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Re: OB: Asherman's, now pregnantFrom: art fougner, md (evsono@pipeline.com)Tue Dec 9 07:05:19 1997
At Mon, 8 Dec 1997, Garry E. Siegel, M.D. wrote: > >Dear ya'll: > >I would love some suggestions with the following patient: > >40 YO P 2002, now 11 weeks pregnant by IVF, who in early 1996 presented >with secondary infertility, and was found to be ovulatory, with a normal >Semen Analysis, and she stated that she thought that her infertility >stemmed from her last delivery. > >Her first delivery was vaginal, and uneventful; the second was an >emergency section, complicated by a postop infections requiring IV >antibiotics (the history was from this reliable patient, no records >could be gotten). Anyway, I did an HSG and, no surprise, she had a >little cavity which essentially was test tube shaped, and no spill. She >underwent hysteroscopy/laparoscopy with a repro endo and me (I watched >through the lapscope--normal pelvis), and subsequently she had to have a >second operative hysteroscopy. > >Obviously, she is at risk for an accreta/percreta/need for emergency >hysterectomy, all of which she has heard from day one. > >Questions: > >1. Would you offer a VBAC versus a repeat section/TL if desired (it >would be desired)? Why or why not? > >2. Any reason that her genetic amnio at 15 weeks should be more >difficult? > >3. I have read a few articles here and there on prenatal diagnosis of >abnormal placentation by ultrasound. It would be excellent if a >prenatal diagnosis could be made, realizing that her ultrasounds could >be normal, yet the placentation might not be. Does anyone have any >thoughts/experience? > >I do plan to run this by my local MFM consultants, too, but I would be >interested in what the Ob-Gyn list experts think. > >Garry > >-- >Garry E. Siegel, M.D., FACOG >Private Practice >Roswell, Ga. > hope she makes it that far along where worries about placental adherence would be paramount. this lady has an increased risk for spontaneous abortion/preterm delivery. good luck! art
-- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com
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