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Re: OB: Second twin From: art fougner, md (evsono@pipeline.com) Tue Jun 9 15:45:06 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard W Lisse: "Re: Treatment of Shoulder Dystocia - Reply" Previous message: Laurie Lovely, M.D.: "Re: OB: Second twin" In reply to: Lynn Montgomery: "Re[2]: pre-orgasm headache" Next in thread: Malcolm Griffiths: "Re: OB: Second twin" Reply: Malcolm Griffiths: "Re: OB: Second twin" hard to quibble with success. was there any thought to using general anesthesia. halothane, specifically has uterine relaxant properties which might have been useful here. also, using ultrasound in the delivery room can aid in locating the foot so the delivery becomes less of a blind procedure. again, hard to quibble with a well-managed case. Art At Tue, 9 Jun 1998, Malcolm Griffiths wrote: > >I've found myself being rather cross over the last few months with >residents who call me for help to deliver 2nd twin after twin 1 is >delivered vaginally and membranes have gone on twin 1 and cervix has >closed down. > >This Sunday afternoon I got the usual story (yeh they do claim that the >membranes just went on the tip of their finger, not ARM'd). > >Went in to find a Multip (4x normal term deliveries max upto 8.5lb). SHe >had delivered one vertex twin of 2.7kg. Now had high breech, cx about >6cm no liquor, and no epidural. > >What to do? > >I got anaesthetist to give spinal, put her up in lithotomy, put hand in >a reached v. high up (ext breech) and found a foot. Brought foot down >and pulled. Next contraction she pushed and I pulled. Then I reached in >and caught other foot. Next contraction she pushed and I pulled. >Delivered upto scapulae. One arm nucchal. Head with Mauriceau Smellie >Veit. > >Intact perineum. Then the placenta didn't come. Out of interest I asked >if she'd ever had placenta problems - of course 2x MROPs and 2x long 3rd >stages! > >Second babe was bigger than sister! (2.9kg). Apgar 9 @5 10 @ 10. > >What would listmembers do? >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]) -- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com Next message: Dr Eberhard W Lisse: "Re: Treatment of Shoulder Dystocia - Reply" Previous message: Laurie Lovely, M.D.: "Re: OB: Second twin" In reply to: Lynn Montgomery: "Re[2]: pre-orgasm headache" Next in thread: Malcolm Griffiths: "Re: OB: Second twin" Reply: Malcolm Griffiths: "Re: OB: Second twin"

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