Re: April fools' marginal placenta previa.
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Mon Apr 2 15:01:42 2007
Art:
You are the man.
Garry
Braves up 2 in the bottom of the 10th!
At Mon, 2 Apr 2007, art fougner, md wrote:
>
>Placental edge to internal os distance in the late third trimester and
>mode of delivery in placenta praevia
>
> * Amarnath Bhide,
>* Federico Prefumo**Dr F. Prefumo, Fetal Medicine Unit, St George's
>Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK.,
> * Jessica Moore,
> * Brian Hollis,
> * Basky Thilaganathan
>
> *
>aFetal Medicine Unit, Academic Department of Obstetrics and Gynaecology,
>St George's Hospital Medical School, London, UK
>
>*Dr F. Prefumo, Fetal Medicine Unit, St George's Hospital Medical
>School, Cranmer Terrace, London SW17 ORE, UK.
>Abstract
>
>Objectives To correlate transvaginal ultrasound findings with mode of
>delivery in cases of placenta praevia.
>
>Design Cohort study.
>
>Setting A London Teaching Hospital.
>
>Methods Retrospective review of all cases of placenta praevia diagnosed
>by transvaginal ultrasound between February 1997 and March 2002.
>
>Main outcome measures Likelihood of vaginal delivery and major obstetric
>haemorrhage.
>
>Results A total of 121 pregnancies were studied with a mean
>scan-to-delivery interval of 10.5 days. In the 64 women who laboured,
>the likelihood of vaginal delivery rose significantly as the placental
>edge to internal os distance increased. Caesarean section rate was 90%
>when the placental edge¨Cinternal os distance was 0.1 to 2.0 cm, falling
>to 37% when this measurement was over 2.0 cm (P< 0.00045).
>
>Conclusion Trial of vaginal delivery is appropriate in cases with a
>placental to internal os distance>2 cm. The term 'praevia' should be
>restricted to cases where the placental edge is ¡Ü2 cm from the
>internal os, as the likelihood of operative delivery and significant
>postpartum haemorrhage is high. Cases where the placenta is more than 2
>cm from the internal os have a greater than 60% chance of vaginal
>delivery and should be defined as 'low lying' in order to reduce the
>clinician's bias towards operative delivery.
>
>Art
>
>At Mon, 2 Apr 2007, R. Daniel Braun wrote:
>>
>>I bet someone of "Stature" said "Gee, I think if it isn't at least 3 cm
>>away, it could bleed a lot." And hence it has been so ever since.
>>Dan
>>
>>On 4/2/07, ainsron <ainsron@sbcglobal.net> wrote:
>>>
>>> What is their rationale for a 2cm cutoff??
>>>
>>> Ronald E. Ainsworth, MD, FACOG
>>>
>>> -----Original Message-----
>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
>>> Siegel, M.D.
>>> Sent: Monday, April 02, 2007 9:52 AM
>>> To: Multiple recipients of list OB-GYN-L
>>> Subject: Re: April fools' marginal placenta previa.
>>>
>>> FWIW, our MFMs quote 2 cm. as the cutoff for allowing a vaginal
>>> delivery.
>>>
>>> Recently saw a scan on a CNM patient, 37 weeks, 9 to 12 mm from the os,
>>> posterior placenta, previous vaginal delivery then LTC/S for breech.
>>>
>>> I got this scan on Friday at 3 PM, called her, and advised a section
>>> this week or if labors, and explained why. And I quote, "The midwife
>>> said it was OK." I told her that I was the obstetrician, and, well, my
>>> opinion was the senior one in this instance and that she was mistaken.
>>>
>>> She did not like my advice, and who knows what will happen when she
>>> comes in this week to see the CNM.
>>>
>>> Garry
>>>
>>> At Mon, 2 Apr 2007, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
>>> wrote:
>>> >
>>> >At Sun, 1 Apr 2007, R. Daniel Braun wrote:
>>> >>
>>> >>Double Setup WHY???????????????????
>>> >>Just cut.
>>> >>Dan
>>> >>
>>> >The patient was expecting a nice midwife no intervention birth and
>>> >really did not want to have c-section; after the double setup I could
>>> >honestly tell her sorry that will not happen today.
>>> >
>>> >--
>>> > Take care, John
>>> >
>>>
>>> --
>>> Garry E. Siegel, M.D.
>>> Private Practice
>>> Roswell, GA
>>>
>>--
>>R. Daniel Braun, MD FACOG(L) CMT
>>Professor Emeritus
>>Dept. of Obstetrics and Gynecology
>>Indiana U. School of Medicine
>>
>>R. Daniel Braun
>>
>> "The way to health is an aromatic bath and scented massage everyday".
>> Hippocrates
>>
>--
>art fougner, md
>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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