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Re: Clincial PelvimetryFrom: Efrain Ramirez (eramirezt@coqui.net)Sun Aug 6 07:53:22 2006
At Sat, 5 Aug 2006, DMECNM@aol.com wrote: >Why do some docs get ultrasounds at 38 weeks for EFW? We know that an >ultrasound EFW at this gestation is notoriously inaccurate. If the EFW is 5500gms >then I think most docs would recommend a section. But an EFW of >4000-4500gms with the inaccuracy of that ultrasound figured in, I think that many would >let her labor and see what happens. >Denise, CNM >So Cal This Practice Bulletin was developed by the ACOG Committee on Practice Bulletins — Obstetrics with the assistance of William H. Barth, Jr, MD. The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. Fetal Macrosomia CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN—GYNECOLOGISTS NUMBER 22, NOVEMBER 2000 (Replaces Technical Bulletin Number 159, September 1991) The following recommendation is based on good and consistent scientific evidence (Level A): The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold's maneuvers). The following recommendations are based on limited or inconsistent scientific evidence (Level B): Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes. With an estimated fetal weight greater than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. The following recommendations are based primarily on consensus and expert opinion (Level C): Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights greater than 5,000 g in women without diabetes and greater than 4,500 g in women with diabetes. Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery. Ef
-- “ The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge.” Daniel J. Boorstin - Historian
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