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Re: OB: Suspected Macrosomia (long) From: Braun, R. Daniel (rbraun@iupui.edu) Fri Feb 13 05:25:35 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "GEN: The American Disease Metastasizes" Previous message: Braun, R. Daniel: "Re: VBA3C" Maybe in reply to: Garry E. Siegel, M.D.: "OB: Suspected Macrosomia (long)" Next in thread: laure: "Re: OB: Suspected Macrosomia (long)" Reply: laure: "Re: OB: Suspected Macrosomia (long)" I would have her sign an informed refusal of cesarean form. Dan R. Daniel Braun, MD "If everyone likes you, you're doing something wrong." Kinky Friedman I believe a self-righteous liberal or conservative with a cause is more dangerous than a Hell's Angel with an attitude. Andy Rooney -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Anna Meenan, MD Sent: Thursday, February 12, 2004 10:23 PM To: Multiple recipients of list OB-GYN-L Subject: Re: OB: Suspected Macrosomia (long) I'd be inclined to allow TOL, with good documentation that elective C-sec was offered and refused. I'd be very careful to document the refusal of DM screening also, and explain the added risks of shoulder dystocia and brachial plexus palsy if she is an undiagnosed GDM. My guess is that somewhere around 8-9 cm (or complete and minus 2 at the very latest), she will agree to a c-sec. PLEASE let us know the outcome of this one. I'm on the edge of my seat. Anna Meenan, MD (Pushed out a 4545 in 3 hours, 20 years ago) At Thu, 12 Feb 2004, Garry E. Siegel, M.D. wrote: > >30 YO P0 at 39w3d, good dates, has had care elsewhere and has planned a >home birth. This week, she transferred in since the Lay Midwife felt >the baby was too big/Fundal height 46 cm. Diabetes screening was >declined. > >Today, the AFI is 28 and the EFW is 5050g. Thus, the CNM in our >practice advised a section, and I counseled the patient for 30 minutes >on why that is what we recommend. Every scenario, from very good to >very bad, was discussed in an open, honest and pleasant fashion. She >will not agree to a schedule section. > >Tonight, I followed up with a call to her and her husband (not at >today's appointment) and reitereated the above. She asked if I would >honor their plan for a vaginal delivery. I replied that I do not >agree, but cannot operate on someone without consent. When she comes >in, I will again tell her she should have a section. > >We all know that the most likely two outcomes are: >1. Normal delivery >2. Arrest disorder leading to a section > >But she COULD have an unpredictable and catastrophic birth injury, too. > >All is documented, of course, FWIW. > >Does anyone out there have any thoughts? > >Would anyone dismiss her right now? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > Next message: art fougner, md: "GEN: The American Disease Metastasizes" Previous message: Braun, R. Daniel: "Re: VBA3C" Maybe in reply to: Garry E. Siegel, M.D.: "OB: Suspected Macrosomia (long)" Next in thread: laure: "Re: OB: Suspected Macrosomia (long)" Reply: laure: "Re: OB: Suspected Macrosomia (long)"

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