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Previa and Preterm PROM:follow-upFrom: dahmd@gate.netTue Jul 2 22:28:47 1996
I wanted to thank everyone for their input and provide some follow-up: First, I passed along incorrect information about the gestational age. I was told she was around 20 weeks based on an early vaginal ultrasound. In fact, when the records from her first scan finally arrived, it put her at almost 23 weeks. Her ultrasound at presentation decreased amniotic fluid, with an amniotic fluid index (AFI) of a little more than 5. Recently she began having increasingly more painful contractions, and was taken to the operating room by another physician for delivery. He told me that she had "above-average" bleeding, and after delivery he awaited spontaneous separation of the placenta without difficulty. He was able to feel the placenta actually "wrapping around" the fetal head as the baby passed through the cervix, but could not tell where the posterior edge of the placenta was located. The bleeding was worse just as the fetal head passed through the cervix. The baby is actually in the neonatal intensive care unit (I am unsure of apgars or other baby information). The mother did not need surgical intervention. To comment on someone's question, she was given informed consent about expectant management versus induction of labor, and from what I gather, was not led in either direction. Shortly before beginning labor, she had decided on induction. I have had patients decide on expectant management and become infected and deliver a non-viable infant, while others delivered a few weeks later and watched the baby die in the ICU. Still others have gone on to deliver viable infants who went home with the parents. I find this particular clinical situation quite difficult, whether or not there is placenta previa involved. Sometimes the 'good old days' of selling lawnmowers looks pretty good to me! Thanks again for your help. My partner is *very* impressed about the depth of experience on this list, and will be joining us shortly. Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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