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Re: (no subject) From: Geffrey H. Klein, MD (gklein@bcm.tmc.edu) Sat Jan 4 08:56:47 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Geffrey H. Klein, MD: "Uterine rupture, pregnant again" Previous message: douglas krell: "Re: Evidence & Economics" Next in thread: richardc@bcm.tmc.edu: "Re: (no subject)" Reply: richardc@bcm.tmc.edu: "Re: (no subject)" Reply: Paul Prior MD: "Re: (no subject)" This case was submitted to me via e-mail. It is a patient asking for advice, but I feel it is so interesting that it might stir an valuable discussion... Below are my recommendations. Any comments, additions, or disagreements? >I am currently 9-10 weeks pregnant and have had two previous C-sections. >The first was due to the size of the baby (10 lbs 4oz.) who never went into >the birth canal after 14 hours of labor. The second was an elective section >which was scheduled for my actual due date. Four days before the due date >the uterus ruptured along the old incision (lower horizontal incision). I >was admitted to the hospital for intense, unceasing pain but the doctors did >not become aware of the actual problem until a couple of hours later when >they decided to do a sonogram and saw that there was no fluid left. The baby >actually was floating in my abdomen when they pulled her out in an emergency >C-section. The newer incision is the classical one Miraculously, both baby >and mother were (are) absolutely fine. That was four years ago and I find >myself pegnant again (quite by accident). I have spoken with two high risk >doctors and a doctor within my own practice. I have mostly conflicting >information on the statistics surrounding this type of situation. I would >normally never terminate a pregnancy and I want to know as much information >as possible before I consider doing that. > >Do you know where I can get information regarding statistics for this >situation? I am afraid that there aren't any because most people who were >lucky enough to get through the first rupture would never be so daft as to >put themselves in that situation again... I do appreciate any assistance >you can give me in locating information and I do realize that you are under >no obligation whatsoever to help me in any way. As this is an unusual situation, I am unaware of any literature to answer this question. I am a little confused, if you had a uterine rupture with the second pregnancy, how did you have a classical incision? My recommendations would not be founded in any scientific data. However, if you truly desire to continue this pregnancy, I would recommend early elective repeat cesarean at 37-38 weeks gestation. Surveillance for symptoms of uterine rupture prior to this should be reported to the doctor. You should be prepared for possible hysterectomy as there are at least two conditions that are higher risk with your history. These include placenta previa (placenta cover the cervical opening and is prone to bleed) and placenta accreta (placenta invades the muscle of the uterus). Best of luck.. -- Geffrey H. Klein, MD listowner: OB-GYN-L Advisory Board Chairman, OBGYN.net < http://www.obgyn.net > gklein@bcm.tmc.edu gklein@icsi.net http://www.bcm.tmc.edu/obgyn/obgyn-ce/geff.html 6800 W. Loop South #520 Bellaire, Texas 77401 (713) 664 8900 Next message: Geffrey H. Klein, MD: "Uterine rupture, pregnant again" Previous message: douglas krell: "Re: Evidence & Economics" Next in thread: richardc@bcm.tmc.edu: "Re: (no subject)" Reply: richardc@bcm.tmc.edu: "Re: (no subject)" Reply: Paul Prior MD: "Re: (no subject)"

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