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Re: Clincial PelvimetryFrom: ainsron (ainsron@sbcglobal.net)Sun Aug 6 21:12:09 2006
I had a gestational diabetic last week at 42 weeks, unfavorable cervix, primigravida with an EFW of 4400gm and body>>head circumference on an ultrasound with oligohydramnios. NST was reassuring but I was quite nervous about the clinical situation, I presented all the information to her and she wanted a TOL, not a primary C/S. Clinically I didn't feel the baby was as large as the sonogram suggested. She had Cervidil at 5PM and we removed it at 3AM because she was having tachyphylaxis. At 3am the cervix, according to the nurse hadn't changed since the Cervidil had been inserted. When I came in for reassessment and rounds at 7AM, I was expecting to find her still unchanged, and ready for a C/S. She had been on an epidural since about midnite, sleeping through her contractions. Of course, when I checked her, she was complete, +2 to +3 and delivered 45 minutes later. The baby weighed 3400gm and slipped right out. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of DMECNM@aol.com Sent: Sunday, August 06, 2006 7:02 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Clincial Pelvimetry In a message dated 8/5/2006 8:19:53 PM Pacific Standard Time, garrys@mindspring.com writes: Denise, you mentioned 5500g EFW as a cutoff for C/S without labor. Good Morning. I didn't say 5500g was a "cutoff". I just used that number as a number that I think most everyone would recommend a section. ***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.*** I think that 5500g is a pretty black or white area. I think that 4000-4500g is our grey area because of the inaccuracy of EFW by ultrasound. My personal belief is that most of life falls somewhere on a bell shaped curve and each aspect of life has its own bell. We need someone on the fringes so that we have the bell. Someone will deliver the 5500g babe vaginally. But not out of my vagina, thank you very much. Denise
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