Re: Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?
From: art fougner, md (evsono@pipeline.com)
Thu Jun 7 08:13:52 2007
Garry
any mention of "Armstrong Forceps (fundal pressure)?
Art
At Wed, 6 Jun 2007, Garry E. Siegel, M.D. wrote:
>
>Not exactly; the CT suggested an intraperitoneal hemorrhage, and
>adherent clot to the uterus and clots in the pelvis. Those findings and
>her clinical condition mandated a laparotomy. While I did do an exam
>under anesthesia (always!), it was not illuminating.
>
>Garry
>
>At Wed, 6 Jun 2007, Betsy Hyde wrote:
>>
>>you did an exam under anesthesia and found a LUS rupture with broad
>>ligament extension.
>>
>>--
>>Betsy Hyde CNM
>>Branford, CT
>>
>>On Jun 6, 2007, at 7:21 PM, Garry E. Siegel, M.D. wrote:
>>
>>> 37 YO P 4004 at term
>>> #1 Term LTC/S, breech, document
>>> #2 and #3--VBACs, uneventful, our CNMs, 9 to 10 pound babies
>>>
>>> This deliver--SROM, irreg ctx., augmented. While the CNM was
>>> caring for
>>> her, I stopped in a followed her a bit. Clincal EFW 4200 g
>>>
>>> Dilatation was protracted for a multip., and she had a couple of
>>> runs of
>>> hyperstimulation (meaning tachysystole with bradycardia) that resolved
>>> with the old Pit on/Pit off/flip sides.
>>>
>>> She progressed to complete dilation, and started with big variables.
>>> After pushing around 5 to 10 minutes, heart tones were jumbled
>>> (FSE) and
>>> unreadable, and I watched the CNM with the head crowning, and simply
>>> whispered to her (she is a newby but a goody) to make an
>>> episiotomy, and
>>> have her push even between contractions and "get the baby out." The
>>> baby
>>> came out, all well.
>>>
>>> PP she hemorrhaged, and it was assumed by the CNMs/L and D nurses
>>> to be
>>> atonic--methergine, more pit, hemabate.
>>>
>>> When she got hypotensive, I got the call.
>>>
>>> Room exam--firm fundus 2 fingers below, no lacerations, lots of BRB.
>>> Belly soft, no complaint of shoulder pain, FWIW.
>>>
>>> Hct. 23 (was 37), quick CT showed fluid in upper abdomen, clot in
>>> pelvis, ?hematoma of uterus--we went from the CT scanner across the
>>> hall
>>> to the theater.
>>>
>>> What did I do and what did I find?
>>>
>>> Garry
>>>
>>> --
>>> Garry E. Siegel, M.D.
>>> Private Practice
>>> Roswell, GA
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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