Re: OB: Fun and Games at 42w1d (long)
From: Anna Meenan, MD (annam@uic.edu)
Wed Oct 12 19:35:36 2005
Once upon a time I would have agreed with you, Andy, but your plan is
only viable in an ideal world, and that we don't have in this country.
--
Anna Meenan, MD
At Wed, 12 Oct 2005, Andrew Folley wrote:
>
>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
