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OB: Premium pregnancy ? ( was 40 y/0;IVF; pit labor?) From: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk) Tue Dec 9 15:10:40 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: GEN: Topical sweets (was Re: Wound dehiscencce)" Previous message: Malcolm Griffiths: "OB: Asherman's, now pregnant" In reply to: rbraun@iupui.edu: "Re: OB: 40 y/0;IVF; pit labor?" Next in thread: rbraun@iupui.edu: "Re: OB: Premium pregnancy ? ( was 40 y/0;IVF; pit labor?)" Reply: rbraun@iupui.edu: "Re: OB: Premium pregnancy ? ( was 40 y/0;IVF; pit labor?)" In message <Pine.HPP.3.96.971209130653.4063A-100000@ruby.iupui.edu>, rbraun@iupui.edu writes >Answer: All of the above twice. > >This lady is 40 and has an IVF pregnancy. Hence this is (and yes I know >they all are) a premium pregnancy. Yes Bob this is gut driven and not >logic. >I did not mean to imply that the IVF pregnancy has an increased risk, per >se. It is possible that it does, but I have no data or studies. I just >meant that this shows that this is a highly desired pregnancy. >There is also the association between maternal age and abruptio placenta. >Ther also is an increased incidence of hypertension-toxemia with >increasing maternal age. I'm not familiar with the expression of "premium pregnancy" - occasionally over here we hear the term "precious pregnancy". If the two terms are synonymous, then I find your expression as offensive as ours! I would contend that no pregnancy is any more precious/premium than any other and to suggest otherwise is callousness towards the other "non- premiums"! In all pregnancies our management should be aimed at the best possible outcome for mother and baby - compatible with the aspirations of the woman. If we genuinely beleived that a routine CS was somehow a better bet for the particular circumstances of a pregnancy (that is not based on obstetric considerations - but "premium-ness"), then surely we would also need to see CS as the best option for all pregnancies. -- ------------- What follows may not be thought to be terribly relevant! -------------------- I once worked with a guy who took this sort of view - though in this -------------------- case to the opposite extreme - viewing some pregnancies as less desired. -------------------- He had a 15 year old who requested termination of pregnancy. SHe had a suction termiantion of pregnancy. But a couple of months later was still pregnant! He claimed he must have missed one of twins! By now termination was too late and she was to continue the pregnancy. The child was to go for adoption. She had preterm ROM. Management was conservative and involved hospital admission. The consultant annotated the notes that she was not for CS in any event for fetal reasons. She developed chroioamnionitis and laboured. Progress was slow and there was fetal distress. A decision to do CS was very much delayed. When CS was unavoidable a resident did CS. The lower segment was extremely friable and there was some difficulty with delivery. The lowere segment tore badly. There was a spiral tear of >360degrees. The only thing connecting the lower and upper segments being one uterine artery. A consultant colleague was able to reattach the uterus - I'm uncertain how it ever healed or functioned. AS this is now >10 years ago the girl is now ~30yo. Wonder how it worked out for her. Wonder how well the severely asphyxiated baby did after adoption? Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" (Someone [1997]) Next message: art fougner, md: "Re: GEN: Topical sweets (was Re: Wound dehiscencce)" Previous message: Malcolm Griffiths: "OB: Asherman's, now pregnant" In reply to: rbraun@iupui.edu: "Re: OB: 40 y/0;IVF; pit labor?" Next in thread: rbraun@iupui.edu: "Re: OB: Premium pregnancy ? ( was 40 y/0;IVF; pit labor?)" Reply: rbraun@iupui.edu: "Re: OB: Premium pregnancy ? ( was 40 y/0;IVF; pit labor?)"

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