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Re: Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)? From: Andrew Folley (agfolley@hotmail.com) Thu Jun 7 11:09:03 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: ainsron: "Re: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" Previous message: Andrew Folley: "Re: Gyn: PMB/pain" In reply to: Garry E. Siegel, M.D.: "Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" Next in thread: ainsron: "Re: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" I would guess a ruptured lower uterine segment to explain the deep variables and bleeding post partum. Foley catheter should tell you if she ruptured into bladder or not. Pretty much oblicgated to evaluate pelvic and abdomen through midline incision in light of drop in HCt and finidings on the CAT. This would be the horses.....Zebra would be accessory lobe of placenta present with percreta. agf >From: garrys@mindspring.com (Garry E. Siegel, M.D.) >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)? >Date: Wed, 6 Jun 2007 18:21:33 -0500 > >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 Next message: ainsron: "Re: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" Previous message: Andrew Folley: "Re: Gyn: PMB/pain" In reply to: Garry E. Siegel, M.D.: "Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" Next in thread: ainsron: "Re: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?"

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