--
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 1:13 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: OB: 31 week IUFD
>From Valerie's original post,
"After 3 Cesareans the risk of placenta accreta in the subsequent
pregnancy is in the neighborhood of about 3%. (I didn't look this up
today--but I'm close on this. If it's not 3%, it's about 4%. The
evidence that this risk increases almost linearly with every Cesarean is
abundant. After four Cesareans, it's 7%!)"
Stats is *not* my strong suit, but that means the risk is about double
(maybe slightly more, maybe slightly less).
But it's the overall mortality risk that she was contrasting between the two
events (uterine rupture versus accreta/percreta).
Heidi
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Richard
> Chudacoff, MD
> Sent: Monday, March 22, 2004 2:06 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: OB: 31 week IUFD
>
> 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
>
