Re: Ob: IVF candidate
From: Meenan, Anna (annam@uic.edu)
Mon Sep 29 23:18:24 2008
I'm with Joanne and Gary. I vote for no further pregnancies. The
American health care system can't handle too many of this kind of pt.
Send her to Namibia. It was good enough for Angalina Jolie, after
all.
Anna Meenan, MD
>Garry,
>
>I think I come down on Joanne's side on this.
>
>If that lady walked into my office, I would probably send her down
>the hall to that SOB I hate so much.
>
>Alternatively, you might refer her to El.
>
>Gordon
>
>On Sep 29, 2008, at 10:36 PM, Joanne Bulley, MD wrote:
>
>>Wait a minute ...
>>
>>She has had 3 premature deliveries ... now has a prior classical CS
>>with dense adhesions ... and another twin pregnancy with increased for
>>yet earlier delivery.
>>
>>She already has 4 living children.
>>
>>At what point does the MD, ObGyn specialist have a responsibility to say
>>"you have 4 healthy children - a twin pregnancy is going to increase the
>>risk of yet an earlier delivery (not to mention uterine rupture and loss
>>of both the babies and the uterus and difficult emergency surgery) ....
>>maybe you should not have more babies."?
>>
>>OK - I have not "done" Ob for 10 years - but this one seems like she
>>needs to be happy with the family she has - not have 6 children to
>>raise.
>>
>>I am probably biased here toward the globe having enough humans ... and
>>that is part of why I quit doing tubal reversals and would never make it
>>in an IVF clinic. I would continually be saying "and just WHY do you
>>and this globe need more babies after you have had 2?"
>>
>>I am interested in seeing what those doing OB say - and that may include
>>telling me I am off base here!
>>
>>Joanne
>>
>>At Mon, 29 Sep 2008, Garry E. Siegel, M.D. wrote:
>>
>>>
>>>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
>>>
>>
>>--
>>Joanne Bulley, MD
>>solo gyn
>>Keene, NH
|
|
