke with a good MFM who simply said, "Tell them NO" and
>>don't do it. I told the couple it might be best for a few hours to pass
>>(so they could stew on it), as this was 6 PM. They pretty much gave
>>zero indication of any home for vaginal delivery, so I had the MFM
>>(different one, on call, same group) come see her for a second opinion.
>>Long story short, she refused induction, and in both our opinions she
>>required delivery.
>>
>>So. . . I did a hysterotomy and delivered a small, macerated fetus
>>with a scrawny placenta.
>>
>>Garry
>>
>>At Sat, 22 Apr 2006, Dr Eberhard Lisse wrote:
>>>
>>>Its not a Cesarean Section, it's a *HYSTEROTOMY*!!!!
>>>
>>>el
>>>
>>>on 4/22/06 3:27 PM Richard Kaplan said the following:
>>>> Gary,
>>>> This question really puts the concept of elective cesarean in focus.
>>>> When you're dealing with a live fetus and the patient asks for cesarean
>>>> you can rationalize that you'll get sued if the baby has a problem
>>>> during labor and delivery. In this case, aquiessence to cesarean has no
>>>> conceivable medical benefit. By the way, is she G2P1001 or G1? If
>>>> parous, was her first baby delivered vaginally?
>>>> I would try to convince her to deliver vaginal and give epidural and
>>>> major sedation.
>>>>
>>>> Richard Kaplan, M.D.
>>>> Greensboro, NC
>>>>
>>>>>>>> ----- Original Message ----- From: "Garry E. Siegel, M.D."
>>>>
>>>> To: "Multiple recipients of list OB-GYN-L"
>>>> Sent: Friday, April 21, 2006 8:45 PM
>>>> Subject: Ob: Term IUFD and suspected gestational hypertension
>>>>
>>>>> 34 YO P1001 at 38 weeks, CNM patient with seemingly uncomplicated
>>>>> pregnancy presented today with a term IUFD and BP 145/85 with no history
>>>>> of PIH, etc.
>>>>>
>>>>> Horribly upset as expected, she blurted out to my partner that she
>>>>> wanted a C/S. She was sent to L and D for confirmatory scan, PIH
>>>>> labwork and BP monitoring.
>>>>>
>>>>> Long story short--BPs 145 to 160/80's to 90's, no edema, hyperreflexia.
>>>>> Urine--no protein in office, creatinine 0.5, platelets OK, but her SGOT
>>>>> is 31 (normal is up to 30). Cervix 2-3/50/high.
>>>>>
>>>>> The patient refuses induction, despite a lengthy discussion by me as
>>>>> well as an MFM consultant.
>>>>>
>>>>> Both the MFM and I think she needs delivery based on the likelihood of
>>>>> gestational hypertension.
>>>>>
>>>>> What's next?
>>>>>
>>>>> Garry
>>>>>
>>>>> --
>>>>> Garry E. Siegel, M.D.
>>>>> Private Practice
>>>>> Roswell, GA
>>>>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
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