Re: Difficult twins
From: Larry Glazerman (l.glazerman@rcn.com)
Sat Dec 30 17:37:14 2006
First of all, why induce? Otherwise, I'd section the second twin.
On Dec 30, 2006, at 7:26 PM, Andrew Folley wrote:
>
> what do you do???
> On call last night. Induced twins for my partner. G2P1 38 weeks.
> Vertex/vertex di/di. Patient with epidural. First baby comes out
> 6:00 pm vacuum outlet assist. no problems. Next baby vertex at -2
> cx 5-6 cm. Of course nurse says heart tones are down in 50-60s.
> Time 6:05. US shows heart rate is low. Mom pushes baby not coming
> out. AROM second twins bag clear fluid. Could not apply vacuum due
> to membranes, placenta from first baby in way etc. 6:08 pm heart
> tones still down. Nurse says can not find heart rate. Mom looks at
> dad, dad looks at me, I look to see if my lawyer has showed up
> yet. What do you do?????????????????andy
>
>> From: "Andrew Folley" <agfolley@hotmail.com>
>> Reply-To: ob-gyn-l@obgyn.net
>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> Subject: Re: Sheehan's syndrome
>> Date: Sat, 30 Dec 2006 10:33:11 -0600
>>
>> Furthermore, it would be unlikely that she would be able to breast
>> feed if there were true pituitary necrosis. agf
>>
>>> From: DoctorJoe@aol.com
>>> Reply-To: ob-gyn-l@obgyn.net
>>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>> Subject: Re: Sheehan's syndrome
>>> Date: Sat, 30 Dec 2006 07:49:01 -0600
>>>
>>> In a message dated 12/29/06 5:59:49 PM, ljmidwife@aim.com writes:
>>>
>>> > I know that Sheehan's is rare (1:10,000) but also know symptoms
>>> can show up
>>> > weeks to years after the occurrence.
>>> > None of my research talked about the extent of blood loss that
>>> can result
>>> > in Sheehan's. Does anyone on the list have experience with this
>>> and can fill
>>> > me in?
>>> >
>>>
>>> Sheehans occurs when there is such dramatic blood loss that the
>>> patient
>>> "shocks out" and the pituitary necroses for lack of blood supply.
>>> In your patient's
>>> case, with only 2 units of blood and a Hgb of 6+, I doubt that she's
>>> affected.
>>>
>>> Joe P.
>>>
>>
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