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Re: VBAC Risks and Prior PolyhydramniosFrom: R.Daniel (anonymous@obgyn.net)Wed, 30 Jul 1997 22:16:14 -0500 (CDT)
At Wed, 30 Jul 1997, anonymous@obgyn.net wrote: > >Hi Mary! > >I'm not a doctor, but I did have a similar experience with my pregnancy and >wanted to relate to you what my OB-GYN told me. I have only been pregnant >once, but was diagnosed with gestational diabetes. Of the side effects and >possible complications, I had both a large baby and a lot of excess fluid (I >never heard the term polyhydramnios used, but I'm suspecting that at least in >part!). I had enough fluid that at 36 weeks my OB couldn't tell size or >position by palpation, so he sent me for an ultrasound (baby at that point >was at 9 lbs and breech!). Anyway, I delivered by c-section. > >I asked him at my annual appointment about VBACs and the risks of scar >ruptures, etc. and the fact that I was likely to have gestational diabetes >again and what if I have excess fluid again? He told me that (a) the rate of >uterine rupture is less than 1% and that most incisions are in an area that >doesn't really expand. The incision is done in a very thin area that >stretches easily, however. (b) he told me that the increased fluid actually >made it LESS likely that I would have the scar tissue separate (I'm looking >forward to hearing one of our wonderful doctors elaborate on that one!). > >The uterus is one incredible organ, isn't it? It stretches incredibly during >pregnancy and reverts back to "normal" so rapidly. No ill effects seem to >remain from one pregnancy to the next! I don't think the polyhydramnios of >the last pregnancy should affect this pregnancy, Mary (at least that's my >non-medical opinion!) and it sounds like if the problem occurred again that >it wouldn't increase the rate of dehiscence at all. So, personally I think >you can rest a little more easily. > >Enjoy your pregnancy (I know you will!) and best wishes for a healthy >full-term delivery and a positive birth experience! > >Darcy Johnson >Co-Moderator, Women's Health Forum Polyhydramnios which by the way is redundant and should really be hydramnios which means too much water, in the last pregnancy should not affect this pregnancy at all unless you have a recurrence of the hydramnios. Hydramnios is most commonly idiopathic ( that really means of unknown cause, but I tell people it means "The idiots can't find the pathology"). This does not tend to recur. The second most common cause is Diabetes and most commonly gestational diabetes that hasn't been diagnosed or controlled. Following this, the causes are much less common things e.g. anything that keeps the baby from swallowing such as obstruction of the esophagus or duodenum or certain muscle weakness disorders like myotonia congenita. I am not aware of any literature on whether or not hydramnios has a good or bad effect on the outcome of a trial of labor in a patient with a previous cesarean. Any information I give out is merely my opinion and not based on any scientific evidence. My first blush is that it would make uterine rupture more likely, but then as I think about it more I can see a mechanism whereby it would have no effect. What mechanism actually occurs is totally unkown to me. Therefore, I don't know!!!!(There I've said it,, a Doctor doesn't know)
-- R.Daniel Braun, MD
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