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Re: 2004 US C/Section RateFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Wed Nov 16 21:30:12 2005
I'm contributing frequently to the rising section rate, with several repeats recently, in patients in whom VBACs weren't desired.. I have a repeat tomorrow (2 prior unknowns in South Africa, no vaginal deliveries) and a primary. The primary is a primigravida at 40.5 weeks, clinical EFW 4400g, sono EFW 3800g a week ago, who is long/closed high. Induction with ripening at 41 weeks offered, but the patient--an R.N--says she is scared of delivering that big of a baby due to concerns about pelvic support, laceration, and she doesn't relish a long labor culminating in a section. A laboring section last week--CNM patient, primigravida at term who was fully dilated for 3.5 hours, +1 to maybe +2 and OP with a clinical EFW of 4250g. Even if I called her +2--and that would have been liberal--a low forceps or low forceps with rotation (i.e. the good old Kielland mid-forceps before the definition changed eons ago) would have been a tough case. I counselled the patient and husband and said that, like the olympics, this would be a 9 or 10 on the 1 to 10 degree of difficulty scale, and that while I was skilled in forceps, the risk of serious maternal laceration/extension and the unknown consequences of a difficult vaginal delivery (to say nothing of the fetal risk, which isn't insignificant) led me to make a C/S my first inclination. I also told them that a C/S was among the more morbid ones due to prolonged labor, and the risk of post-op infection, laceration, etc. I also told them that laboring sections at full dilatation may have a negative effect on perineal/pelvic support issues, i.e. the horse is already out of the barn here. C/S done--bilateral cervical extensions, postop fever, 9+ pound baby, all home and well. Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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