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Re: OB: Fun and Games at 42w1d (long) From: Andrew Folley (agfolley@hotmail.com) Wed Oct 12 17:44:10 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "GYN: Breast biopsy by the radiologist" Previous message: Robert J. Carpenter, Jr. MD: "Re: Active management - third stage" In reply to: rmodugno@aol.com: "Re: OB: Fun and Games at 42w1d (long)" Next in thread: Garry E. Siegel, M.D.: "Re: OB: Fun and Games at 42w1d (long)" Reply: Garry E. Siegel, M.D.: "Re: OB: Fun and Games at 42w1d (long)" Reply: Anna Meenan, MD: "Re: OB: Fun and Games at 42w1d (long)" All one can do as a professional is to provide the best information that we have at the time and lay out the options and make our recommendation. . I do not see a problem in discussing the options with this couple and allowing them to accept the risks of increased neonatal mortality of 2 fold at 42 weeks and 3 fold at 43 weeks etc along with the risks of VBAC and PIH etc. We have the technology to observe the fetus better than ever with nsts, BPP and doppler studies. The couple seems motivated and educated. We can provide statistics but ultimately we have to deal with individual patients and if they are willing to share the risk and the responsibility I am willing to let them ( I know I am the minooooooooority opiniion) andy >From: rmodugno@aol.com >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: Re: OB: Fun and Games at 42w1d (long) >Date: Wed, 12 Oct 2005 15:13:46 -0500 > >Gail - there is no medical literature I know that would support a gravida >going "well over 42 weeks", yet alone 44 weeks.As far as them "all having >good outcomes'' your series is in contra- distinction to the world >literature that states that after 42 weeks there is a rise in perinatal >morbidity/mortality. At our institution - delivering 17000+ per annum and >delivering them after 41 weeks we have seen a dramatic decrease in severe >asphixia and meconium aspiration - personal communication from the head of >neonatology. > >I would hardly call a woman who has had a previous cesarean with >pre-eclampsia, transverse lie, at 42 weeks (Garry's example) who does not >recognize that this is a problem "empowered" - indeed I would have another >adjective for her. > >Robert Modugno MD MBA FACOG >Marietta, GA > >-----Original Message----- >From: GA12L@aol.com >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Sent: Wed, 12 Oct 2005 13:15:45 -0500 >Subject: Re: OB: Fun and Games at 42w1d (long) > >In a message dated 12/10/2005 18:41:46 GMT Standard Time, rmodugno@aol.com >writes: >My thoughts: > >1) New adage: Nothing good happens after 41 weeks. >2) No one EVER tells a general surgeon how to do an appy or a gall-bag. >3) The inmates are running the asylum. >Geez, you'd have a fit over her in the UK. Women who employ an independent >midwife and some who have their care under the NHS often refuse induction >and go well over 42 weeks. I know of several who have gone 43 + and one who >went 44 + 1. All with good outcomes. > >I don't know about the inmates running the asylum but I do know plenty of >empowered women. Personally, I prefer the more empowered woman. > >Gail Next message: Garry E. Siegel, M.D.: "GYN: Breast biopsy by the radiologist" Previous message: Robert J. Carpenter, Jr. MD: "Re: Active management - third stage" In reply to: rmodugno@aol.com: "Re: OB: Fun and Games at 42w1d (long)" Next in thread: Garry E. Siegel, M.D.: "Re: OB: Fun and Games at 42w1d (long)" Reply: Garry E. Siegel, M.D.: "Re: OB: Fun and Games at 42w1d (long)" Reply: Anna Meenan, MD: "Re: OB: Fun and Games at 42w1d (long)"

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