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Jaguar symphisiotomyFrom: Terrence.Jones@EMC2NCALWed Dec 20 12:59:00 1995
>Cheri, >Tina & Joe will explain, residents and med students are insatiable here. (Tho when my Wife delivered I was grateful for the wealth of experience their workload confers {mec, shoulder...}.) Regarding the strange & unusual - anyone have any experience with monozygotic multiple pregnancy with acardia? In this case normal concordant appropriate-for-gest-age twins with a triplet anceps (brain, skull, femur, trunk present - no heart), dx'd by sono yesterday at 16.5 wks. No measurements available yet on the chorioangiopagus parasiticus, rel to its sibs - but would be interested if anyone has used these ratios in their own clinical management (see Tom Moore's study from San Diego -- AJOG 9/90, vol 163: 907-12 -- * co-author: Kurt Benirschke). Also if anyone has experience with selective termination of the acardiac fetus, along the lines of Sepulveda (Green Jnl O/G 10/95, vol 84: 680-1). Have come across one ref in triplets by Loh (Int J Gynaecol Obs 1994, vol 45: 153-57). >Perinatology is following this case, and initial impression is to shy away from hysterotomy (and removal of anomalous triplet), and intravascular coils. Intervention is heading in the direction of reduction, by amnio, thru vascular injection - specifics pending. Would greatly appreciate any experience with acardiac/nml sib size ratios in determining outcome risk (preterm birth, hydramnios, hydrops from high output failure, etc...) >From a different perspective (human), I first met this pt. at the time of a ruptured ectopic 2/95. She's Asian-Amer. and barely speaks a word of english, her husband works two jobs and can only come on fridays, to translate. This, her second pregnancy, was spontaneous, and somewhat miraculous - as was the look on her face on her 7 wk sono. I'm thinking of joining Woody Allen as an existential atheist - 'If we're wrong, and there is a God, we deny our own existence'. For those believers among you, don't think of me as the enemy, just the loyal opposition. :( >Sacraligiously Yours, >Terry Jones/Kaiser SF Miraculous events without God? Maybe my beliefs blind me but that sounds like an oxymoron. J.G.M.Robertson MD, 109-9181 Main St., Chilliwack, B.C., Canada, V2P 4M9 (604) 793-9988 e-mail jgmr@unixg.ubc.ca The best we can do for one another is to exchange our thoughts freely; and that, after all, is about all. James A. Froude (1818-1894)
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