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Re: A Case of Uterine RuptureFrom: Joanne Bulley (jbulley@cheshire.net)Tue Feb 3 21:37:31 1998
At Wed, 28 Jan 1998, Timothy C. A. Brown, M.D. wrote: > >28 yo G8 P3044 woman admitted at 37 weeks for stabilization and >induction with BP 170/90, 3+ protein, and severe edema 'snip' >The patient was started on MgSO4 2gm/hr and Cervidil placed (Cx >1cm/40%/-3). 'snip' Baby weighed 6lb 7oz, apgars 8-9, and was free >floating in the abdomen. Uterus was successfully repaired and mom and >baby are both doing well. > Tim, Like many - we do use PG on rare occasions when there has been a prior C/S. But then - we are using the "home made" gel ... so we are already out on that limb. Anyway - I suspect the rupture was due to the tetanic contraction superimposed on a uterus that had had 4 miscarriages (terminations?) twins AND the C/S.... I had a patient present with a hemoperitoneum at 12 weeks (but no care yet for this pregnancy - and the dates were in question) she had had 4 prior terminations "uncomplicated" interspersed with three vag deliveries. The hemoperitoneum was from a placenta percreta (yes, at 12 weeks) It was definitively indentified to NOT be a ruptured interstitial pregnancy. The presumption was there had been a uterine perf with one of the terminations that was asymptomatic and the pregnancy had implanted at the site of the prior rupture and this interfered with the normal response of the uterus preventing the invasion of the trophoblast. I did do a major literature search and wrote the case up ... but then never sent it in - I probably could have had it published... This case is part of what makes me think this uterus was at risk by its history - I would guess it was at the same risk fron even a spontaneous labor. It is just an easier legal case when (as Marco P said) the prosecutor can have the pertinent part of the package insert blown up ... highlighted ... then read by you, the defendent... Work: Home: Joanne E Bulley, MD, FACOG Joanne E Bulley Hitchcock Clinic - Keene jbulley@cheshire.net Joanne.E.Bulley@Hitchcock.ORG
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