Re: What would you do?
From: Bernard Cristalli (bcrist@club-internet.fr)
Fri Dec 29 00:52:57 2006
This seems to be a rear-guard battle.
2007 will be the 100% cesarean rate.
Bernard
Efrain Ramirez a écrit :
> 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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