Re: OB: 31 week IUFD
From: Anna Meenan, MD (annam@uic.edu)
Mon Mar 22 12:21:19 2004
Richard, I don't get your point, and I don't think you're getting
Valerie's point. And Valerie, thank you for the time you took to give
the most organized and well-thought-out discussion of this poor lady's
choices. You are an asset to the list.
--
Anna Meenan, MD
At Mon, 22 Mar 2004, Richard Chudacoff, MD wrote:
>
>Is the risk that much less for a percreta after three than after four
>c-sections?
>
>--
>Richard Chudacoff, MD
>
>As Mankind becomes more liberal, they will be more apt to allow
> that all those who conduct themselves as worthy members of the
> community are equally entitled to the protections of civil
> government. I hope ever to see America among the foremost
> nations of justice and liberality.
>
>George Washington
>
>If the freedom of speech is taken away then dumb
> and silent we may be led, like sheep to the slaughter.
>
>George Washington
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Heidi
>Sent: Monday, March 22, 2004 12:44 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: OB: 31 week IUFD
>
>> -----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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