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Re: OB: My case list...From: Geffrey H. Klein, MD (gklein@bcm.tmc.edu)Fri May 29 15:16:10 1998
On 5/29/98, Marco A. Pelosi, III, MD wrote this: Q> In the spirit of the Boards, a couple of questions: great exercise.. thanks.. Hope I can answer satisfactorily.. Q> First, why did you choose to manage this patient expectantly for two Q> weeks with preeclampsia clearly developing and term gestation achieved? good question. somewhat opposite of what I was expecting. I was suspecting that some might ask why I induced a patient with at best mild pre-eclampsia and an unripe cervix. But this is my answer. For the two weeks leading up to the date of delivery, I debated induction, but could not demonstrate severe pre-eclampsia or a favorable cervix. So, I decied to manage expectantly. Once she reached 39 weeks and began to experience decreased fetal movement, I felt obligated to intervene. Q> Second, it appears that the fetal heart tracing findings prompted Q> delivery. Was an etiology confirmed at delivery? It was one part of the equation, but was additive on the lack of progress despite an adequate mechanism. There was no cord entanglement, uterine dehiscence, or placental abruption. Unexplained in my mind.. Q> Third, why was uterine atony not detected at the time of tubal Q> sterilization? Interestingly, the uterus was firm while performing the sterilization. The atony occurred after closing the abdomen and just prior to leaving the OR.. Q> Fourth, if the patient had not desired tubal sterilization, would you Q> have considered an alternate course of management? If she had not been hypotensive, I would have considered uterine artery ligation or ligation of the anterior division of the internal iliac artery. Might have been tough to justify these steps in the face of hypotension. ---------------------------------- Geffrey H. Klein, MD ---------------------------------- gklein@bcm.tmc.edu -- ---------------------------------- List-owner OB-GYN-L
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