OB-GYN-L Messages for September, 2008: Re: Ob: IVF candidate

Re: Ob: IVF candidate

From: Ginny Lee

kaupilimakoa@hotmail.com

Mon Sep 29 23:26:53 2008

> Date: Mon, 29 Sep 2008 23:19:52 -0500> From: annam@uic.edu> To: ob-gyn-l@mail.obgyn.net> Subject: Re: Ob: IVF candidate> > 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 tuba
>>>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>

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