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Re: OB: 31 week IUFDFrom: Heidi (heidi@nybble.net)Mon Mar 22 11:42:24 2004
> -----Original Message----- > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Richard > Chudacoff, MD > > I'm sorry, but are you suggesting that an 'unknown percreta' is better > treated with a vaginal delivery than with a c-section (which can diagnose > this condition prior to the hysterotomy and thus arrange for > blood products > prior to deliver.) You'd rather be in a position of " Seeing > blood pour out > as fast as it is put into" a patient who is not prepped for surgery? > > I'm confused This is not at all what Valerie was suggesting. She was discussing the relative risks of overall maternal mortality with a) Performing a 3rd cesarean section in a case with IUFD (maternal mortality even with a resultant rupture is extremely low) b) The increased risk of placenta acreta/percreta/increta in a 4th pregnancy following 3 c/s (maternal mortality, even WITH a planned c/s for these conditions is much higher) In other words, in this case being discussed, performing another cesarean in order to terminate the pregnancy with an already-dead fetus may be greatly increasing the mother's risk of death in a future pregnancy, compared with awaiting spontaneous labor or perhaps even inducing labor despite the risks inherent in inducing women with prior uterine surgery. There was no discussion whatsoever regarding vaginal birth for percreta/increta/acreta (or the previa that so often accompanies such complications).
-- Heidi
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