Re: suspected macrosomia outcome ?
From: art fougner, md (evsono@pipeline.com)
Tue Mar 9 05:48:56 2004
Garry -
now that you're ahead of the game here, at the postpartum check-up, are
you considering discharging this patient from your practice?
art
At Mon, 8 Mar 2004, Garry E. Siegel, M.D. wrote:
>
>Art:
>
>Certainly, in terms of outcome, it is a win-win, and I think that we all
>knew in our hearts that she would labor and eventually arrest.
>
>It is NOT a win for my practice, frankly. I think that when my partners
>or I advise a section in such a circumstance (and how uncommon is
>this--pretty uncommon), and it is refused, that we are left potentially
>hanging out to dry should the outcome be less than ideal.
>
>I do not enjoy practicing when patients refuse reasonable intervention
>presented in a reasonable fashion. I'm all for two was discussion and
>all, but, let's face it, this baby was at significant risk of birth
>injury and the mother refused to allow an appropriate section.
>Furthermore, she put herself and her baby at increased risk (albeit not
>much) by insisting on laboring.
>
>Garry
>
>At Mon, 8 Mar 2004, art fougner, md wrote:
>>
>>Healthy Mom? Healthy Infant? Looks like win - win here.
>>
>>art
>>
>>At Mon, 8 Mar 2004, ainsron wrote:
>>>
>>>I would have done it the same way.
>>>
>>>Ronald E. Ainsworth
>>>
>>>-----Original Message-----
>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
>>>Siegel, M.D.
>>>Sent: Saturday, March 06, 2004 8:51 PM
>>>To: Multiple recipients of list OB-GYN-L
>>>Subject: Re: suspected macrosomia outcome ?
>>>
>>>Betsy:
>>>
>>>One of my partners managed her labor and section. Remember, this is a
>>>patient that our practice had advised to have a scheduled section a week
>>>earlier, and she had refused. We had decided as a group that if she
>>>labored and progressed, so be it, but we would not induce or augment
>>>labor.
>>>
>>>What would others have done?
>>>
>>>Garry
>>>
>>>At Sat, 6 Mar 2004, Betsy Hyde wrote:
>>>>
>>>>On Saturday, March 6, 2004, at 06:33 PM, Garry E. Siegel, M.D. wrote:
>>>>
>>>>> But of course--while laboring, not just for the section.
>>>>>
>>>>I'm curious why she didn't get any pitocin? I certainly would not have
>>>>chased after a dysfunctional labor pattern with a macrosomic fetus, but
>>>>it's been my experience that women with epidurals often have inadequate
>>>>labor without pit.
>>>>
>>>>What were her contractions like? Did she not get pit because she
>>>>didn't need it, or because of other reasons?
>>>>
>>>>--
>>>>Betsy Hyde CNM
>>>>Branford,CT
>>>>
>>>--
>>>Garry E. Siegel, M.D.
>>>Private Practice
>>>Roswell, GA
>>>
>>--
>>art fougner, md
>>ich bin ein New Yorker
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
ich bin ein New Yorker
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