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Ob: IVF candidateFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Mon Sep 29 22:13:44 2008
Here's a case for discussion: 41 YO P1414 with no medical problems or issues. I have cared for her only in her last pregnancy, and the history is from the reliable patients, as opposed to records. Ob #1 32 week Monoamniotic twins, IUFD, C/Section Myomectomy Ob #2 36 week C/Section (PTL) Ob #3 Term C/Section Ob #4 35 week C/Section (PTL) Ob #5 First trimester missed Ab, D and C Ob #6 36 week C/Section, PTL, Classical due to densely adherent bladder Subsequently, she had an apparent ventral hernia of some type, and underwent an abdominoplasty and the general surgeon did not find a hernia. While in the OR I did a Pomeroy TL via the laparotomy. She now has sought IVF and is planning to do so. She ideally would want a twin pregnancy, as she wants two more children. Obviously, she is at risk for surgical complications at laparotomy, AND increased risk of uterine rupture, premature labor, hysterectomy, and abnormal placentation. She asked (paraphrased): If we could predict this, and I had enough embryos, should I "shoot for" a twin pregnancy, versus two separate singletons to have two more children? Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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