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Re: What would you do? From: Efrain Ramirez (eramirezt@coqui.net) Fri Dec 29 15:03:12 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Andrew Folley: "Re: What would you do?" Previous message: ljmidwife@aim.com: "Sheehan's syndrome" In reply to: Andrew Folley: "Re: What would you do?" Next in thread: Andrew Folley: "Re: What would you do?" Reply: Andrew Folley: "Re: What would you do?" Reply: Ina May Gaskin: "Engelmann book" Andrew.. would you do the same thing in your setting even with this statement? Ef 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 Should women with a previous cesarean delivery undergo induction or augmentation of labor? Spontaneous labor is more likely to result in a successful VBAC rather than labor induction or augmentation (52, 61, 62). A meta-analysis of studies published before 1989 found no relationship between the use of oxytocin and rupture of the uterine scar (83). In contrast, several more recent large studies have shown an increased risk (37, 61, 62, 84). In one large retrospective study of more than 20,000 women, uterine rupture was nearly 5 times more common among women undergoing labor induction with oxytocin compared with those who had an elective repeat cesarean delivery (37). However, uterine rupture occurred in less than 1% of women in both groups. Furthermore, among the women attempting VBAC, the rate of uterine rupture was not different between those who received oxytocin and those who labored spontaneously. There is considerable evidence that cervical ripening with prostaglandin preparations increases the likelihood of uterine rupture (37, 61, 85–87). In a review of Washington State birth records, the rate of uterine rupture during labor induced with prostaglandin was 24.5 in 1,000, which was 15-fold higher than that of women electing to have a repeat cesarean delivery (37). Likewise, misoprostol has been associated with an unacceptably high rate of uterine rupture in women with a previous cesarean delivery (88–91). Therefore, the use of prostaglandins for induction of labor in most women with a previous cesarean delivery should be discouraged. At Fri, 29 Dec 2006, Andrew Folley wrote: > >Use of lovenox daily IM until 36 weeks. Switch over to heparin at that >time. >Plan vaginal birth. Consider induction and stop heaprin the night before. >Reheparinize 24 hour post partum and start coumadin for 6 months. >dc heparin when coumadin PT level 2-3x normal. Also recommend a greenfield >filter for her either now during the pregnacy or postartum. > >In addition do thrombophilia workup including homocystiene level, anti >phospholipids, lupus, ana >and typical antitrhombin 111 deficiency protein s and c etc. > >>From: Bernard Cristalli <bcrist@club-internet.fr> >>Reply-To: ob-gyn-l@obgyn.net >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >>Subject: Re: What would you do? >>Date: Thu, 28 Dec 2006 08:04:17 -0600 >> >>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. >>>>BC >>>> >_________________________________________________________________ >Dave vs. Carl: The Insignificant Championship Series.  Who will win? >_________________________________________________________________ > >-- >_________________________________________________________________ >http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?href=http://davevscarl.spaces.live.com/?icid=T001MSN38C07001 >_________________________________________________________________ > -- “ The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge.” Daniel J. Boorstin - Historian Next message: Andrew Folley: "Re: What would you do?" Previous message: ljmidwife@aim.com: "Sheehan's syndrome" In reply to: Andrew Folley: "Re: What would you do?" Next in thread: Andrew Folley: "Re: What would you do?" Reply: Andrew Folley: "Re: What would you do?" Reply: Ina May Gaskin: "Engelmann book"

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