--
Richard Chudacoff, MD
Beer is living proof that God loves us and wants us to be happy.
<http://www.brainyquote.com/quotes/quotes/b/benjaminfr109859.html> Benjamin
Franklin
Heaven grant that the burden you carry may have as easy an exit as it had an
entrance.
[Prayer To A Pregnant Woman]
- <http://www.brainyquote.com/quotes/quotes/d/desiderius148996.html>
Desiderius Erasmus
_____
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Charlie
Chambers
Sent: Wednesday, June 09, 2004 4:30 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Double nuchal cord on ultrasound
Brings up the argument of why report or look for the nuchal cord. I do not
routinely look for a nuchal cord, and doubt that I would report the finding.
After all, no tried and true management will impact outcome. Plus, you are
looking at up to 25% population will have a nuchal cord, and will no
sequelae.
****************************************************************************
**
Charlie Chambers
--
Hood River, OR USA
cchamber@alumni.rice.edu
"All good things...come by grace,
and grace comes by art,
and art does not come easy."
Norman Maclean
****************************************************************************
***
On Jun 9, 2004, at 12:25 PM, Richard Chudacoff, MD wrote:
I agree. I was always taught; if it doesn't affect the outcome, don't do the
test. Here the test (ultrasound with noted nuchal cord) does not affect the
management, unless you look at it from a purely medico-legal perspective,
which we all are being forced to do by attorneys. I'm sure that someone,
somewhere, would be willing to testify that the patient should have been
offered alternative once the nuchal cord is discovered, or even immediate
c-section once fetal lung maturity could be assured. So be it; I offer
alternatives. It is all about practicing the best medicine I can, while
getting sued the least I can. Lawsuits and the threat of lawsuits take their
toll on solo practitioner the hardest; therefore they are ALWAYS at the
forefront of my decisions made regarding these outside-of-the-textbook
situations.
Richard Chudacoff, MD
Beer is living proof that God loves us and wants us to be happy.
Benjamin Franklin
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
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Braun, R.
Daniel
Sent: Wednesday, June 09, 2004 2:03 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Double nuchal cord on ultrasound
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
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
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
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
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
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
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.
