--
Richard Chudacoff, MD
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From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron
Sent: Tuesday, August 02, 2005 5:20 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Postdates,Neonatal Death
That's the point, three weeks before delivery would have been 38 weeks. Is
that when we should be delivering all of our patients? Seems like a
slippery slope to me. How many deliveries does one have to induce to
prevent one complication from meconium aspiration, not to mention one death
due to the same? If Richard's rationale is correct, it should be the
standard of care - and it isn't, not according to what I read. If you
passed that idea by most of the Ivory Towers of medicine, I doubt it would
get a serious look, let alone the IRB approving it as a pilot study.
Ronald E. Ainsworth, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R. Daniel
Braun
Sent: Tuesday, August 02, 2005 11:38 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Postdates,Neonatal Death
Delivery prior to passage of Meconium would have prevented it. By the
description of the stained placenta and cord it probably happened sometime
between 2 days and 3 weeks before delivvery. It takes a while for those
phagfocytes to gobble up the Mec and after 3 weeks it begins to turn brown
and yellow.
Dan
On 8/2/05, ainsron <ainsron@sbcglobal.net> wrote:
How exactly would delivery at 39 weeks have prevented this unfortunate
neonatal death? With Apgars 8/9, labor management and timing of the
decision for C/S sounds perfect to me. I wonder what the pH was? The
question is, what was the cause of pulmonary hemorrhage - meconium
aspiration? Was the baby adequately suctioned by the neonatologist?
Ronald E. Ainsworth, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard
Chudacoff, MD
Sent: Tuesday, August 02, 2005 6:40 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Postdates,Neonatal Death
This happens. If anyone can find me any literature that supports pregnancy
after 40 weeks I'd change my practice. However, situations like this
reinforce my belief of 39 week inductions.
Richard Chudacoff, MD
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From: ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net
<mailto:ob-gyn-l@obgyn.net> ] On Behalf Of Ingrid Gold
Sent: Monday, August 01, 2005 8:55 PM
To: Multiple recipients of list OB-GYN-L
Subject: Postdates,Neonatal Death
As I'm sure most of you remember, I'm in a group practice. 2 CNM's, 2 OB's,
almost all patients are shared, most are monolingual spanish. Last week, on
Monday I think I sent a woman over from the office to be induced, indication
postdates. She was 41 1/7, with good dates, G4 P3 (all NSVD), no previous
problems (spanish only). She was being induced without incident (I was not
on call) when the strip got bad and the midwife called the OB. They waited
about 1 1/2 hours before deciding that she ought to have a cesarean. As is
standard at our hospital, a neonatologist was present for the ceserean.
Apgars were 8 & 9. Thick meconium was present at delivery, it had not been
noted earlier, even though membranes were ruptured, and internal leads
placed. The baby and placenta were heavily stained. At 1 hour the baby had a
pulmonary hemmorhage and was transported from our level I facility to a
level III, 3 miles away (by helicopter of course). About 4 hours later
resuscitative attempts were stopped and the baby was pronounced dead.
The next day, Tuesday, after office hours I went to L & D, planning to see
the parents and express my sorrow. I was warned by both the OB nurse and the
OB there not to go into the patient room, that she was in a blaming mode,
and I'd be a perfect scapegoat. I followed their advice. One of the
questions she'd asked was why I had waited to have her induced, and not sent
her in a week earlier. I had seen her for her last 4 prenatal visits. Until
now our practice has done NST's at 41 weeks, and induction at 42 weeks. I
had a hard time deciding to send her in "so early", but without insurance
she'd have to pay for the NST (but not the delivery, FES). I actually gave
her the option and she chose induction.She was 2-3 cm, 80%, -2 when I sent
her in.
Complicating my timing were that they had just brought the baby over from
the other hospital, a priest was there, and so were the organ donation
people (who she refused to see). I went home without seeing her that day.
The next day I was on call, and had 6 deliveries. (a record for me in one
day, and with only 2 OB nurses).
I did not stop in and see them. Then I had four days off, and went out of
town (it was great to escape the 115 degrees in Phoenix, and go to the top
of Sandia mountain in Albuquerque where it was 66).
She came to the office today. I didn't realize she was there until she was
gone. The MA said she was accepting, not blaming, and doing well given the
circumstances.
Your comments please.
--
R. Daniel Braun
Kinky for Governor
