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32 week bleeder From: R.Daniel Braun, MD FACOG (rbraun@netdirect.net) Sat Aug 30 11:26:41 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R.Daniel Braun, MD FACOG: "Re: PPROM at 34 wks" Previous message: Geffrey Klein: "Re: PPROM at 34 wks" How would you deal with this case ? 28 y/o G8 P1061 at 32 weeks by 16 week U/S presented to outlying community Hosp. because of vaginal bleeding. She had onset of uterine contractions at the same time as the bleeding. She was afraid she couldn't make it all the way in to our hospital and stopped on the way. She was seen by a 3rd year FP resident who tells me the above and that she is contracting every 2-3 minutes and the FHR is 160-170. She had an U/S done which had not yet been read by the radiologist, but the Technician did not think the patient had a previa. Can he put her in an ambulance and ship her to us so she can deliver near the NICU ? This is what he asked at this point. So I said, What is her BP and pulse ? He responded by calling down the hall and asking the nurse what her BP & P were. He really didn't know and hadn't asked before. BP was 110/54 and P was 114. I asked if he had any idea re: Would she deliver in the ambulance on the way to our place? He had no idea. I then took a leap of faith in the U/S tech and asked him to check her cervix. She was 3-4 and -1 station. I was informed by him that the ambulance was there and waiting all we had to do was say OK and she would be on her way. I said OK. Opinions re: having her checked and also re: accepting transfer at this point. She arrives 30 minutes later. on arrival P, BP, & FHR's unchanged. light to moderate vaginal bleeding is noted. U/S reveals posterior fundal Placenta, EFW 1600 grams, Nl. AFI, and vertex presentation. FHR 160-170 variability(on external U/S, no decels and some accels. Mother is actually sitting up joking and laughing. Abdomen is non tender and pain free except when having a contraction every 2-3 minutes(on external evaluation by the Multichannel Automated Neonatal Sensor [MANS unit] which has 5 digits if you count the thumb) Yes GASP I actually felt her belly. Cervix at this time was 4 cm 50% eff vtx @ -1 sta. I decided we should giver her Betamethasone and Ampicillin(GBBS prophylaxis) and observe for awhile. Labs showed a HGB of 10.2, had been 10.4 in clinic 3 weeks ago, and Fibrinogen of 265. I continued to watch her for awhile. Comments??? At 0500 this AM, She remains exactly the same except now HGB is 10.1 and fibrinogen is 125 (repeat 118) Still 4 cm and still contracting Q 2-3 minutes. Recommendations ??????????? I started Oxytocin. Her C/S permit had been signed on admission and her room is 10 feet away from C/S Room. I was relieved by my colleague at 0800 hours after I had been up most of the night. I will let everyone know next week how things turn out. BTW, the FP resident had never called the OBGYN backup he had on call. -- R.Daniel Braun, MD "Heisenberg might have slept here" Unknown or Indecisve Next message: R.Daniel Braun, MD FACOG: "Re: PPROM at 34 wks" Previous message: Geffrey Klein: "Re: PPROM at 34 wks"

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