Re: A Case of Uterine Rupture
From: rbraun@iupui.edu
Wed Feb 4 05:41:35 1998
You still can have it published. Polish it up and submit it. If not to a
regular journal, then to OBGYN.net.
R. Daniel Braun, MD FACOG
On Tue, 3 Feb 1998, Joanne Bulley wrote:
> 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
>
