Re: Double nuchal cord on ultrasound
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Wed Jun 9 20:08:08 2004
Academically, Dan, you are correct.
However, if induction at 38 weeks results in a live birth, then that
intervention would avoid the infrequent, but feared 38 or more week
stillbirth. I would probably do the same, and accept the tiny risk of
immature lungs as less likely than awaiting labor and a possible loss.
There are lots of good thoughts on this thread, and the art of medicine
is how to handle situations such as these.
Garry
At Wed, 9 Jun 2004, Braun, R. Daniel wrote:
>
>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.
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
