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Re: 2nd trimester fetal demise From: Barbara Nicol (blnicol@ix.netcom.com) Wed Jun 28 16:18:52 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Barbara Nicol MD: "Re: 2nd trimester fetal demise" Previous message: Dr Eberhard Lisse: "Re: 2nd trimester fetal demise" Maybe in reply to: Dr. Ainsworth: "2nd trimester fetal demise" Next in thread: Barbara Nicol MD: "Re: 2nd trimester fetal demise" Reply: Barbara Nicol MD: "Re: 2nd trimester fetal demise" In residency, did a similar case at 23 weeks by D&E but she was a multipara with a 3 cm dilated cervix (and active bleeding). It was a pleasure to be able to avoid hysterotomy - the patient was stable for discharge within a few hours! (The cervical dilation was visible on ultrasound, before you ask). The patient had Crohn's disease as well so we REALLY wanted to avoid abdominal surgery. I think it would be rather difficult to dilate to a size adequate for D&E without prep, and both lams and cytotec seem contraindicated to me, though there may be information about previa in the abortion research literature that would help. You may be stuck with hysterotomy. - Barb Nicol, M.D. San Francisco -----Original Message----- >From: Dr Eberhard Lisse <el@lisse.NA> >Sent: Jun 28, 2006 12:52 PM >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: Re: 2nd trimester fetal demise > >Induce a Placenta Previa? > >Please load the Golf bag into the Porsche and let me have the keys and >the registration, you will not be needing them any longer. > >on 6/28/06 8:42 PM Dr. Ainsworth said the following: >> I have a patient who is a surrogate mom - donor egg and sperm from the >> biological parents, now at 20wks with a fetal demise that probably >> occurred one week ago. She has a complete previa. If she wants to >> terminate the pregnancy, would you do a D&E with laminaria or try >> cytotec? At this point, she is showing no signs of labor and does not >> want to continue the pregnancy. If you used cytotec, what dose - >> 200mcg, 400mcg, 800mcg q6h? Would you try a low dose and work up? Would >> you do it as an inpatient with blood available, or as an outpatient >> until you begin getting some response? > >el > >-- >Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar) >el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell) >PO Box 8421 \ / Please send DNS/NA-NiC related e-mail >Bachbrecht, Namibia ;____/ to dns-admin@na-nic.com.na Next message: Barbara Nicol MD: "Re: 2nd trimester fetal demise" Previous message: Dr Eberhard Lisse: "Re: 2nd trimester fetal demise" Maybe in reply to: Dr. Ainsworth: "2nd trimester fetal demise" Next in thread: Barbara Nicol MD: "Re: 2nd trimester fetal demise" Reply: Barbara Nicol MD: "Re: 2nd trimester fetal demise"

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