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Re: Elective Induction - something goes wrong From: Garry E. Siegel, M.D. (garrys@mindspring.com) Thu Jul 8 23:23:48 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Braun, R. Daniel: "Re: Elective Induction - something goes wrong" Previous message: Efrain Ramirez: "Re: Elective Induction - something goes wrong" In reply to: Efrain Ramirez: "Re: Elective Induction - something goes wrong" Next in thread: Richard Chudacoff, MD: "Re: Elective Induction - something goes wrong" Efrain: Totally agree with proper selection beforehand. It takes a bit of experience (like selecting poorly when younger in practice, or pressured by the patient) to have a good feel for what will and won't work. Larry, thanks for the agreement. All said, I absolutely realize, as do Efrain, Larry, and others, that the tremendously low incidence of complications and need for sections means that, even when we screw up, we almost always will get a good outcome because the OVERWHELMING majority of our deliveries, however poorly managed, result in a good outcome. Garry At Thu, 8 Jul 2004, Efrain Ramirez wrote: > >Garry - one excellent point - the BIG difference between induction - and >the need to do pre-induction ripeneng... IMHO - if a multiparous >patient needs more than 12 hours for the whole process of elective >induction - patient selection was borderline.. > >>At Thu, 8 Jul 2004, Garry E. Siegel, M.D. wrote: >> >>What a great can of worms that has been opened here. >> >>I will induce people at 39w0days (OK, I might cheat a day or two to >>38w5d)electively if: >> >>1. The dates are solid. >>2. The cervix is favorable, meaning no need for ripening. In multips, >>this is 2 cm./50% and able to undergo amniotomy based on office exam. In >>primigravidas, I'm very unlikely to do this unless 3 cm./100% or >>thereabouts. >>3. The patient understands that this is elective, voluntary, and being >>done for mutual convenience. In reality, this means that it is a day >>that I'll be on call (i.e. I don't set up patients for my partner >>without asking all involved). >>4. If it doesn't feel right, well, I either don't mention it or >>decline. >> >>Thus, if someone, for lack of a better way to say it, is tired of being >>pregnant and asks for an elective induction, I'm game if the above are >>satisfied. If not, well, I tell them that it won't work and let's not >>do anything until past their due date or if they become favorable. >> >>Whether you agree or not, using common sense and experience has, >>fortunately, resulted in uniformly good outcomes. I cannot remember >>when I had to do a section in those circumstances, and it is rare that >>someone who comes in by 7:30 AM is pregnant at 5 PM (just had one >>recently that didn't deliver until 8:30 PM). >> >>I bet that many other private practice docs do this, too, to a degree. >> >>Garry >> >>-- >>Garry E. Siegel, M.D. >>Private Practice >>Roswell, GA >> >-- >"The opposite of a correct statement is a false statement. >But the opposite of a profound truth may well be another profound truth." > >Niels Bohr (1885 - 1962) > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Braun, R. Daniel: "Re: Elective Induction - something goes wrong" Previous message: Efrain Ramirez: "Re: Elective Induction - something goes wrong" In reply to: Efrain Ramirez: "Re: Elective Induction - something goes wrong" Next in thread: Richard Chudacoff, MD: "Re: Elective Induction - something goes wrong"

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