Re: Clincial Pelvimetry
From: Efrain Ramirez (eramirezt@coqui.net)
Fri Aug 4 17:51:46 2006
Garry – I routinely assess patient’s pelvis before induction – or at
38-39 weeks routine pelvic examinations at our office – I do not write
in the record my impression but I do tell the patient my feelings – or
whatever – about that pelvic examination – if I find a Primigravid
patient 39-40 weeks with an unengaged vertex I definitively tell the
couple that it is not a good sign – I’ll try to explain them that maybe
it is because the size of the baby or patient’s pelvis architecture or
both .. I have done very, very few primary C/S based on these findings
–my anecdotal percentage of been right …eventually doing a C/S because
of failure to progress is quiet high … maybe 75% ??? - but there are a
few patients that will amaze you .. giving TOL to ALL patients maybe is
no right – NOT giving TOL to ALL patients also might be not the right
thing to do – that’s our challenge – that is the crossroad (encrucijada)
that our patients must know and should/must try to help us/them -
Ef
>At Thu, 3 Aug 2006, Garry E. Siegel, M.D. wrote:
>
>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
>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
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