Re: Ob: Arrest of dilatation
From: Jamie (ajfields@pine-net.com)
Thu Aug 3 08:24:53 2006
Or maybe the answer is to lay out the statistics for the patient and let
her choose which set of risks she prefers. This isn't a previa-it's far
less cut and dried. In the end, Dr. Siegel did not subject her to 20+
hours of labor, she chose it. It's a valid choice. Does she now regret
waiting to agree to the c/s?
At Thu, 3 Aug 2006, R. Daniel Braun wrote:
>
>Gary,
>You are correct, but if you have done that and documented it well,you may
>save yourself some real grief down the line.
>
>Sue,
>With an 80% or higher chance of having a C/S, which this patient
>demonstrated, is it better to subject them to 20 + hours of labor which
>increases their infection rate 300-400% when they do get sectioned or is it
>better to do an elective section which has minimum morbidity and mortality?
>If you don't section, the 20% who succeed will have very low morbidity, but
>the 80% who fail will have quite high morbidity. If you do section, 100%
>will have a minimal increase in morbidity. The 80% will be better off and
>the 20% will be slightly worse off.
>Obviously, the answer is to determine which person will succeed and which
>won't. I have been unable to do that and no of no one who can.
>
>Dan
>
>On 8/2/06, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote:
>>
>> Sue:
>>
>> What's the solution?
>>
>> I think we would agree that induction with pre-eclampsia at term is
>> warranted, and if she's not progressing, she's not progressing.
>>
>> Her reticence to proceed to a section allowed a fever to develop, and
>> she didn't progress, got antibiotics, and still had a section.
>>
>> Dan, this patient did not have an assessment of her pelvis before
>> induction.
>>
>> Listers, would you expect a CNM or MD to have done so?
>>
>> Dan, had I personally assessed her pelvis in the office, and told her
>> that it was not good, and that the chance of success was poor, I think
>> she would have looked at me like I was crazy, and then asked why not
>> try. I have not been successful convincing/selling/arguing/cajoling
>> patients who are not accepting of honestly given advice and direction,
>> and, you know, they don't always do what you want/tell them to do.
>>
>> Garry
>>
>> At Wed, 2 Aug 2006, Stmidwife@aol.com wrote:
>> >
>> >Respectfully, that is why they are going to a midwife for midwifery as
>> >opposed to an Obstetrician to participate in the Obstetrics of 2006.
>> >
>> >Sue
>> >
>> >In a message dated 8/2/2006 4:19:37 P.M. Pacific Standard Time,
>> >ob-gyn-l@obgyn.net writes:
>> >
>> >You're on the mark, but I truly think that the CNMs are pretty
>> >supportive and frankly attract those patients who are dissatisfied
>> >elsewhere, and are unrealistic about hospital based Obstetrics in 2006.
>> >
>> >Garry
>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>>
>--
>R. Daniel Braun
>
> "The way to health is an aromatic bath and scented massage everyday".
> Hippocrates
>
--
JFields, RN, BSN
|
|
