Re: Delivery suggestions
From: Andrew Folley (agfolley@hotmail.com)
Fri May 25 07:12:41 2007
She is a primagravida with twins and VERTEX VERTEX presentation. There is
NO indication for csection in this lady.
>From: Dr Eberhard Lisse <el@lisse.NA>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Delivery suggestions
>Date: Fri, 25 May 2007 00:14:02 -0500
>
>Steve,
>
>she is a primigravida with twins. We don't even know the presentation.
>
>I would prefer an elective C/S to an emergency C/S.
>
>el
>
>on 5/25/07 4:59 AM Raymond Stephen said the following:
> > Am J Obstet Gynecol. 1994 Feb;170(2):560-5.
> > Massive maternal obesity and perioperative caesarean morbidity. Perlow
> > JH, Morgan MA.
> > Department of Obstetrics and Gynecology, Long Beach Memorial Medical
> > Center Women's Hospital, California.
> >
> > OBJECTIVE: Our purpose was to determine the impact of massive maternal
> > obesity (weight > 300 pounds) on perioperative morbidity among patients
> > undergoing caesarean section.
> > STUDY DESIGN: A case-control study was conducted on 43 massively obese
> > pregnant women, identified by perinatal database search, who were
> > delivered by caesarean section between Jan. 1, 1987, and Dec. 31, 1991,
> > at Long Beach Memorial Women's Hospital. Forty-three randomly selected
> > patients who underwent caesarean delivery served as the control group.
> > Medical records were abstracted for perioperative variables and compared
> > between groups. Student t test, chi 2, and Fisher's exact statistical
> > analysis were used where appropriate.
> > RESULTS: No significant differences were observed between groups for
> > maternal age, parity, use of prophylactic antibiotics, length of
> > recovery room stay, or wound dehiscence. The massively obese group was
> > observed to be at significantly increased risk for emergency caesarean
> > section (32.6% vs 9.3%, p = 0.02), prolonged delivery interval (25.6% vs
> > 4.6%, p = 0.01), and total operative time (48.8% vs 9.3%, p < 0.0001),
> > blood loss > 1000 ml (34.9% vs 9.3%, p = 0.009), multiple epidural
> > placement failures (14.0% vs 0%, p = 0.02), postoperative endometritis
> > (32.6% vs 4.9%, p = 0.002), and prolonged hospitalization (34.9% vs
> > 2.3%, p = 0.0003).
> > CONCLUSION: Massively obese pregnant women undergoing caesarean section
> > are at significantly increased risk for perioperative morbidity.
> >
> > PMID: 8116713 [PubMed - indexed for MEDLINE]
> >
> > Do you still want to do a Caesar?
> >
> > Steve
> >
> > -----Original Message-----
> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
> > Ramirez
> > Sent: Friday, 25 May 2007 9:44 AM
> > To: Multiple recipients of list OB-GYN-L
> > Subject: Re: Delivery suggestions
> >
> > Pray for an easy vaginal - an emergency C/S in this lady?! - if any
> > doubt - "easy" C/S - elective .. good luck - I like transverse
> >
> > Ef
> >
> >> Wed, 23 May 2007, Lynn Montgomery wrote:
> >>
> >> I have a good one for y'all to ponder. 23 y.o. primigravida, currently
> >> at 34 weeks gestational age with twins. Currently weighs 399. EFW at
> >> 31 weeks on both twins was 5 pounds. Cephalic/cephalic presentation.
> >> During a visit to L&D for false labor, monitoring was essentially
> >> impossible.
> >>
> >> Route of delivery?
> >>
> >> Lynn
> >>
> >> --
> >
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>--
>Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
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