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Re: PP hemorrhage in a VBAC--why do we VBAC, anyway :)? From: ainsron (ainsron@sbcglobal.net) Thu Jun 7 11:53:39 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Charlie Chambers: "Re: Postpartum depression" Previous message: Andrew Folley: "Re: Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" In reply to: Garry E. Siegel, M.D.: "Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" Next in thread: rmodugno@aol.com: "Re: Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" Ruptured uterus, you probably did a hysterectomy, unless it was repairable. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Wednesday, June 06, 2007 4:22 PM To: Multiple recipients of list OB-GYN-L Subject: Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)? 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: Charlie Chambers: "Re: Postpartum depression" Previous message: Andrew Folley: "Re: Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" In reply to: Garry E. Siegel, M.D.: "Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?" Next in thread: rmodugno@aol.com: "Re: Ob: PP hemorrhage in a VBAC--why do we VBAC, anyway :)?"

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