Clincial Pelvimetry
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Thu Aug 3 22:53:36 2006
Hank:
It was anethema in my training not to perform clinical pelvimetry and a
clincal EFW pre-induction.
I am pretty sure that these are passe, and that someone somewhere has
said--just go ahead and induce anyway, as you will be surprised at how
wrong you are upfront, i.e. more babies will deliver vaginally than you
think.
CNMs--do you perform clincial pelvimetry? Are you trained in it?
MDs--ditto?
In our practice, this patient might not have had a physical examination
by the MD, only a chart review/curbside consult pre-induction.
Garry
At Thu, 3 Aug 2006, Henry Gregor wrote:
>
>Clinical pelvimetry...independent of any actual medical issue, were there to be an adverse outcome, and were CPD or complication of induction to occur, plaintiff's attorney will definitely have a paragraph in the suit papers calling one and all's attention to the deviation from good clinical practice evidenced by such a disregard for proper pelvic assessment. I knew a university department attending who never failed to provide some such wording on virtually all the plaintiff attorney case reviews she did.
>
> As she would put it, attention to an entry re pelvic adequacy will save all concerned some depsition time and eliminate at least one paragraph in the attorney's litany of charges of substandard practice.
>
> Hank
>
>"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
>
> Next-gen email? Have it all with the all-new Yahoo! Mail Beta.
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
