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Re: OB: Second twin From: Bernard Cristalli (bcrist@club-internet.fr) Tue Jun 9 22:29:47 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard W Lisse: "Re: Treatment of Shoulder Dystocia - Reply" Previous message: Bernard Cristalli: "Re: Twins after 2 previous C/S" Maybe in reply to: Malcolm Griffiths: "OB: Second twin" Next in thread: Braun, R. Daniel: "Re: OB: Second twin" 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? -- Second twin is the remaining indication for breech extraction. I would have done the same. -- Bernard Cristalli MD CNGOF AIHP - ACCA Paris - France http://www.obgyn.net/corresp/cristalli.htm Next message: Dr Eberhard W Lisse: "Re: Treatment of Shoulder Dystocia - Reply" Previous message: Bernard Cristalli: "Re: Twins after 2 previous C/S" Maybe in reply to: Malcolm Griffiths: "OB: Second twin" Next in thread: Braun, R. Daniel: "Re: OB: Second twin"

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