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Re: 24 weeker From: R. Daniel Braun, M.D. (rbraun@iunet.iupui.edu) Wed Mar 11 09:26:58 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun, M.D.: "Re: Postpartum Managment HSIL" Previous message: R. Daniel Braun, M.D.: "Re: Focal eclamptic seizures" YES. When you have membranes bulging at the introitus, RESIST THE URGE. Leave them intact. at least until you have checked cervical dilation by ultrasound. Yes that's right, checked cervical dilation by ultrasound. This is the only way you can check it when the membranes are bulging out the introitus. Now that they are ruptured, you need to get her delivered. I would also have neonatology discuss with her the chances of survival, and have a preset plan i.e. to section or not for fetal distress, Full court press for the NICU, etc. Better to make these plans now, than after the baby starts having late decels. Dan R. Daniel Braun, MD A human being should be able to change a diaper, plan an invasion, butcher a hog, con a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, and die gallantly. Specialization is for insects. Lazarus Long. -----Original Message----- From: Geffrey H. Klein, MD <gklein@bcm.tmc.edu> To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net> Date: Wednesday, March 11, 1998 2:11 AM Subject: OB: 24 weeker >Case for the list > >20 Y/O G2P0A1 at 24 weeks by 7 wk CRL presents in PTL at 5-6 cm with very >painful contractions. She is cephalic and the head is at a -3 station. >Membranes are bulging. Pt afebrile and VSS. > >Pt started on MgSO4, steroids, and pen G in hope that we can stop labor... > >One hour later, membranes are protruding through the inroitus and she is >bearing down hard. Hard to examine above membranes, but still cephalic by >US. Appears as if delivery is imminent. MgSO4 stopped and membranes >ruptured. Re-examination pt is cephalic 6 cm dilated, -1 station on 70-80% >effaced. After an hour, she has not changed and is very comfortable >because she now has an epidural.. > >Do you start pitocin? > >---------------------------------- >Geffrey H. Klein, MD >---------------------------------- >gklein@bcm.tmc.edu >---------------------------------- >List-owner OB-GYN-L > Next message: R. Daniel Braun, M.D.: "Re: Postpartum Managment HSIL" Previous message: R. Daniel Braun, M.D.: "Re: Focal eclamptic seizures"

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