Hey guys, just need some input on this situation (im still in school and just finished my OB rotation).
Mother admitted to L/D at 35.4 wks with twins presenting vertex-vertex (contraction roughly 6/hr). MD decides for vaginal delivery. Labor augmented with pitocin. Baby A is delivered, but causes HUGE (at least i think so) laceration - through clitoris, and 2nd degree below. At this point, mother is bleeding profusely and within minutes her pressure drops from 130/80's to 50/30's. Baby B is delivered, but born pretty much lifeless (1min apgar of maybe 1), however NICU nurses rescucitated and baby ends up ok.
My question - Can the mothers blood loss result in blood being shunted away from baby B? If not, what other possibilities could there be for baby B to become hypoxic?
Oct 29, '06
Ok...think this thru. You already started the pathway...keep going. You had a dramatic drop in BP....then what happened? Think about placental physiology and fetal circulation. You almost answered your own question.
Oct 29, '06
Any drop in maternal bp can cause problems with baby. The body tries to keep itself alive first, if mom isn't alive then baby wont be either. You answered you own question. If mom doesn't have enough blood pressure than no blood with be given to baby, you were right on.
Second twins are ofter born a little less lively than the first, they go through a lot, the first twin is delivered, baby B drops into the pelvis (hopfully) the bag of waters is ruptured if not already, the baby is born hopfully quicker than the first all of this can happen in a matter of minutes, that is very stressful and the baby can't compensate quick enough. Sounds like mom had a severe laceration if her blood pressure dropped that much. Glad everyone if fine though.
Consider yourself lucky, not many people get to see twins born vaginally while on a rotation!
Oct 29, '06
thanks for the replys. EBL was 2000cc, how significant is that? The mother did not get a transfusion, I asked the doc why not and he said that although thats quite a bit of blood she lost, her total blood volume increased about 40% throughout pregnancy.
To treat the bp, all they did was bolus her fluids (i think ~4L total). any other thoughts? thanks again guys!
Oct 30, '06
2000 ml of blood loss is quite significant! and whether a person gets blood or not depends on her prior H/H and how much it drops, not just blood loss itelf, and symptoms as well.
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