Re: Clinical Pelvimetry
From: Myer Bornstein (mborn@massmed.org)
Fri Aug 4 12:26:45 2006
I just reviewed 25 primary C/Section records for completeness. In every one
except one; in which the physician noted the EFW from the U/S that was
performed that day; was there any mention of whether the pelvis was adequate
in size or what the estimated fetal weight was
Myer
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
> Siegel, M.D.
> Sent: Thursday, August 03, 2006 11:55 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Clincial Pelvimetry
>
> 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
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