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Re: 32 week bleeder From: Philip Suarez, M.D. (philip@ICSI.Net) Fri Oct 10 07:32:26 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: rbraun@indyunix.iupui.edu: "TGIF" Previous message: Bernard Cristalli: "Re: Steel vs Quiche" > 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. > Comments??? I personally think you ducked a huge bullet. You didn't mention whether that hospital did obstetrics or not. If they DID have an L&D, I would NOT have even considered a transfer. I also would have insisted on talking to an ObGyn doc instead of an FP resident in this case, if there was one around (since you said he didn't talk to his ObGyn backup, I would presume he HAD one). In my opinion luck was with you. Had it not and this lady delivered en route you would have had serious problems with our legal buddies, I suspect. > 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. ????? Oxytocin? Why????? From your presentation you have a clearly preterm pregnancy with some bleeding, but stable. Steroids have not been on board for 48 hours. I'm not staring at the patient, but my inclination would be to continue to ride this patient out. If it's a marginal abruption that is not affecting the status of the fetus (presuming FHTs are great), the uterine irritability may actually be causing the mild contraction pattern. A short course of tocolytics may calm the uterus down just enough that the abruption will stop. At this stage a few days to a week or two would make a significant difference. I'm not sure I see any overwhelmingly convincing evidence that she NEEDS to be delivered right away. Am I missing something?? Philip > BTW, the FP resident had never called the OBGYN backup he had on > call. I would chase this FP resident down and kill him... <grin> PS ----------------------------------------------------- Philip Suarez, M.D. philip@icsi.net ----------------------------------------------------- Fellow - American College Ob/Gyn -- ----------------------------------------------------- Delegate - Texas Medical Association President - Internet Connect Services, Inc. Advisory Board Member - OBGYN.net ----------------------------------------------------- Internet Connect Services, Inc. ----------------------------------------------------- http://www.icsi.net ----------------------------------------------------- ----------------------------------------------------- Next message: rbraun@indyunix.iupui.edu: "TGIF" Previous message: Bernard Cristalli: "Re: Steel vs Quiche"

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