Re: What would you do?

From: Efrain Ramirez (eramirezt@coqui.net)
Thu Dec 28 17:19:21 2006


I agree with JoeP .. I would not do an amnio.. sticking a needle into the uterus on heparin with 36 weeks.. ?

Bernard ..the risk of uterine rupture after 2 C/S is definitively greater..

CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN—GYNECOLOGISTS NUMBER 54, JULY 2004 • (Replaces Practice Bulletin Number 5, July 1999)

• What are contraindications for VBAC? A trial of labor is not recommended in patients at high risk for uterine rupture. Circumstances under which a trial of labor should not be attempted are as follows: • Previous classical or T-shaped incision or extensive transfundal uterine surgery • Previous uterine rupture • Medical or obstetric complication that precludes vaginal delivery • Inability to perform emergency cesarean delivery because of unavailable surgeon, anesthesia, sufficient staff, or facility • Two prior uterine scars and no vaginal deliveries

Ef

At Thu, 28 Dec 2006, Garry E. Siegel, M.D. wrote: >
>It might not be so crazy to consider an amniocentesis for maturity (if
>it looks easy to do), and if mature, reverse the anti-coagulation, and
>deliver per Joe.
>
>Garry
>
>At Thu, 28 Dec 2006, Bernard Cristalli wrote:
>>
>>Then you seem to have your answer, but two previous CSs don't mean
>>another CS if the indication for the previous ones isn't there any longer.
>>BC
>>
>>Dr Eberhard Lisse a écrit :
>>> 2 previous C/S...
>>>
>>> el
>>>
>>> on 12/28/06 4:03 PM Bernard Cristalli said the following:
>>>
>>>> Then let the pregnancy go its normal way and discuss the way of delivery
>>>> on time.
>>>> A vaginal delivery would expose to a lesser risk than a CS. Lesser risk
>>>> of hemorrhage and lesser risk of thrombo-embolic accidents.
>>>> IMHO
>>>> BC
>>>>
>>>> Dr Eberhard Lisse a écrit :
>>>>
>>>>> And then do what?
>>>>>
>>>>> el
>>>>>
>>>>> on 12/28/06 12:36 PM Bernard Cristalli said the following:
>>>>>
>>>>>> Wait till the cardio-pulmonary situation is stable.
>>>>>>
>--
>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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