Approximately 2 minutes after amniotomy, ETCO 2 dropped (34 to 11) followed quickly by hypotension (60/40), oxygen desaturation and bradycardia. Rupture of amniotic membranes was noted and an expected amount of amniotic fluid was evacuated using suction (65 mmHg). Osmotic dilators were removed, further cervical dilation was achieved with Pratt dilators, and a 14 mm cannula inserted for evacuation via suction. In the operating room, general anesthesia induction and intubation were uneventful. All laboratory values were within normal limits and an EKG from one month prior was unremarkable. On the day of dilation and evacuation, preoperative laboratory tests were drawn (Table 1). Her procedure was scheduled the day following dilator placement (two days following diagnosis of fetal demise). As the patient elected to undergo surgical treatment, osmotic cervical dilators were placed the next day. This pregnancy had reached 24 weeks gestation by 14 week ultrasound however, routine 24 week gestation ultrasound demonstrated a fetal demise measuring 19 weeks by fetal biometry with a normal amniotic fluid volume. She had one hospitalization at 21 weeks gestation for hypertensive urgency that was treated with intravenous medications and transitioned to oral therapy prior to discharge. Obstetrical history included a classical cesarean section in her first pregnancy secondary to pre-eclampsia and an uncomplicated, term repeat cesarean delivery for her second pregnancy. The patient’s medical history included hypertension, diet-controlled type II diabetes mellitus, tobacco and marijuana abuse, and obesity (BMI 30.4 cm²/kg).
International Journal of Hematology and Therapy.Journal of Stem Cell and Regenerative Biology.
Journal of Pediatrics and Palliative Care ISSN:2690-4810.Journal of Heart and Cardiology ISSN:2378-6914.International Journal of Cancer and Oncology ISSN:2377-0902.International Journal of Neurology and Brain Disorders ISSN:2377-1348.Journal of Diabetes and Obesity ISSN:2376-0494.Journal of Gynecology and Neonatal Biology ISSN:2380-5595.Journal of Dentistry and Oral Care ISSN:2379-1705.Investigative Dermatology and Venereology Research ISSN:2381-0858.Journal of Gastrointestinal Disorders and Liver function ISSN:2471-0601.Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK.
Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Anne is a freelance lecturer and medical writer at Mind Body Ink.
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