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Re: Double nuchal cord on ultrasoundFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed Jun 9 14:01:45 2004
All that will tell you is that the baby is alive. There will not be a decrease in fetal movement before you get an occlusion of the cord. Which by the way I think is either an act of G_d or FETUS. Dan "Sound is like water. If you drill one hole in the wall the sound will leak right through." - JAY BRAUN, a band member by love, a soundproofer by necessity. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD Sent: Wednesday, June 09, 2004 12:42 PM To: Multiple recipients of list OB-GYN-L Subject: RE: Double nuchal cord on ultrasound I think the studies regarding daily fetal movement assessment should be adequate. In my opinion, this is theoretical, since I specially will not look for nuchal cords for this very reason. I think it is a non-issue, brought up only when an ultrasound has been performed at an outside entity, such as a non-medical ultrasound center. Richard Chudacoff, MD Beer is living proof that God loves us and wants us to be happy. Benjamin Franklin <http://www.brainyquote.com/quotes/quotes/b/benjaminfr109859.html> Heaven grant that the burden you carry may have as easy an exit as it had an entrance. [Prayer To A Pregnant Woman] -Desiderius Erasmus <http://www.brainyquote.com/quotes/quotes/d/desiderius148996.html> _____ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Braun, R. Daniel Sent: Wednesday, June 09, 2004 12:21 PM To: Multiple recipients of list OB-GYN-L Subject: RE: Double nuchal cord on ultrasound If you are going to do ANYthing about it, you should undertake continuos fetal monitoring from the time of discovery until delivery. Anything else in either irrational or ineffective. Dan "Sound is like water. If you drill one hole in the wall the sound will leak right through." - JAY BRAUN, a band member by love, a soundproofer by necessity. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD Sent: Wednesday, June 09, 2004 11:55 AM To: Multiple recipients of list OB-GYN-L Subject: RE: Double nuchal cord on ultrasound You are right. Probably at 39 weeks, or sooner if indicated (labor, fetal distress, oligohydramnios) Richard Chudacoff, MD Beer is living proof that God loves us and wants us to be happy. Benjamin Franklin <http://www.brainyquote.com/quotes/quotes/b/benjaminfr109859.html> Heaven grant that the burden you carry may have as easy an exit as it had an entrance. [Prayer To A Pregnant Woman] -Desiderius Erasmus <http://www.brainyquote.com/quotes/quotes/d/desiderius148996.html> _____ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron Sent: Tuesday, June 08, 2004 7:32 PM To: Multiple recipients of list OB-GYN-L Subject: RE: Double nuchal cord on ultrasound But at what point are you going to do the C/S? And during the intervening weeks, how are you going to monitor the fetus? What if the nuchal cord was found at 28 weeks? Its just such a nebulous bag of worms with no EBM to base any strict decision making on. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD Sent: Tuesday, June 08, 2004 3:19 PM To: Multiple recipients of list OB-GYN-L Subject: RE: Double nuchal cord on ultrasound So, you can debate with the patient for two weeks, with serious counseling about the benefit of a vaginal delivery, or you can say "if you are really worried we can perform a c-section; however we also have the option of close monitoring with fetal kick counts and continuous electronic fetal monitoring in labor." Now the patient feels better, and if they chose the latter, at least they know you gave the finding a serious consideration, and the patient a choice of treatment options. If they chose the former, no IUFD. I'm fine with either, and probably have decreased my lawsuit potential dramatically. Richard Chudacoff, MD Beer is living proof that God loves us and wants us to be happy. Benjamin Franklin <http://www.brainyquote.com/quotes/quotes/b/benjaminfr109859.html> Heaven grant that the burden you carry may have as easy an exit as it had an entrance. [Prayer To A Pregnant Woman] -Desiderius Erasmus <http://www.brainyquote.com/quotes/quotes/d/desiderius148996.html> _____ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of DoctorJoe@aol.com Sent: Tuesday, June 08, 2004 4:43 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Double nuchal cord on ultrasound In a message dated 6/8/04 16:21:05, dellview@earthlink.net writes: We just had a double nuchal cord that was fine in the office on ultrasound last Wednesday and by Friday (when she came in with srom) the baby was a demise. my answer today is different than it was last week. it was a rough weekend And therein lies the problem. It's not a problem until something happens. And with cord problems, where the BABY governs what goes on in there, YOU have no control over what happens, except WHEN the baby comes out (i.e. when you make the incision). Other than that, you're merely an observer. (Not like severe preeclampsia, or whatever, where you can give medicine, etc.) Joe P.
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